thesis for health and wealth

Health Thesis Statemen

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Navigating the intricate landscape of health topics requires a well-structured thesis statement to anchor your essay. Whether delving into public health policies or examining medical advancements, crafting a compelling health thesis statement is crucial. This guide delves into exemplary health thesis statement examples, providing insights into their composition. Additionally, it offers practical tips on constructing powerful statements that not only capture the essence of your research but also engage readers from the outset.

What is the Health Thesis Statement? – Definition

A health thesis statement is a concise declaration that outlines the main argument or purpose of an essay or research paper thesis statement focused on health-related topics. It serves as a roadmap for the reader, indicating the central idea that the paper will explore, discuss, or analyze within the realm of health, medicine, wellness, or related fields.

What is an Example of a Medical/Health Thesis Statement?

Example: “The implementation of comprehensive public health campaigns is imperative in curbing the escalating rates of obesity and promoting healthier lifestyle choices among children and adolescents.”

In this example, the final thesis statement succinctly highlights the importance of public health initiatives as a means to address a specific health issue (obesity) and advocate for healthier behaviors among a targeted demographic (children and adolescents).

100 Health Thesis Statement Examples

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Discover a comprehensive collection of 100 distinct health thesis statement examples across various healthcare realms. From telemedicine’s impact on accessibility to genetic research’s potential for personalized medicine, delve into obesity, mental health, antibiotic resistance, opioid epidemic solutions, and more. Explore these examples that shed light on pressing health concerns, innovative strategies, and crucial policy considerations. You may also be interested to browse through our other  speech thesis statement .

• Childhood Obesity : “Effective school-based nutrition programs are pivotal in combating childhood obesity, fostering healthy habits, and reducing the risk of long-term health complications.”
• Mental Health Stigma : “Raising awareness through media campaigns and educational initiatives is paramount in eradicating mental health stigma, promoting early intervention, and improving overall well-being.”
• Universal Healthcare : “The implementation of universal healthcare systems positively impacts population health, ensuring access to necessary medical services for all citizens.”
• Elderly Care : “Creating comprehensive elderly care programs that encompass medical, social, and emotional support enhances the quality of life for aging populations.”
• Cancer Research : “Increased funding and collaboration in cancer research expedite advancements in treatment options and improve survival rates for patients.”
• Maternal Health : “Elevating maternal health through accessible prenatal care, education, and support systems reduces maternal mortality rates and improves neonatal outcomes.”
• Vaccination Policies : “Mandatory vaccination policies safeguard public health by curbing preventable diseases and maintaining herd immunity.”
• Epidemic Preparedness : “Developing robust epidemic preparedness plans and international cooperation mechanisms is crucial for timely responses to emerging health threats.”
• Access to Medications : “Ensuring equitable access to essential medications, especially in low-income regions, is pivotal for preventing unnecessary deaths and improving overall health outcomes.”
• Healthy Lifestyle Promotion : “Educational campaigns promoting exercise, balanced nutrition, and stress management play a key role in fostering healthier lifestyles and preventing chronic diseases.”
• Health Disparities : “Addressing health disparities through community-based interventions and equitable healthcare access contributes to a fairer distribution of health resources.”
• Elderly Mental Health : “Prioritizing mental health services for the elderly population reduces depression, anxiety, and cognitive decline, enhancing their overall quality of life.”
• Genetic Counseling : “Accessible genetic counseling services empower individuals to make informed decisions about their health, family planning, and potential genetic risks.”
• Substance Abuse Treatment : “Expanding availability and affordability of substance abuse treatment facilities and programs is pivotal in combating addiction and reducing its societal impact.”
• Patient Empowerment : “Empowering patients through health literacy initiatives fosters informed decision-making, improving treatment adherence and overall health outcomes.”
• Environmental Health : “Implementing stricter environmental regulations reduces exposure to pollutants, protecting public health and mitigating the risk of respiratory illnesses.”
• Digital Health Records : “The widespread adoption of digital health records streamlines patient information management, enhancing communication among healthcare providers and improving patient care.”
• Healthy Aging : “Promoting active lifestyles, social engagement, and cognitive stimulation among the elderly population contributes to healthier aging and reduced age-related health issues.”
• Telehealth Ethics : “Ethical considerations in telehealth services include patient privacy, data security, and maintaining the quality of remote medical consultations.”
• Public Health Campaigns : “Strategically designed public health campaigns raise awareness about prevalent health issues, motivating individuals to adopt healthier behaviors and seek preventive care.”
• Nutrition Education : “Integrating nutrition education into school curricula equips students with essential dietary knowledge, reducing the risk of nutrition-related health problems.”
• Healthcare Infrastructure : “Investments in healthcare infrastructure, including medical facilities and trained personnel, enhance healthcare access and quality, particularly in underserved regions.”
• Mental Health Support in Schools : “Introducing comprehensive mental health support systems in schools nurtures emotional well-being, reduces academic stress, and promotes healthy student development.”
• Antibiotic Stewardship : “Implementing antibiotic stewardship programs in healthcare facilities preserves the effectiveness of antibiotics, curbing the rise of antibiotic-resistant infections.”
• Health Education in Rural Areas : “Expanding health education initiatives in rural communities bridges the information gap, enabling residents to make informed health choices.”
• Global Health Initiatives : “International collaboration on global health initiatives bolsters disease surveillance, preparedness, and response to protect global populations from health threats.”
• Access to Clean Water : “Ensuring access to clean water and sanitation facilities improves public health by preventing waterborne diseases and enhancing overall hygiene.”
• Telemedicine and Mental Health : “Leveraging telemedicine for mental health services increases access to therapy and counseling, particularly for individuals in remote areas.”
• Chronic Disease Management : “Comprehensive chronic disease management programs enhance patients’ quality of life by providing personalized care plans and consistent medical support.”
• Healthcare Workforce Diversity : “Promoting diversity within the healthcare workforce enhances cultural competence, patient-provider communication, and overall healthcare quality.”
• Community Health Centers : “Establishing community health centers in underserved neighborhoods ensures accessible primary care services, reducing health disparities and emergency room utilization.”
• Youth Health Education : “Incorporating comprehensive health education in schools equips young people with knowledge about reproductive health, substance abuse prevention, and mental well-being.”
• Dietary Guidelines : “Implementing evidence-based dietary guidelines and promoting healthy eating habits contribute to reducing obesity rates and preventing chronic diseases.”
• Healthcare Innovation : “Investing in healthcare innovation, such as telemedicine platforms and wearable health technologies, transforms patient care delivery and monitoring.”
• Pandemic Preparedness : “Effective pandemic preparedness plans involve cross-sector coordination, rapid response strategies, and transparent communication to protect global health security.”
• Maternal and Child Nutrition : “Prioritizing maternal and child nutrition through government programs and community initiatives leads to healthier pregnancies and better child development.”
• Health Literacy : “Improving health literacy through accessible health information and education empowers individuals to make informed decisions about their well-being.”
• Medical Research Funding : “Increased funding for medical research accelerates scientific discoveries, leading to breakthroughs in treatments and advancements in healthcare.”
• Reproductive Health Services : “Accessible reproductive health services, including family planning and maternal care, improve women’s health outcomes and support family well-being.”
• Obesity Prevention in Schools : “Introducing physical activity programs and nutritional education in schools prevents childhood obesity, laying the foundation for healthier lifestyles.”
• Global Vaccine Distribution : “Ensuring equitable global vaccine distribution addresses health disparities, protects vulnerable populations, and fosters international cooperation.”
• Healthcare Ethics : “Ethical considerations in healthcare decision-making encompass patient autonomy, informed consent, and equitable resource allocation.”
• Aging-in-Place Initiatives : “Aging-in-place programs that provide home modifications and community support enable elderly individuals to maintain independence and well-being.”
• E-Health Records Privacy : “Balancing the benefits of electronic health records with patients’ privacy concerns necessitates robust data security measures and patient consent protocols.”
• Tobacco Control : “Comprehensive tobacco control measures, including high taxation and anti-smoking campaigns, reduce tobacco consumption and related health risks.”
• Epidemiological Studies : “Conducting rigorous epidemiological studies informs public health policies, identifies risk factors, and guides disease prevention strategies.”
• Organ Transplant Policies : “Ethical organ transplant policies prioritize equitable organ allocation, ensuring fair access to life-saving treatments.”
• Workplace Wellness Programs : “Implementing workplace wellness programs promotes employee health, reduces absenteeism, and enhances productivity.”
• Emergency Medical Services : “Strengthening emergency medical services infrastructure ensures timely responses to medical crises, saving lives and reducing complications.”
• Healthcare Access for Undocumented Immigrants : “Expanding healthcare access for undocumented immigrants improves overall community health and prevents communicable disease outbreaks.”
• Primary Care Shortage Solutions : “Addressing primary care shortages through incentives for healthcare professionals and expanded training programs enhances access to basic medical services.”
• Patient-Centered Care : “Prioritizing patient-centered care emphasizes communication, shared decision-making, and respecting patients’ preferences in medical treatments.”
• Nutrition Labels Impact : “The effectiveness of clear and informative nutrition labels on packaged foods contributes to healthier dietary choices and reduced obesity rates.”
• Stress Management Strategies : “Promoting stress management techniques, such as mindfulness and relaxation, improves mental health and reduces the risk of stress-related illnesses.”
• Access to Reproductive Health Education : “Ensuring access to comprehensive reproductive health education empowers individuals to make informed decisions about their sexual and reproductive well-being.”
• Medical Waste Management : “Effective medical waste management practices protect both public health and the environment by preventing contamination and pollution.”
• Preventive Dental Care : “Prioritizing preventive dental care through community programs and education reduces oral health issues and associated healthcare costs.”
• Pharmaceutical Pricing Reform : “Addressing pharmaceutical pricing reform enhances medication affordability and ensures access to life-saving treatments for all.”
• Community Health Worker Role : “Empowering community health workers to provide education, support, and basic medical services improves healthcare access in underserved areas.”
• Healthcare Technology Adoption : “Adopting innovative healthcare technologies, such as AI-assisted diagnostics, enhances accuracy, efficiency, and patient outcomes in medical practices.”
• Elderly Falls Prevention : “Implementing falls prevention programs for the elderly population reduces injuries, hospitalizations, and healthcare costs, enhancing their overall well-being.”
• Healthcare Data Privacy Laws : “Stricter healthcare data privacy laws protect patients’ sensitive information, maintaining their trust and promoting transparent data management practices.”
• School Health Clinics : “Establishing health clinics in schools provides easy access to medical services for students, promoting early detection and timely treatment of health issues.”
• Healthcare Cultural Competence : “Cultivating cultural competence among healthcare professionals improves patient-provider communication, enhances trust, and reduces healthcare disparities.”
• Health Equity in Clinical Trials : “Ensuring health equity in clinical trials by diverse participant representation enhances the generalizability of research findings to different populations.”
• Digital Mental Health Interventions : “Utilizing digital mental health interventions, such as therapy apps, expands access to mental health services and reduces stigma surrounding seeking help.”
• Aging and Neurodegenerative Diseases : “Exploring the connection between aging and neurodegenerative diseases informs early interventions and treatment strategies to mitigate cognitive decline.”
• Healthcare Waste Reduction : “Implementing sustainable healthcare waste reduction measures decreases environmental impact and contributes to a greener healthcare industry.”
• Medical Ethics in End-of-Life Care : “Ethical considerations in end-of-life care decision-making ensure patient autonomy, quality of life, and respectful treatment choices.”
• Healthcare Interoperability : “Enhancing healthcare data interoperability between different medical systems and providers improves patient care coordination and information sharing.”
• Healthcare Disparities in Indigenous Communities : “Addressing healthcare disparities in Indigenous communities through culturally sensitive care and community engagement improves health outcomes.”
• Music Therapy in Healthcare : “Exploring the role of music therapy in healthcare settings reveals its positive effects on reducing pain, anxiety, and enhancing emotional well-being.”
• Healthcare Waste Management Policies : “Effective healthcare waste management policies regulate the disposal of medical waste, protecting both public health and the environment.”
• Agricultural Practices and Public Health : “Analyzing the impact of agricultural practices on public health highlights the connections between food production, environmental health, and nutrition.”
• Online Health Information Reliability : “Promoting the reliability of online health information through credible sources and fact-checking guides empowers individuals to make informed health decisions.”
• Neonatal Intensive Care : “Advancements in neonatal intensive care technology enhance premature infants’ chances of survival and long-term health.”
• Fitness Technology : “The integration of fitness technology in daily routines motivates individuals to engage in physical activity, promoting better cardiovascular health.”
• Climate Change and Health : “Examining the health effects of climate change emphasizes the need for mitigation strategies to protect communities from heat-related illnesses, vector-borne diseases, and other climate-related health risks.”
• Healthcare Cybersecurity : “Robust cybersecurity measures in healthcare systems safeguard patient data and protect against cyberattacks that can compromise medical records.”
• Healthcare Quality Metrics : “Evaluating healthcare quality through metrics such as patient satisfaction, outcomes, and safety indicators informs continuous improvement efforts in medical facilities.”
• Maternal Health Disparities : “Addressing maternal health disparities among different racial and socioeconomic groups through accessible prenatal care and support reduces maternal mortality rates.”
• Disaster Preparedness : “Effective disaster preparedness plans in healthcare facilities ensure timely responses during emergencies, minimizing casualties and maintaining patient care.”
• Sleep Health : “Promoting sleep health education emphasizes the importance of quality sleep in overall well-being, preventing sleep-related disorders and associated health issues.”
• Healthcare AI Ethics : “Navigating the ethical implications of using artificial intelligence in healthcare, such as diagnosis algorithms, safeguards patient privacy and accuracy.”
• Pediatric Nutrition : “Prioritizing pediatric nutrition education encourages healthy eating habits from a young age, reducing the risk of childhood obesity and related health concerns.”
• Mental Health in First Responders : “Providing mental health support for first responders acknowledges the psychological toll of their work, preventing burnout and trauma-related issues.”
• Healthcare Workforce Burnout : “Addressing healthcare workforce burnout through organizational support, manageable workloads, and mental health resources improves patient care quality.”
• Vaccine Hesitancy : “Effective strategies to address vaccine hesitancy involve transparent communication, education, and addressing concerns to maintain vaccination rates and community immunity.”
• Climate-Resilient Healthcare Facilities : “Designing climate-resilient healthcare facilities prepares medical centers to withstand extreme weather events and ensure continuous patient care.”
• Nutrition in Aging : “Emphasizing balanced nutrition among the elderly population supports healthy aging, preventing malnutrition-related health complications.”
• Medication Adherence Strategies : “Implementing medication adherence strategies, such as reminder systems and simplified regimens, improves treatment outcomes and reduces hospitalizations.”
• Crisis Intervention : “Effective crisis intervention strategies in mental health care prevent escalations, promote de-escalation techniques, and improve patient safety.”
• Healthcare Waste Recycling : “Promoting healthcare waste recycling initiatives reduces landfill waste, conserves resources, and minimizes the environmental impact of medical facilities.”
• Healthcare Financial Accessibility : “Strategies to enhance healthcare financial accessibility, such as sliding scale fees and insurance coverage expansion, ensure equitable care for all.”
• Palliative Care : “Prioritizing palliative care services improves patients’ quality of life by addressing pain management, symptom relief, and emotional support.”
• Healthcare and Artificial Intelligence : “Exploring the integration of artificial intelligence in diagnostics and treatment planning enhances medical accuracy and reduces human error.”
• Personalized Medicine : “Advancements in personalized medicine tailor treatments based on individual genetics and characteristics, leading to more precise and effective healthcare.”
• Patient Advocacy : “Empowering patients through education and advocacy training enables them to navigate the healthcare system and actively participate in their treatment decisions.”
• Healthcare Waste Reduction : “Promoting the reduction of healthcare waste through sustainable practices and responsible disposal methods minimizes environmental and health risks.”
• Complementary and Alternative Medicine : “Examining the efficacy and safety of complementary and alternative medicine approaches provides insights into their potential role in enhancing overall health and well-being.”

Thesis Statement Examples for Physical Health

Discover 10 unique good thesis statement examples that delve into physical health, from the impact of fitness technology on exercise motivation to the importance of nutrition education in preventing chronic illnesses. Explore these examples shedding light on the pivotal role of physical well-being in disease prevention and overall quality of life.

• Fitness Technology’s Influence : “The integration of fitness technology like wearable devices enhances physical health by fostering exercise adherence, tracking progress, and promoting active lifestyles.”
• Nutrition Education’s Role : “Incorporating comprehensive nutrition education in schools equips students with essential dietary knowledge, reducing the risk of nutrition-related health issues.”
• Active Lifestyle Promotion : “Public spaces and urban planning strategies that encourage physical activity contribute to community health and well-being, reducing sedentary behavior.”
• Sports Injuries Prevention : “Strategic implementation of sports injury prevention programs and adequate athlete conditioning minimizes the incidence of sports-related injuries, preserving physical well-being.”
• Physical Health in Workplace : “Prioritizing ergonomic design and promoting workplace physical activity positively impact employees’ physical health, reducing musculoskeletal issues and stress-related ailments.”
• Childhood Obesity Mitigation : “School-based interventions, including physical education and health education, play a pivotal role in mitigating childhood obesity and promoting lifelong physical health.”
• Outdoor Activity and Wellness : “Unstructured outdoor play, especially in natural settings, fosters children’s physical health, cognitive development, and emotional well-being.”
• Senior Nutrition and Mobility : “Tailored nutrition plans and physical activity interventions for seniors support physical health, mobility, and independence during the aging process.”
• Health Benefits of Active Commuting : “Promotion of active commuting modes such as walking and cycling improves cardiovascular health, reduces pollution, and enhances overall well-being.”
• Physical Health’s Longevity Impact : “Sustaining physical health through regular exercise, balanced nutrition, and preventive measures positively influences longevity, ensuring a higher quality of life.”

Thesis Statement Examples for Health Protocols

Explore 10 thesis statement examples that highlight the significance of health protocols, encompassing infection control in medical settings to the ethical guidelines for telemedicine practices. These examples underscore the pivotal role of health protocols in ensuring patient safety, maintaining effective healthcare practices, and preventing the spread of illnesses across various contexts.  You should also take a look at our  thesis statement for report .

• Infection Control and Patient Safety : “Rigorous infection control protocols in healthcare settings are paramount to patient safety, curbing healthcare-associated infections and maintaining quality care standards.”
• Evidence-Based Treatment Guidelines : “Adhering to evidence-based treatment guidelines enhances medical decision-making, improves patient outcomes, and promotes standardized, effective healthcare practices.”
• Ethics in Telemedicine : “Establishing ethical guidelines for telemedicine practices is crucial to ensure patient confidentiality, quality of care, and responsible remote medical consultations.”
• Emergency Response Preparedness : “Effective emergency response protocols in healthcare facilities ensure timely and coordinated actions, optimizing patient care, and minimizing potential harm.”
• Clinical Trial Integrity : “Stringent adherence to health protocols in clinical trials preserves data integrity, ensures participant safety, and upholds ethical principles in medical research.”
• Safety in Daycare Settings : “Implementing robust infection prevention protocols in daycare settings is vital to curb disease transmission, safeguarding the health of children and staff.”
• Privacy and E-Health : “Upholding stringent patient privacy protocols in electronic health records is paramount for data security, fostering trust, and maintaining confidentiality.”
• Hand Hygiene and Infection Prevention : “Promoting proper hand hygiene protocols among healthcare providers significantly reduces infection transmission risks, protecting both patients and medical personnel.”
• Food Safety in Restaurants : “Strict adherence to comprehensive food safety protocols within the restaurant industry is essential to prevent foodborne illnesses and ensure public health.”
• Pandemic Preparedness and Response : “Developing robust pandemic preparedness protocols, encompassing risk assessment and response strategies, is essential to effectively manage disease outbreaks and protect public health.”

Thesis Statement Examples on Health Benefits

Uncover 10 illuminating thesis statement examples exploring the diverse spectrum of health benefits, from the positive impact of green spaces on mental well-being to the advantages of mindfulness practices in stress reduction. Delve into these examples that underscore the profound influence of health-promoting activities on overall physical, mental, and emotional well-being.

• Nature’s Impact on Mental Health : “The presence of green spaces in urban environments positively influences mental health by reducing stress, enhancing mood, and fostering relaxation.”
• Mindfulness for Stress Reduction : “Incorporating mindfulness practices into daily routines promotes mental clarity, reduces stress, and improves overall emotional well-being.”
• Social Interaction’s Role : “Engaging in regular social interactions and fostering strong social connections contributes to mental well-being, combating feelings of loneliness and isolation.”
• Physical Activity’s Cognitive Benefits : “Participation in regular physical activity enhances cognitive function, memory retention, and overall brain health, promoting lifelong mental well-being.”
• Positive Effects of Laughter : “Laughter’s physiological and psychological benefits, including stress reduction and improved mood, have a direct impact on overall mental well-being.”
• Nutrition’s Impact on Mood : “Balanced nutrition and consumption of mood-enhancing nutrients play a pivotal role in regulating mood and promoting positive mental health.”
• Creative Expression and Emotional Well-Being : “Engaging in creative activities, such as art and music, provides an outlet for emotional expression and fosters psychological well-being.”
• Cultural Engagement’s Influence : “Participating in cultural and artistic activities enriches emotional well-being, promoting a sense of identity, belonging, and purpose.”
• Volunteering and Mental Health : “Volunteering contributes to improved mental well-being by fostering a sense of purpose, social connection, and positive self-esteem.”
• Emotional Benefits of Pet Ownership : “The companionship of pets provides emotional support, reduces stress, and positively impacts overall mental well-being.”

Thesis Statement Examples on Mental Health

Explore 10 thought-provoking thesis statement examples delving into various facets of mental health, from addressing stigma surrounding mental illnesses to advocating for increased mental health support in schools. These examples shed light on the importance of understanding, promoting, and prioritizing mental health to achieve holistic well-being.

• Stigma Reduction for Mental Health : “Challenging societal stigma surrounding mental health encourages open dialogue, fostering acceptance, and creating a supportive environment for individuals seeking help.”
• Mental Health Education in Schools : “Incorporating comprehensive mental health education in school curricula equips students with emotional coping skills, destigmatizes mental health discussions, and supports overall well-being.”
• Mental Health Awareness Campaigns : “Strategically designed mental health awareness campaigns raise public consciousness, reduce stigma, and promote early intervention and access to support.”
• Workplace Mental Health Initiatives : “Implementing workplace mental health programs, including stress management and emotional support, enhances employee well-being and job satisfaction.”
• Digital Mental Health Interventions : “Leveraging digital platforms for mental health interventions, such as therapy apps and online support groups, increases accessibility and reduces barriers to seeking help.”
• Impact of Social Media on Mental Health : “Examining the influence of social media on mental health highlights both positive and negative effects, guiding responsible usage and promoting well-being.”
• Mental Health Disparities : “Addressing mental health disparities among different demographics through culturally sensitive care and accessible services is crucial for equitable well-being.”
• Trauma-Informed Care : “Adopting trauma-informed care approaches in mental health settings acknowledges the impact of past trauma, ensuring respectful and effective treatment.”
• Positive Psychology Interventions : “Incorporating positive psychology interventions, such as gratitude practices and resilience training, enhances mental well-being and emotional resilience.”
• Mental Health Support for First Responders : “Recognizing the unique mental health challenges faced by first responders and providing tailored support services is essential for maintaining their well-being.”

Thesis Statement Examples on Covid-19

Explore 10 illuminating thesis statement examples focusing on various aspects of the Covid-19 pandemic, from the impact on mental health to the role of public health measures. Delve into these examples that highlight the interdisciplinary nature of addressing the pandemic’s challenges and implications on global health.

• Mental Health Crisis Amid Covid-19 : “The Covid-19 pandemic’s psychological toll underscores the urgency of implementing mental health support services and destigmatizing seeking help.”
• Role of Public Health Measures : “Analyzing the effectiveness of public health measures, including lockdowns and vaccination campaigns, in curbing the spread of Covid-19 highlights their pivotal role in pandemic control.”
• Equitable Access to Vaccines : “Ensuring equitable access to Covid-19 vaccines globally is vital to achieving widespread immunity, preventing new variants, and ending the pandemic.”
• Online Education’s Impact : “Exploring the challenges and opportunities of online education during the Covid-19 pandemic provides insights into its effects on students’ academic progress and mental well-being.”
• Economic Implications and Mental Health : “Investigating the economic consequences of the Covid-19 pandemic on mental health highlights the need for comprehensive social support systems and mental health resources.”
• Crisis Communication Strategies : “Evaluating effective crisis communication strategies during the Covid-19 pandemic underscores the importance of transparent information dissemination, fostering public trust.”
• Long-Term Health Effects : “Understanding the potential long-term health effects of Covid-19 on recovered individuals guides healthcare planning and underscores the importance of ongoing monitoring.”
• Digital Health Solutions : “Leveraging digital health solutions, such as telemedicine and contact tracing apps, plays a pivotal role in tracking and managing Covid-19 transmission.”
• Resilience Amid Adversity : “Exploring individual and community resilience strategies during the Covid-19 pandemic sheds light on coping mechanisms and adaptive behaviors in times of crisis.”
• Global Cooperation in Pandemic Response : “Assessing global cooperation and collaboration in pandemic response highlights the significance of international solidarity and coordination in managing global health crises.”

Nursing Thesis Statement Examples

Explore 10 insightful thesis statement examples that delve into the dynamic realm of nursing, from advocating for improved nurse-patient communication to addressing challenges in healthcare staffing. These examples emphasize the critical role of nursing professionals in patient care, healthcare systems, and the continuous pursuit of excellence in the field.

• Nurse-Patient Communication Enhancement : “Elevating nurse-patient communication through effective communication training programs improves patient satisfaction, treatment adherence, and overall healthcare outcomes.”
• Nursing Leadership Impact : “Empowering nursing leadership in healthcare institutions fosters improved patient care, interdisciplinary collaboration, and the cultivation of a positive work environment.”
• Challenges in Nursing Shortages : “Addressing nursing shortages through recruitment strategies, retention programs, and educational support enhances patient safety and healthcare system stability.”
• Evidence-Based Nursing Practices : “Promoting evidence-based nursing practices enhances patient care quality, ensuring that interventions are rooted in current research and best practices.”
• Nursing Role in Preventive Care : “Harnessing the nursing profession’s expertise in preventive care and patient education reduces disease burden and healthcare costs, emphasizing a proactive approach.”
• Nursing Advocacy and Patient Rights : “Nurse advocacy for patients’ rights and informed decision-making ensures ethical treatment, patient autonomy, and respectful healthcare experiences.”
• Nursing Ethics and Dilemmas : “Navigating ethical dilemmas in nursing, such as end-of-life care decisions, highlights the importance of ethical frameworks and interdisciplinary collaboration.”
• Telehealth Nursing Adaptation : “Adapting nursing practices to telehealth platforms requires specialized training and protocols to ensure safe, effective, and patient-centered remote care.”
• Nurse Educators’ Impact : “Nurse educators play a pivotal role in shaping the future of nursing by providing comprehensive education, fostering critical thinking, and promoting continuous learning.”
• Mental Health Nursing Expertise : “The specialized skills of mental health nurses in assessment, intervention, and patient support contribute significantly to addressing the growing mental health crisis.”

Thesis Statement Examples for Health and Wellness

Delve into 10 thesis statement examples that explore the interconnectedness of health and wellness, ranging from the integration of holistic well-being practices in healthcare to the significance of self-care in preventing burnout. These examples highlight the importance of fostering balance and proactive health measures for individuals and communities.

• Holistic Health Integration : “Incorporating holistic health practices, such as mindfulness and nutrition, within conventional healthcare models supports comprehensive well-being and disease prevention.”
• Self-Care’s Impact on Burnout : “Prioritizing self-care among healthcare professionals reduces burnout, enhances job satisfaction, and ensures high-quality patient care delivery.”
• Community Wellness Initiatives : “Community wellness programs that address physical, mental, and social well-being contribute to healthier populations and reduced healthcare burdens.”
• Wellness in Aging Populations : “Tailored wellness programs for the elderly population encompass physical activity, cognitive stimulation, and social engagement, promoting healthier aging.”
• Corporate Wellness Benefits : “Implementing corporate wellness programs enhances employee health, morale, and productivity, translating into lower healthcare costs and higher job satisfaction.”
• Nutrition’s Role in Wellness : “Prioritizing balanced nutrition through education and accessible food options plays a pivotal role in overall wellness and chronic disease prevention.”
• Mental and Emotional Well-Being : “Fostering mental and emotional well-being through therapy, support networks, and stress management positively impacts overall health and life satisfaction.”
• Wellness Tourism’s Rise : “Exploring the growth of wellness tourism underscores the demand for travel experiences that prioritize rejuvenation, relaxation, and holistic well-being.”
• Digital Health for Wellness : “Leveraging digital health platforms for wellness, such as wellness apps and wearable devices, empowers individuals to monitor and enhance their well-being.”
• Equitable Access to Wellness : “Promoting equitable access to wellness resources and facilities ensures that all individuals, regardless of socioeconomic status, can prioritize their health and well-being.”

What is a good thesis statement about mental health?

A thesis statement about mental health is a concise and clear declaration that encapsulates the main point or argument you’re making in your essay or research paper related to mental health. It serves as a roadmap for your readers, guiding them through the content and focus of your work. Crafting a strong thesis statement about mental health involves careful consideration of the topic and a clear understanding of the points you’ll discuss. Here’s how you can create a good thesis statement about mental health:

• Choose a Specific Focus : Mental health is a broad topic. Determine the specific aspect of mental health you want to explore, whether it’s the impact of stigma, the importance of access to treatment, the role of mental health in overall well-being, or another angle.
• Make a Debatable Assertion : A thesis statement should present an argument or perspective that can be debated or discussed. Avoid statements that are overly broad or universally accepted.
• Be Clear and Concise : Keep your thesis statement concise while conveying your main idea. It’s usually a single sentence that provides insight into the content of your paper.
• Provide Direction : Your thesis statement should indicate the direction your paper will take. It’s like a roadmap that tells your readers what to expect.
• Make it Strong : Strong thesis statements are specific, assertive, and supported by evidence. Don’t shy away from taking a clear stance on the topic.
• Revise and Refine : As you draft your paper, your understanding of the topic might evolve. Your thesis statement may need revision to accurately reflect your arguments.

How do you write a Health Thesis Statement? – Step by Step Guide

Crafting a strong health thesis statement requires a systematic approach. Follow these steps to create an effective health thesis statement:

• Choose a Health Topic : Select a specific health-related topic that interests you and aligns with your assignment or research objective.
• Narrow Down the Focus : Refine the topic to a specific aspect. Avoid overly broad statements; instead, zoom in on a particular issue.
• Identify Your Stance : Determine your perspective on the topic. Are you advocating for a particular solution, analyzing causes and effects, or comparing different viewpoints?
• Formulate a Debatable Assertion : Develop a clear and arguable statement that captures the essence of your position on the topic.
• Consider Counterarguments : Anticipate counterarguments and incorporate them into your thesis statement. This adds depth and acknowledges opposing views.
• Be Concise and Specific : Keep your thesis statement succinct while conveying the main point. Avoid vague language or generalities.
• Test for Clarity : Share your thesis statement with someone else to ensure it’s clear and understandable to an audience unfamiliar with the topic.
• Refine and Revise : Your thesis statement is not set in stone. As you research and write, you might find it necessary to revise and refine it to accurately reflect your evolving arguments.

Tips for Writing a Thesis Statement on Health Topics

Writing a thesis statement on health topics requires precision and careful consideration. Here are some tips to help you craft an effective thesis statement:

• Be Specific : Address a specific aspect of health rather than a broad topic. This allows for a more focused and insightful thesis statement.
• Take a Stance : Your thesis statement should present a clear perspective or argument. Avoid vague statements that don’t express a stance.
• Avoid Absolute Statements : Be cautious of using words like “always” or “never.” Instead, use language that acknowledges complexity and nuance.
• Incorporate Keywords : Include keywords that indicate the subject of your research, such as “nutrition,” “mental health,” “public health,” or other relevant terms.
• Preview Supporting Points : Your thesis statement can preview the main points or arguments you’ll discuss in your paper, providing readers with a roadmap.
• Revise as Necessary : Your thesis statement may evolve as you research and write. Don’t hesitate to revise it to accurately reflect your findings.
• Stay Focused : Ensure that your thesis statement remains directly relevant to your topic throughout your writing.

Remember that your thesis statement is the foundation of your paper. It guides your research and writing process, helping you stay on track and deliver a coherent argument.

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• Volume 59, Issue 7
• Wealth and health: the need for more strategic public health research
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• Correspondence to:
 Professor F Baum
 Department of Public Health, Flinders University, GPO Box 2100, Adelaide 5001, Australia; fran.baumflinders.edu.au

This article argues that public health researchers have often ignored the analysis of wealth in the quest to understand the social determinants of health. Wealth concentration and the inequities in wealth between and within countries are increasing. Despite this scare accurate data are available to assist the analysis of the health impact of this trend. Improved data collection on wealth distribution should be encouraged. Epidemiologists and political economy of health researchers should pay more attention to understanding the dynamics of wealth and its consequences for population health. Policy research to underpin policies designed to reduce inequities in wealth distribution should be intensified.

• inequalities
• health status
• political economy

https://doi.org/10.1136/jech.2004.021147

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↵ * Inequality is concerned with difference so that equality is about sameness. Inequity is concerned with fairness and ethical considerations stemming from inequalities. The terms are often used interchangeably in the literature on disparities in health status.

Funding: none.

Conflicts of interest: none declared.

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• In this issue Complexity, ecology, the environment, and isn't it time to study the wealthy? Carlos Alvarez-Dardet John R Ashton Journal of Epidemiology & Community Health 2005; 59 533-533 Published Online First: 17 Jun 2005.

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Exploring the Important Link Between Health and Wealth

November 5, 2019  • Rhett Buttle & Financial Security Program

Over the past several months, the Aspen Institute’s prestigious programs, the Financial Security Program and the Health, Medicine and Society Program, embarked on a unique collaboration to explore the link between good health and financial wellbeing.

The connection between financial wellness and health is significant, with evidence showing that increased financial security is linked to improved health outcomes and improved quality of life. What’s more, finance and health are among the fastest-growing sectors of the economy — in the US, they comprise more than 40 percent of GDP — and both are targets of innovation.

Research has found that more than half of an individual’s life expectancy in the DC region could be explained by education and economic factors. According to another report, income growth not only correlates to life expectancy increases, but also to a decrease in the risk of chronic illness and an increase in access to resources that promote longevity and health. Other research has shown that financial insecurity is a serious source of mental stress, reducing an individual’s productivity and job performance. And yet more research notes that poor physical health directly impacts financial stability, increasing the likelihood of personal bankruptcy from medical debt.

Stakeholders across public, private, and philanthropic sectors are increasingly convinced of the necessity of a multidisciplinary approach that would result in solutions designed to tackle issues related to both economic and health inequality. Some of these efforts are being driven by the changes we are seeing in our economy — for example, the growth of the “gig” economy, high levels of debt, record income disparities, and challenges to retirement security that are all leaving their mark on an individual’s health. With economic structures in transition, entrepreneurs are beginning to link up with care providers and health advocates are promoting microenterprise. So, what does the link between health and wealth mean in this evolving economy?

Given these developments and questions, our collaboration sought to explore the connection between these two fields. Our work has manifested itself in two ways.

A Set of Exploratory Roundtables

First, the programs co-hosted a set of roundtables — one in Washington, DC, and one in San Francisco, CA — with key stakeholders from both fields. Each roundtable included approximately 20 to 30 sharp minds, including public health, healthcare, and financial security leaders from across academia, business, community-based and advocacy organizations, and other appropriate experts. The roundtables began a necessary dialogue, promoted an open space, and fostered trust in order to identify and discover areas of partnership.

Integrating Health & Wealth into the Aspen Ideas Festival

In addition to the roundtables, we brought the conversation to Aspen Ideas: Health (the three-day opening event of the Aspen Ideas Festival). There, we produced a track (or “theme”) focused exclusively on Health & Wealth. Content included a conversation with the US Surgeon General and the President of the Federal Reserve of Philadelphia, who explored ways that their jobs and missions are both fundamentally geared toward advancing the health of America’s families, communities, and economy. We also featured several business leaders who spoke to the business case for thinking about health and wealth together, and how both sectors can do more to ensure that the end goal of business aligns with helping households experience greater wellbeing. Another panel looked at how a living wage can create better health outcomes, and another explored how the growing burden of medical debt is one of the most common financial burdens for Americans. Attendees left increasingly aware that health and financial wellness are fundamentally linked.

What’s Next

These times require an authentic conversation about the substantial financial challenges facing our families — and increasing financial insecurity more broadly. Examining the connection between health and financial security is at the heart of this — and, we believe, the right place to start.

It is our hope that in partnership with several of the Institute’s policy programs — the Financial Security Program and the Health, Medicine and Society Program — we can explore an effort that combines each program’s networks, learnings, and expertise. Working together, the programs can move forward with the opportunity to examine the common essential building blocks of healthcare, medicine, wellness, and financial well-being. The true power in this effort comes from the ability to examine problems in new ways, integrate networks, and explore innovative solutions that stem from real collaboration. Through public convenings — and intensive, off-the-record dialogues with leaders from a wide cross-section of private, public, and nonprofit institutions — the Aspen Institute can play a lead role in advancing a conversation on how to improve health and wealth in tandem.

Long-lasting improvement on the issues of financial and health inequality requires multidisciplinary solutions that embrace the inter-relatedness of these issues. Improving health outcomes will allow people to live longer and healthier lives, and participate more fully in the economy. Coming together with a diverse set of committed leaders, we can effect change and improve the lives of millions.

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IS THE LINK BETWEEN HEALTH AND WEALTH CONSIDERED IN DECISION MAKING? RESULTS FROM A QUALITATIVE STUDY

Martina garau.

Office of Health Economics, Email: gro.eho@uaragm

Koonal Kirit Shah

Office of Health Economics

Priya Sharma

United States Agency for International Development

Adrian Towse

Associated data.

For supplementary material accompanying this paper visit http://dx.doi.org/10.1017/S0266462315000616.

Objectives: The aim of this study was to explore whether wealth effects of health interventions, including productivity gains and savings in other sectors, are considered in resource allocations by health technology assessment (HTA) agencies and government departments. To analyze reasons for including, or not including, wealth effects.

Methods: Semi-structured interviews with decision makers and academic experts in eight countries (Australia, France, Germany, Italy, Poland, South Korea, Sweden, and the United Kingdom).

Results: There is evidence suggesting that health interventions can produce economic gains for patients and national economies. However, we found that the link between health and wealth does not influence decision making in any country with the exception of Sweden. This is due to a combination of factors, including system fragmentation, methodological issues, and the economic recession forcing national governments to focus on short-term measures.

Conclusions: In countries with established HTA processes and methods allowing, in principle, the inclusion of wider effects in exceptional cases or secondary analyses, it might be possible to overcome the methodological and practical barriers and see a more systematic consideration of wealth effect in decision making. This would be consistent with principles of efficient priority setting. Barriers for the consideration of wealth effects in government decision making are more fundamental, due to an enduring separation of budgets within the public sector and current financial pressures. However, governments should consider all relevant effects from public investments, including healthcare, even when benefits can only be captured in the medium- and long-term. This will ensure that resources are allocated where they bring the best returns.

AIM OF THE STUDY

Traditionally, the primary outcome of health interventions considered by decision makers is the impact on patients’ health in terms of reduced morbidity or mortality. Additionally, interventions can generate “wealth effects” (also referred to as indirect costs, nonhealth benefits, or wider societal effects) which extend beyond the health gains accruing to patients. Wealth effects include: improvements in the labor productivity of patients and of their caregivers; cost savings to healthcare, social care, and other sectors; and increases in national income.

In 2003, David Byrne, the then European Commissioner for Health and Consumer Protection, delivered a speech that focused on the importance of health as a “driver of economic prosperity” for European Union (EU) Member States ( 1 ). There is a growing body of research aimed at demonstrating the interdependencies between health and wealth ( 2 – 4 ). However, we are not aware of any published studies of whether the consideration of wealth effects, as defined above, has had an impact on resource allocation decisions in practice. This study examines the extent to which the link between health and wealth has influenced national decision making in a sample of eight countries.

We focused on three types of decision makers: health technology assessment (HTA) agencies which make recommendations about the use and/or public reimbursement of health interventions; Health Ministries that run national health systems and in some cases allocate resources across separate health system components; and Finance Ministries/Treasuries that control the budgets of government departments.

CONCEPTUAL FRAMEWORK

We began by developing a categorization of potential wealth effects based on the published literature. We identified relevant articles by following up the references in recent reviews and comprehensive analyses of the impact of health on economic growth in high-income countries, labor productivity and other indirect costs in economic evaluations ( 5 – 9 ). We identified further publications by conducting searches of Google Scholar using the keywords and abstract terms from these studies.

Figure 1 presents our conceptual framework. It illustrates that in addition to health effects such as reducing morbidity or mortality ( Figure 1 , box A), health interventions can also produce a variety of wealth effects.

Conceptual framework of the link between health and economic outcomes.

The economic costs of illness often fall on sectors other than the healthcare sector; the use of health interventions can lead to important cost savings to those sectors ( Figure 1 , box B). The resources freed up could then be used to provide additional services within the sector. For example, it has been shown that one of the key drivers of the cost of Alzheimer's disease (almost 40 percent) is the cost of social care provided in patients’ homes or in other community settings ( 10 ).

Despite evidence showing that indirect costs can constitute a significant proportion of the total cost of illness to society, the inclusion of those costs in economic evaluations remains limited. Stone et al. ( 11 ) found that productivity costs were considered in less than 10 percent of published cost-utility analyses.

Figure 1 also shows that at the macroeconomic level, a positive link may exist between the health of a population and the level of national income ( Figure 1 , box C). At the microeconomic level, healthcare interventions can have an impact on individuals or households by improving patients’ productivity at work (if they are of working age) and by reducing patients’ and carers’ absences from work due to ill health ( Figure 1 , box D). The arrow linking macro and micro effects indicates that some micro effects are captured at the macro level, for example, reducing sickness absence can improve individual firms’ production which can also contribute to national income growth. Some effects, however, such as time spent doing unpaid work (e.g., housework), tend only to be captured at the micro level.

Empirical evidence using a global sample of countries has shown that health, measured in terms of life expectancy, is a robust predictor of economic growth ( 12 – 15 ). However, the role of health seems to be stronger in the context of low- and medium-income countries compared with high-income countries, where evidence is limited and shows mixed results. For example, Knowles and Owen ( 16 ) found that life expectancy had a minor impact on the economic growth of a sample of high-income countries, while Bhargava et al. ( 17 ) found that above a certain level of income per capita in high-income countries, improvements in adult survival rates had a negative impact on growth rates.

The results of these types of studies should be interpreted with caution for two reasons. The first relates to the indicators used to measure population health, which in most studies is life expectancy or adult mortality. While there is wide variation in life expectancy between middle- and low-income countries, there is little variation among high-income countries. As a result, more relevant indicators of health are needed to capture the different levels of health in different high-income countries ( 4 ). An example of this is cardiovascular disease (CVD) mortality as used in a study by Suhrcke and Urban ( 18 ). They show that a 10 percent increase in CVD mortality among OECD countries reduces the per capita income growth rate by one percentage point. CVD mortality was used as a proxy for health for two reasons. The first was the large disease burden of noncommunicable diseases in OECD countries, CVD in particular. The second was the impact on labor productivity, as CVD affects individuals of working age.

The second reason relates to institutional factors that prevent countries from realizing the positive effects of health improvements. As life expectancy exceeds the retirement age by a growing margin, the old age dependency ratio increases, thus negatively impacting government fiscal stability and, indirectly, economic growth. One way to overcome this would be to increase the retirement age so that the improved health of older people can result in an increase of labor supply and productivity ( 19 ). Those policies have already been implemented or are under discussion in several countries.

The literature also explores the issue of casual effect between health and wealth and shows that higher income can increase consumption and provision of goods and services promoting health ( 6 ; 13 ). This effect will ultimately reinforce the importance of recognizing the role of improving health outcomes on national income, which can create a “virtual” cycle between health and wealth.

At the micro-economic level, ill health can affect individuals’ participation in the labor force in the short-term, long-term or permanently. This affects individuals’ ability to earn income for themselves and their family, to consume market goods and to engage in leisure activities. A body of literature estimates what are called “indirect costs” to society due to ill health. They include losses due to: (i) Reduced productivity at work (presenteeism): some illnesses, such as back pain and depression ( 9 ; 20 ), do not necessarily prevent individuals from attending work but may affect their on-the-job performance; (ii) Sickness absence (absenteeism): individuals who are suffering, recovering from illness, or who are undergoing treatment may require absence from work. For example, it is estimated that a major component of the cost of breast cancer is due to patients’ absence from work due to treatment-related symptoms ( 21 ); (iii) Non-employment / early retirement: illnesses that are particularly debilitating may result in individuals being unable to return to work (and, therefore, unable to produce output) on a permanent basis. For example, Kobelt ( 22 ) reported that 38 percent of the total cost of multiple sclerosis is due to lost productivity from early retirement.

The effects of ill health also apply to those providing informal (i.e., unpaid) care to patients ( 23 ). For example, when children attend hospital appointments, their parents often need to be absent from work to take them to their appointments.

We conducted semi-structured interviews with decision makers and academic experts in eight countries. The aim of the interviews was to explore whether the wealth effects of interventions identified in our conceptual framework represented in Figure 1 are considered by HTA agencies in their health technology evaluations, and by government departments in their budget setting decisions. We also asked about the reasons why these wealth effects were or were not considered. Wealth effects were defined as nonhealth, economic effects generated by the use of health interventions, including impacts on labor productivity and supply, and savings to other sectors.

The potential interviewees invited to participate included individuals representing one or more of the three categories of decision makers (HTA agencies, Health Ministries, Finance Ministries). All were either currently employed by the relevant body or ministry, or local academic experts directly involved in their country's HTA processes and/or in advising their country's Ministry of Health.

The initial geographical scope included countries with established or emerging HTA systems, and near universal health coverage: Australia, Canada, France, Germany, Italy, Poland, South Korea, Sweden, Turkey, and the United Kingdom (UK). The final list of countries was based on whether invitees responded to our request for an interview. These were: Australia, France, Germany, Italy, Poland, South Korea, Sweden, and the United Kingdom.

We developed two questionnaires, one to be used for the HTA or reimbursement decision makers and HTA experts (“Questionnaire for HTA decision makers/experts”; Supplementary Table 1 ); and the other to be used for the employees of Health and Finance Ministries who had little or no technical knowledge of HTA (“Questionnaire for Ministry of Health/Finance/experts”). The questionnaire for HTA decision makers/experts aimed at exploring whether effects on individuals/households (box D of Figure 1 ) generated by health interventions matter in the HTA processes of the interviewee's country; and if they are, which types of effects tend to be considered, in which diseases areas they are particularly important, what type of evidence is required to show their impact and what are the key issues encountered. Hypothetical interventions for three conditions were presented to illustrate those effects: Alzheimer's disease, breast cancer, and depression. The case studies were developed using data from recently published cost of illness studies ( 10 ; 21 ; 24 ). They focused on drug therapies, because many of the interviewees (particularly the HTA experts) were more familiar with the evaluation of drugs than of other types of health intervention, but it was emphasized to all interviewees that we were interested in the effects of all health interventions. In addition, the final question asked interviewees about the impact of new health interventions on national income (box C in Figure 1 ) and whether it mattered in the decision-making process they had experience of.

Categorization of Countries According to the Extent of Consideration of Wealth Effects in Resource Allocation Decisions

The questionnaire for Ministry of Health/Finance/experts asked interviewees about how any effects of health interventions on nonhealth public sectors (box B of Figure 1 ) influence budget setting decisions, for example, whether resource transfers are possible when benefits from health spending are captured in other sectors. For the sake of simplicity, this questionnaire included only one case study (the hypothetical intervention for Alzheimer's disease).

Both questionnaires included open-ended questions. This enabled the interviewer to structure the interview by asking predefined questions, but also to pursue additional topics in more depth or to probe for information on themes emerging from the interviewers’ answers. The questionnaires were sent to the interviewees in advance of the hour-long telephone interview. Two researchers were present at all interviews. Summary notes of the interviews were sent to the interviewees for confirmation and correction (if necessary) to ensure that all points made in the discussion were appropriately captured.

The finalized notes from the full set of interviews were reviewed by three researchers (M.G., K.S., and P.S.) who, working independently, summarized the answers in a tabular form, proposed categorizations of countries based on their consideration of wealth effects, and grouped common barriers to the inclusion of wealth effects. In particular, based on answers to two key questions (Are wealth effects mentioned in HTA guidelines/methods guide? Are they considered by your HTA body in practice?), we developed a categorization of countries designed to summarize the impact of wealth effects on their decision-making processes. This categorization is presented in the next section.

Results from those analyses were then discussed and validated, and key themes were agreed, in a group discussion involving all four researchers.

INTERVIEW RESULTS

We interviewed thirteen individuals from eight countries: seven academic experts and six individuals working (either currently or formerly) for HTA agencies or the Ministries of Health; two individuals from each country were interviewed, with the exception of France, Italy, and South Korea. When the experts stated they had a direct experience or extensive knowledge of the processes of the HTA agencies and/or the Ministries of Health in their countries, we asked them questions related to those topics (suggesting that the HTA/Health Ministry perspectives were represented).

In two countries (Italy, Poland), a Ministry of Finance perspective was represented as the interviewees were able to answer the questions about the allocation of resources among different ministries. In all countries, the Health Ministry and HTA perspectives were represented.

Do Decision Makers Consider Wealth Effects?

Based on our analysis of the interviewees’ responses (following the approach described in the methods section), we assigned each country to one of four categories: countries that consider wealth effects regularly; countries that consider wealth effects in principle but rarely or never in practice; countries that do not consider wealth effects within HTA; and countries that apparently do not currently consider any economic or cost data when making reimbursement and healthcare budget-setting decisions.

As shown in Table 1 , with the exception of Sweden, no country considers wealth effects on a regular basis. In Australia, Poland, and the United Kingdom, although economic evaluations of individual drug interventions submitted to HTA agencies could include wealth effects as part of a secondary analysis, in practice this rarely happens. In Germany, Italy, and Poland there is no scope for including anything other than the direct costs to the healthcare sector and benefits of a new drug. In France, the HTA agency did not consider economic or cost data at the time of our analysis.

At the Finance Ministry level, our two interviewees (from Poland and Italy) emphasized that there is reluctance to consider wider effects of health interventions in their decisions about allocating resources across sectors. Two other interviewees (from the United Kingdom and Australia) referred to national policy reports emphasizing the importance of wealth effects ( 25 ; 26 ) but noted that these have not resulted in any specific policy changes to date.

Key Barriers for the Inclusion of Wealth Effects

Our interviews revealed several legislative, evidence, and policy barriers to incorporating wealth effects into decision making. We have grouped those into the following themes: (i) System fragmentation, including a persistent culture of silo budgets whereby interlinks between governmental departments’ expenditures are not considered regularly if at all and views that the healthcare system should concentrate on health; (ii) Methodological and data generation issues, such as difficulties in demonstrating with reliable data the impact of a specific treatment on productivity; (iii) Practical issues due to added complexity if those effects are included in decision making; (iv) Equity issues as the inclusion of productivity effects can favor interventions for working-age individuals; (v) Weakness of evidence on the relationship between health and economic growth at the macro level which is limited in relation to high-income countries.

System Fragmentation

The general view among decision makers is that the primary and often sole objective of health care is to improve citizens’ health. Thus healthcare budgets tend to be separate from budgets for other sectors even when they are closely related, such as social care. Any spill-overs that occur across sectors are not captured, for example, where spending on a healthcare intervention leads to lower social care costs that are paid out of a separate budget.

In Australia, Italy, and Poland we found that there are also silo budgets within the heathcare sector. In Australia for example, hospital and primary care are financed separately with no scope for transferring any cost savings between the different parts of the healthcare system.

In South Korea, the Government created a separate budget to cover the cost of care for dementia. However, this budget covers community care but not drug costs, which are funded by means of the health budget. Any savings that may result from a new dementia drug that delays the need for community care would, therefore, not be considered in a drug benefit assessment as they would accrue outside the healthcare sector.

In Sweden, even though the HTA body adopts a societal perspective when making reimbursement recommendations on new medicines (i.e., all relevant costs and benefits associated with a treatment and illness are considered), individual County Councils can restrict use of HTA-approved medicines to meet their own budget targets (the key criterion for their decisions is budget impact) ( 8 ).

A few examples of integrated decision making, where nonhealth programs recognize health benefits, were identified (for example, local authority-funded cycle lanes in the United Kingdom). However, our interviewees could not identify any cases where nonhealth benefits of medicine-based interventions were taken into account when allocating resources to the healthcare sector or more specifically to the budget for pharmaceuticals.

Methodological and Data Generation Issues

When incorporating wealth effects in economic evaluation, there are methodological issues around measuring, and providing evidence of, productivity effects. First, there is no methodology to disaggregate productivity gains and improvements in quality of life measured by the quality-adjusted life-years (QALY). Are changes in the individuals’ ability to earn income reflected in the QALY? If they are, there is a potential for double counting those effects.

Second, even when productivity effects are included in the cost-effectiveness estimation of drug interventions (as indirect costs), HTA bodies require evidence showing productivity effects which are directly attributable to the intervention, which is rarely available. For example, what is the proportion of patients that return to work due to the treatment?

In addition, it was noted that short-term absences from work do not necessarily lead to significant losses for the firm employing the patient as the returning employee might catch up on her/his work and be more productive.

Those concerns were highlighted by interviewees from Australia and the United Kingdom, where the HTA process rely on cost-effectiveness evidence. In Sweden, where wealth effects are considered on a regular basis, an interviewee raised concerns about the poor quality of the studies showing productivity benefits underpinning recent submissions to the HTA body. The reason identified was that other HTA bodies such as NICE do not ask for this evidence, hence it is not a priority for companies to collect it. Overall, it emerged that, if HTA bodies were to consider productivity effects and other wealth effects of health interventions, including savings falling to other public sectors, then robust data showing those effects would be demanded.

The interviewees from Poland and South Korea discussed the issue of transferability of the data on indirect effects across countries, as evidence collected in the United Kingdom or Sweden, for example, may not be applicable to them. Therefore, the lack of country-specific data was identified as a barrier to the incorporation of indirect costs in their HTA decisions.

Practical Issues

Some interviewees were skeptical of the impact that wealth effects, particularly productivity gains, can have on final decisions. As one interviewee stated, indirect costs are unlikely to be “the factor that tips the scale in favor of a treatment or not.”

Furthermore, adopting a wider perspective in economic evaluations would result in more work for HTA agencies and for the manufacturers collecting the evidence. Many of our interviewees questioned whether the inclusion of these wealth effects was worth the additional cost and effort.

In some countries, there are legislative barriers to taking wealth effects into consideration when evaluating health interventions. For example, the National Institute for Health and Care Excellence (NICE) in the United Kingdom has until recently been required to adopt a narrow, healthcare sector perspective as specified in the legislation that defined its remit. The new legislation. Public health is already an exception, partly because many of the actions recommended in public health guidance relate to actors outside the health sector. This is reflected in NICE's public health activities where the Institute is more open to reflecting costs and benefits to other sectors. Similarly, in Poland the objective of the healthcare system is defined by law to be to improve the health of the Polish population with no mention of other nonhealth gains. Finally, German decision makers are guided by the statutory Social Code Book regulations, according to which drug benefit assessments should be based on patient relevant benefits identified using clinical endpoints.

Equity Issues

Including indirect effects in the assessment of health interventions can have distributive effects between different social groups. For example, including productivity effects will favor treatments aimed at working age individuals over those who are unable to work because of permanent disabilities, older/retired individuals (who tend to consume more resources than they produce, although they may have been net producers in the past), and children (who may eventually become net producers, but effects accruing over a life time are difficult to estimate). Importantly, this could result in situations where treatments which extend the lives of the older patients for a certain period of time will be found to be less cost-effective than treatments that extend the lives of working age patients for the same amount of time.

Interviewees from Australia and the United Kingdom had particularly strong concerns around the fact that including productivity effects of health interventions conflicted with the principles of equity and nondiscrimination that their health systems were founded upon. Some of the disadvantaged groups are already among the worst-off in society, so any reprioritization of resources away from them could be deemed to be inequitable.

This is in contrast with the approach in Sweden, which is the only country considering wealth effects on a regular basis, despite the fact that it is not an insurance-based system where, arguably, interventions increasing people's ability to work would be favored by employers contributing to insurance funds.

Weakness of Evidence on Health Impact on Economic Growth

We asked all interviewees whether the Suhrcke and Urban ( 18 ) study, which provides evidence on the impact of improved health outcomes in CVD on macroeconomic growth, had had any resonance in their country. Almost all interviewees said that the study, which was commissioned by the European Commission ( 4 ), has not had any impact on their national policy.

There are reservations about applying the Suhrcke and Urban results to inform resource allocation decisions. One issue identified was that the focus of the study is on one disease area, although one with the largest burden in high-income countries. Therefore, the results do not necessarily support investment in healthcare generally as a means to promote economic growth. In addition, the results cannot be used to inform priority setting within the health sector as evidence on the impact of other disease areas on macroeconomic indicators is not available.

A few interviewees questioned the validity of these studies, especially in light of documented methodological limitations ( 7 ). Only in the United Kingdom, according to one of the interviewees, was the Suhrcke and Urban ( 18 ) study discussed by a decision-making committee; however, this was primarily for public health interventions.

The barriers to the incorporation of wealth effects in decision making identified by our interviewees could be addressed in several ways. Breaking down silo budgeting may be difficult, as this will require not only a change in the operation of government financial systems to allow for resource transfers across departments, but also potentially the need to develop more integrated healthcare systems focusing on outcomes that go beyond health gains.

On the other hand, methodological issues can be addressed in the short term by undertaking research comparing the available approaches (e.g., friction cost approach, human capital approach) to estimating productivity gains and assess their validity in different economic contexts. In addition, empirical studies can be conducted to test the extent to which effects of changes in individuals’ income are captured by the QALY such as the study by Tilling et al. ( 27 ). This will give HTA bodies more confidence in considering wealth effects systematically.

A clear signal from HTA bodies to a more open approach to the consideration of wealth effects will encourage bio-pharmaceutical companies to invest in generating the evidence needed to demonstrate the presence and the size of those effects for specific treatments. In particular, for each category of wealth effect, including productivity, there is a need to identify the type of studies that can be undertaken and approach to incorporate this evidence in HTA submissions. If HTA remains ambivalent regarding the importance of wealth effects, companies are unlikely to generate good quality evidence to prove them. The UK Department of Health and NICE recently proposed introducing a new, value-based pricing system for pharmaceuticals ( 28 ), based on the recognition that the value of a medicine should capture all benefits to society beyond health. Though the proposal was ultimately rejected, it demonstrates that UK decision makers have at least considered the feasibility of incorporating a broader range of non-health effects in assessment processes.

Equity concerns should be considered in light of certain indirect effects of interventions. Taking into account productivity benefits could result in favoring treatments for diseases affecting individuals of working age. However, all members of society could potentially benefit from keeping people at work if the increased tax revenues are redistributed across different groups (e.g., by means of investment in public services). Furthermore, the improved health of nonworking individuals can also have positive effects on the economy by allowing their (informal) carers to remain in work and maintain their labor supply. This may be particularly true for quality of life-improving treatments for nonworking patients with chronic conditions, whose need for caregiving falls as a result of treatment.

The issue of uncertain results on the link between health and economic growth in high-income countries does not justify moving resources away from the health sector. From a methodological perspective, more research can be done entailing, for example, the use of health indicators other than life expectancy to better reflect variation of health states in rich countries and also the application of the Suhrcke and Urban ( 18 ) approach to different disease areas. From a national governments perspective, there is an opportunity to expand taxable income when funding interventions that increase patients’ ability to work and earn income, and, therefore, to set a virtuous cycle of “better health—more income for citizens—more taxable income for governments,” which could increase the total resources available and partly help dealing with public deficits.

STUDY LIMITATIONS AND SUGGESTIONS FOR FURTHER RESEARCH

Our qualitative analysis was based on a relatively small number of interviews (one or two in each country) conducted by telephone. This was sufficient for us to identify common issues preventing countries from considering all relevant effects of healthcare spending, including positive economic spill-overs. A larger sample, however, would have allowed us to compare a greater number of views and to validate some of the claims being made. Further analyses could include more countries with emerging HTA systems and growing economies (such as Brazil) and new EU Member States facing budgetary pressures, to investigate whether and how health could be considered a long-term investment. In terms of methodology, qualitative approaches other than interviews could be used, such as focus groups or workshops allowing participants to interact with one another and to make recommendations following a period of discussion and deliberation.

CONCLUSIONS

There is evidence suggesting that, in certain diseases areas, health interventions can produce economic gains for patients and national economies ( 9 ; 18 ; 22 ; 23 ). Those benefits include improvements in the productivity of patients and their carers at work, and cost savings to other sectors such as education and social care.

Despite this evidence, the results from our interviews with decision makers and expert commentators in eight countries suggest that, with the exception of Sweden, considerations of the link between health and wealth have little to no impact on decision making, from budget setting across ministries to reimbursement decisions on individual therapies.

In countries with established HTA processes and methods guides that in principle allow the inclusion of wider effects in exceptional cases or secondary analyses (Australia, Poland, and the United Kingdom in our study), it might be possible to overcome some of the methodological and practical barriers identified and move toward a more systematic consideration of wealth effects in drug decision making. The United Kingdom, for example, considered this option when developing a proposal for value-based assessment ( 28 ). Ultimately, considering all relevant elements, including both health and wealth effects, is consistent with principles of efficient priority setting and does not necessarily require increasing the healthcare budget.

As far as national government decisions are concerned, barriers to the consideration of wealth effects in decision making and investment assessments are more fundamental due to an enduring separation of budgets within the public sector (and in some cases within the health sector) which prevents the capture of spill-overs across areas. In addition, given current financial pressures, it seems unlikely that governments will be willing to shift their focus away from cost-cutting measures aimed at reducing fiscal deficits in the short term toward public investments, including in healthcare, with longer-term benefits. Governments should not, however, overlook how to make the best use of the available resources and should consider all relevant effects, whether positive or negative, when making resource allocation decisions. In difficult economic times it becomes even more important to use resources where they bring the best returns to the economy.

CONFLICTS OF INTEREST

The work on this paper conducted by Martina Garau, Koonal Shah, Priya Sharma, and Adrian Towse was funded by Eli Lilly and Company. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Supplementary material

• Open access
• Published: 28 January 2022

Assessing equity in health, wealth, and civic engagement: a nationally representative survey, United States, 2020

• Thomas J. Stopka   ORCID: orcid.org/0000-0003-2314-8924 1 , 2 , 3 ,
• Wenhui Feng 1 ,
• Laura Corlin 1 , 4 ,
• Erin King 5 , 6 ,
• Jayanthi Mistry 7 ,
• Wendy Mansfield 8 ,
• Ying Wang 8 ,
• Peter Levine 5 &
• Jennifer D. Allen 3  

International Journal for Equity in Health volume  21 , Article number:  12 ( 2022 ) Cite this article

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The principle of equity is fundamental to many current debates about social issues and plays an important role in community and individual health. Traditional research has focused on singular dimensions of equity (e.g., wealth), and often lacks a comprehensive perspective. The goal of this study was to assess relationships among three domains of equity, health, wealth, and civic engagement, in a nationally representative sample of U.S. residents.

We developed a conceptual framework to guide our inquiry of equity across health, wealth, and civic engagement constructs to generate a broad but nuanced understanding of equity. Through Ipsos’ KnowledgePanel service, we conducted a cross-sectional, online survey between May 29–June 20, 2020 designed to be representative of the adult U.S. population. Based on our conceptual framework, we assessed the population-weighted prevalence of health outcomes and behaviors, as well as measures of wealth and civic engagement. We linked individual-level data with population-level environmental and social context variables. Using structural equation modeling, we developed latent constructs for wealth and civic engagement, to assess associations with a measured health variable.

We found that the distribution of sociodemographic, health, and wealth measures in our sample ( n  = 1267) were comparable to those from other national surveys. Our quantitative illustration of the relationships among the domains of health, wealth, and civic engagement provided support for the interrelationships of constructs within our conceptual model. Latent constructs for wealth and civic engagement were significantly correlated ( p  = 0.013), and both constructs were used to predict self-reported health. Beta coefficients for all indicators of health, wealth, and civic engagement had the expected direction (positive or negative associations).

Through development and assessment of our comprehensive equity framework, we found significant associations among key equity domains. Our conceptual framework and results can serve as a guide for future equity research, encouraging a more thorough assessment of equity.

Introduction

Individuals, communities, and societies can experience equitable or inequitable conditions across multiple domains including health, wealth, and civic engagement. Traditional research approaches typically focus on only one or perhaps two of these dimensions at a time. For example, it is well established that income and wealth (i.e., net worth and assets) are directly associated with health outcomes [ 1 , 2 , 3 ], and that inequalities in wealth are associated with inequalities in health as assessed by metrics such as life expectancy [ 4 , 5 , 6 ]. The associations among these domains can appear bidirectional. For example, adverse mental health damages individuals’ economic circumstances, and poverty contributes to adverse mental health [ 7 ].

Similarly, accounting for the health and civic engagement domains, research indicates that increased well-being, physical health and mental health are associated with increased civic engagement [ 8 ], and that poor health earlier in life is associated with lower levels of civic engagement later in life [ 9 , 10 ].

Finally, considering the wealth and civic engagement domains, researchers have consistently found associations between wealth and social class, on one hand, and civic engagement behaviors, on the other [ 11 ]. Income inequality has risen as volunteering and associational membership have decreased [ 12 ], and social capital and civic engagement are negatively associated with income inequality [ 13 , 14 , 15 ].

While the connections between health and wealth, civic engagement and health, and wealth and civic engagement have been explored previously, there is a paucity of research that explores the interrelationships between all three domains, that is between equity in health, wealth, and civic engagement. To help fill this gap in the assessment of holistic connections across all three domains, we conducted a cross-sectional, online survey between May 29–June 20, 2020 designed to be representative of the adult U.S. population. In this paper, we present our guiding conceptional equity framework, our methodological approach, and salient results from our quantitative assessment.

Conceptual framework

We developed a conceptual framework to guide our interdisciplinary research and inform development of our study. For our framework, we adapted elements from the World Health Organization’s Commission on Social Determinants of Health’s (CSDH) framework [ 16 ] and the social ecological model [ 17 , 18 ]). We adapted the CSDH model following extensive discussion with our interdisciplinary team that includes experts in community health, economics, education, epidemiology, human development, philosophy, One Health, psychology, and statistics [ 19 ].

In our final framework (Fig.  1 ), the central triangle presents major categories of variables that we directly measured in our survey: health, wealth, and civic engagement. The figure also provides examples of specific variables within those categories, such as health outcomes, income, and voting, respectively. The arrows suggest that these three domains are empirically associated, which we hypothesized based on the literature, and set out to test in our data.

Conceptual Framework: Equity in Health, Wealth, and Civic Engagement

On the left-hand side of the panel, the figure depicts contextual factors that may influence individuals within the target population of interest and the relationships among the individual-level variables we measured. For example, the survey was conducted during a pandemic and a recession, when large-scale biomedical and economic conditions likely affected individuals’ responses. The model suggests that people are also affected by policies, at all levels of government, and by other’s treatment of them. These experiences, such as discrimination at the individual, institutional, and structural levels, can mediate associations between contextual factors and individual characteristics. For some of these contextual factors, respondents to our survey serve as informants. For example, they report on whether they experience discrimination, which is suggestive evidence of the degree of the actual discrimination they face. For other variables, we can link external data (e.g., measured environmental conditions or policies passed in a region) to individuals to understand the environmental or political context. Our conceptual framework allows us to investigate various aspects of equity understood as relative positions in a stratified social structure, or concrete experiences of inequity, or both [ 20 ]. To explore relative positions, we can examine the variables in the survey that measure conditions that may be distributed unequally in society, such as income, voter turnout, and health outcomes. Such findings provide a basis for discussing whether circumstances are inequitable. To explore concrete experiences of inequity, we can examine data on discrimination, perceived treatment in the healthcare system, and the responsiveness of institutions, among other measures. Statistical models can then investigate the relationships among demographic characteristics (e.g., race/ethnicity, age, and gender); relative positions in the social structure; concrete experiences of inequity; and health, wealth, or civic engagement outcomes.

From our cross-sectional survey data (see Methods and Results below), we can indicate whether particular populations are equal or unequal in various respects. For this purpose, equality is defined as an empirical matter, a mathematical relationship between two variables. In contrast to equality, equity is a normative or value-laden concept, debated by people who hold different normative principles. For example, according to the survey, people who identify as female are 10 percentage points more likely to suffer from depression than those who identify as male. Determining whether a 10 point difference in the prevalence of a specific health condition by gender is a sign of inequity, and why, requires an argument based on normative principles and reasons. To argue that the prevalence of a given health condition should be the same by gender implies a broader theory of equity that needs justification, and it raises further questions: Is any incidence of an adverse health condition acceptable? Would the situation be more equitable if both men and women reported equal, but higher, rates of the condition? Do the reasons for the difference matter when considering whether the outcome is equitable? If the health condition could be cured without solving the causes of it, would that be equitable?

The right-hand panel of the framework presents evaluative criteria that are influential in public debates, although also controversial. For instance, focusing on the fairness of opportunities versus outcomes can yield different judgements. Efficiency refers to the social cost of obtaining a benefit, such as public health, whereas liberty is sometimes understood as a right that must be protected regardless of cost/benefit efficiency.

The model suggests hypotheses about these types of questions, and others, that can be tested through subsequent analyses relating normative arguments to empirical data. In our conceptual framework, the double-headed arrow between the central and right-hand elements of the model represents a dialogue between normative principles and empirical evidence. Such a dialogue is a feature not only of our interdisciplinary research team but also of a healthy public debate. Facts should influence people’s values; and values should influence what is measured and how the data are interpreted [ 21 ].

Survey administration

We collaborated with Ipsos, a social science research company, to conduct the survey using the web-enabled KnowledgePanel®, the largest, online, probability-based panel designed to be representative of the U.S. population. Initially, participants were chosen by a random selection of telephone numbers and residential addresses. Persons in selected households were then invited by telephone or by mail to participate in the web-enabled KnowledgePanel. For people who did not already have Internet access but agreed to participate, Ipsos provided a laptop/netbook and Internet Service Provider (ISP) connection at no cost to the participant. People who already had computers and internet service were permitted to participate using their own equipment. Panelists then received unique log-in information for accessing surveys online. They were sent emails a few times each month inviting them to participate in research. Due to the probability-based recruitment methodology Ipsos used, samples selected from the KnowledgePanel were representative of the US population with a measurable level of accuracy—a feature not obtainable from nonprobability or opt-in online panels (for comparisons of results from probability versus nonprobability methods, see [ 22 , 23 , 24 ]).

In our final instruments and analyses, we examined measures from both the survey we developed with our interdisciplinary team (the “Tufts equity survey”) and Ipsos’s own annual surveys of the KnowledgePanel (“Ipsos profile surveys”). The latter collect information on personal and household characteristics, personal health, health coverage and attitudes, lifestyle, finance, politics, media usage, and other subjects.

Equity survey sampling frame

Participants were non-institutionalized adults aged 18 years or older living in the United States. A total of n  = 1980 KnowledgePanel members were invited to complete the equity survey.

We fielded the equity survey in English and Spanish from May 29 to June 10, 2020. On day three of the field period, an automatic email reminder was sent to all non-responding sample members. Additional email reminders were sent to non-Hispanic Black and Hispanic non-responders on day 11 of the field period in an effort to maximize the survey completion rate from these demographic groups. The median completion time of the equity survey was 17 min. Upon completion, qualified respondents received their standard incentive payment (for most respondents, 1000 points, the cash-equivalent of $1 and an entry into the KnowledgePanel sweepstakes for completing a survey longer than 15 min).

Response rates

From the random sample of 1980 panel members, 1267 responded to the invitation, and all qualified for the survey, yielding a final stage completion rate of 64.0% and a qualification rate of 100% percent. The panel recruitment rate (for agreeing to join the panel) for this study, reported by Ipsos, was 11.9% and the profile rate (for completing the profile survey collecting key demographics for sampling and weighting, required before panel members can complete any other surveys) was 61.1%, resulting in a cumulative response rate (recruitment rate x profile rate x survey completion rate) of 4.7%.

Survey development

Survey items focused on the domains of equity in health, wealth, and civic engagement were developed through a collaborative process within our interdisciplinary team. Broadly, our operational definition of equity in these three domains includes a holistic understanding of equity, including overall health measures, specific chronic and communicable disease outcomes, income, education, home ownership and poverty measures, and active and passive service and civic activities (e.g., volunteer work, voting, collaboration to solve a community problem, protesting) in local communities. Where possible, standardized survey items were employed. Final survey items were programmed, piloted, and fielded to our target sample.

The variables were heterogeneous in type. Some measured psychological states, such as the sense that one suffers discrimination. Psychological states are often constructs that are best measured with multiple survey items that form meaningful scales. In contrast, some variables measured objective assets, such the size of one’s annual income and whether one owns a home. Such assets are additive—a greater total implies more wealth—but they may not scale because they are not psychological constructs. In fact, a person could hold multiple assets and yet not feel wealthy. Finally, some variables were concrete behaviors, such as voting in the 2000 election. Voting is an example of a way of influencing institutions--and so is protest. Like various forms of wealth, voting and protest are additive: voting in multiple elections plus protesting add up to a higher level of engagement. However, whether responses to survey questions about such forms of participation form scales is not our focus, because we are interested in actual engagement rather than the psychological construct of feeling civically engaged. Our overall strategy is not to investigate or report scales, because only a few of our variables measure psychological constructs. Instead, we aggregate the variables using a structural equation model applied to the population as a whole, as described below.

Health measures

We assessed self-rated general health, clinician-diagnosed history of specific infectious diseases (e.g., “Have you ever been told by a health care professional that you had COVID-19 , the human immunodeficiency virus [HIV], the hepatitis C virus [HCV]), chronic conditions (chronic kidney disease, chronic obstructive pulmonary disease [COPD] or asthma, heart conditions [heart attack, heart disease, or other heart condition], pulmonary arterial hypertension, high blood pressure, diabetes or pre-diabetes, and non-alcoholic fatty liver disease), and history of mental health conditions (anxiety, depression, mood disorder, schizophrenia).” Participants also reported their height and weight, from which we calculated individual body mass index (BMI) and obesity status (BMI ≥ 30 kg/m 2 ). We included behavioral health indicators: whether the respondents smoked ≥100 cigarettes in their lifetime, whether they ever vaped, and whether they have been told by healthcare professionals that they have alcohol use disorder, substance use disorder, or opioid use disorder. At the time of survey development, there were few validated items to assess COVID-19 experiences. We included questions from the standardized CoRonavIruS Health Impact Survey (CRISIS) [ 25 ] to assess whether a participant or a family member had been tested (e.g., “Have you ever received a test for the Coronavirus?”) and/or diagnosed with COVID (i.e., “Have you personally been told by a healthcare professional that you were infected with Coronavirus?”). Response options were “yes”, “no”, “don’t know”. We also included items to assess COVID-related behaviors (e.g., social distancing [“Have you tried to isolate yourself from contact with other people because of Coronavirus?”], vaccine intentions [“If a vaccine became available to prevent the Coronavirus, would you get it”]) and the same response options were provided.

Wealth measures

Our wealth outcomes consisted of educational attainment (less than high school, high school, some college, Bachelor’s degree or higher), home ownership status (owned or being bought by you or someone in your household, rented for cash, occupied without payment of cash rent), primary source of health insurance (employer sponsored insurance, Medicare/Medicaid, Health Insurance Marketplace, Veteran’s Affairs, or other health insurance), and annual household income (<$10,000, $10,000–$14,999, $15,000–$24,999, $25,000–$34,999, $35,000–$49,999, $50,000–$74,999, $75,000–$99,999, $100,000–$149,999, $150,000–$199,999, ≥$200,000), employment status (working, laid off/looking, retired/disabled/other not working). We took each income interval’s median value to convert the income information into a percentage of the 2020 federal poverty level (FPL) accounting for family size [ 26 ].

Civic engagement measures

We define civic engagement as all the ways that people act to maintain or improve their communities and political regimes. It encompasses horizontal relationships among members of communities and vertical relationships between residents and institutions, e.g., voters casting ballots to choose leaders. It has behavioral components, such as voting, volunteering, and expressing political opinions, as well as affective components, such as a sense of efficacy—both personal and collective—or the confidence to make change ([ 27 , 28 ].)

The survey included measures of voting, news consumption, opinions, financial donations, and participation in specific groups and movements, including political parties, unions, and a list of 25 named activist organizations. We also included three concrete behavioral measures: canvassing, serving as a nonprofit board member, and planning to vote in the 2020 election (using the item that Gallup uses to assess likelihood of voting on a 10-point scale)[ 29 ]. We also added three general civic engagement items:

Have you ever worked together informally with someone or some group to solve a problem in the community where you live? [ 30 ] (Community problem-solving). [Response options: Yes, within past 12 months; Yes, but not within past 12 months, No, Refused.]

Please think about the problems you see in your community. How much difference do you believe YOU can personally make in working to solve the problems you see? (Personal efficacy). [Response options: Refused; No difference at all; Some difference; A great deal of difference].

How much difference do you believe you and other members of your community can make if you work together? (Collective efficacy). [Response options: Refused; No difference at all; Some difference; A great deal of difference].

We created a composite measure for civic engagement that included activities tied to activism or community organizing (e.g., attended a political protest or rally; contacted a government official; served on a committee for a civic, non-profit or community organization; commented about politics on a message board or Internet site; held a publicly elected office; shared opinion about a town or community issue at a public meeting; signed a petition; volunteered or worked for a presidential campaign; volunteered or worked for a political candidate other than a presidential campaign; volunteered or worked for a political party, issue, or cause; or written a letter or email to a newspaper/magazine or called a live radio or TV show).

Perceived discrimination measures

We included seven close-ended survey items to measure perceived discrimination and one open-ended. The close-ended items were adapted from the Perceived Discrimination Scale developed by Williams, Neighbors, and Jackson, [ 31 ], for the 1995 Detroit Area Study, which collected face-to-face interviews with 1139 adults residing in three counties of Michigan. The original two-part scale was used to measure (a) major experiences of unfair treatment, as well as (b) more chronic, routine, and relatively minor experiences of unfair treatment. The Perceived Discrimination Scale [ 31 ] has been validated in adult samples across multiple studies, with the internal reliability of the Everyday Discrimination subscale ranging from 0.80 to 0.90. The convergent validity for the scale has been established with other scales of perceived stress, depression, and negative affect and social strain diary data in a sample of older adults in the Pittsburgh metro area [ 32 ], and to assess a self-report measure for population health research on racism and health tied to discrimination [ 33 ]. In addition, this scale is one of the resources recommended by the CDC in its 2007 publication “Expanding our understanding of the psychosocial work environment: a compendium of measures of discrimination”.

Of the seven close-ended perceived discrimination survey items included in the Tufts equity survey, four items represent major discrimination experiences, one of which is from the original Perceived Discrimination Scale, and three items, all from the original scale, represent everyday experiences of discrimination. The first question asks: “In your day-to-day life, how often have any of the following things happened to you? ” with prompts such as “You are treated with less courtesy or respect than other people are”, and “You are threatened or harassed.” Respondents are asked to estimate the frequency of each of these experiences for Major Perceived Discrimination on a 4-point scale (1 = never, 2 = once or twice, 3 = 3 times or more times, or 4 = Not this year, but in the past). Respondents answered the frequency questions for Everyday Perceived Discrimination on a 4-point scale (1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Frequently). In the current study, we assessed frequencies and percentages for response options for the seven items.

After each of the items, respondents are asked to select the perceived reason for the discrimination from a set of six options (your race/ethnicity, your gender, your religion, your health, your sexual orientation, your economic situation).

Linkage to other data

Our data captured individuals’ current and childhood exposure to community-level economic, social, and environmental factors at the ZIP Code and county-level. Data were linked to participants based on their current ZIP Code and county of residence and their self-reported ZIP Code and county at 10 years of age. We obtained data for economic and social community-level factors (e.g., percentage of a ZIP Code with a given race/ethnicity, percentage of a ZIP Code with different levels of educational attainment, median household income for the ZIP Code, and residential racial segregation) from the U.S. Census Bureau’s American Community Survey (United States Census Bureau, 2015–2019). We also obtained data on social capital (e.g., family unity, family interaction, social support, community health, institutional health, collective efficacy, and philanthropic health) at the state and county level [ 34 ]. The dataset included standard state and county level indices for these factors, as well as data on the factors contributing to each indicator and state and county-level socioeconomic and health benchmarks (e.g., incarceration rates, relative and absolute immobility, unemployment rate, percent with housing costs > 35% of income, percent of children receiving public assistance, on-time graduation rate, percent diabetic, and percent who smoke).

We obtained environmental data from multiple sources: Air pollution data (particulate matter < 2.5 μm [PM 2.5 ] in aerodynamic diameter and nitrogen dioxide) were available at the census tract level. These modeled exposure estimates were derived from annual average PM 2.5 models developed for the global burden of disease effort. We used the North-American-specific models developed at 0.01 × 0.01-degree resolution to calculate the census tract average PM 2.5 [ 35 ]. We obtained temperature data (daily average, minimum, maximum; 4 km × 4 km resolution) from the PRISM Climate group at Oregon State University [ 36 , 37 ]. Heatwave days were calculated on a per-pixel basis as the number of days during the warm season (May–September) in which the maximum temperature exceeded the pixel-specific 95th percentile for the warm season maximum temperature for 1999–2018 for two or more consecutive days. Pixel values were averaged across tracts and counties and rounded to the nearest whole number to get the number of heatwave days per county. Proximity to greenspace and access to open space were derived using the normalized difference vegetation index (NDVI; an index that indicates photosynthetic activity in plants). We used the 16-day NDVI composites from the Moderate Resolution Imaging Spectroradiometer (MODIS) sensor at 250 m resolution onboard the Terra satellite (MOD13Q1; mean county-level annual maximum NDVI) [ 38 ]. Toxic waste site data were available from the Environmental Protection Agency (EPA) Toxic Release Inventory website [ 39 ]. We calculated the number of toxic waste sites per county.

Sample weighting

In order to ensure a balanced representation of survey participants from across the U.S., we incorporated sample weighting techniques in advance of recruitment. KnowledgePanel members represent the U.S. adult population with respect not only to a broad set of geodemographic indicators, but also for hard-to-reach adults (such as those without internet access or Spanish-language-dominant Hispanics) who are recruited in representative proportions. Consequently, the raw distribution of KnowledgePanel mirrors that of the U.S. adults fairly closely, barring occasional disparities that may emerge for certain subgroups due to differential attrition.

To select the general population sample for this study, Ipsos used its patented methodology developed to ensure that all samples behave as an equal probability of selection method samples. Briefly, this methodology started by weighting the pool of active members to the geodemographic benchmarks secured from the March 2019 supplement of the U.S. Census Bureau’s Current Population Survey along the geodemographic dimensions listed below [ 40 ]. Using the resulting weights as measures of size, a probability-proportional-to-size (PPS) procedure was used to select the study sample. It is the application of this PPS methodology with the imposed size measures that produced the fully self-weighting sample, for which each sample member carried a design weight of unity.

The geodemographic dimensions used to weight the active panel members for computation of size measures include: gender (female, male); age (18–29, 30–44, 45–59, ≥60 years); race/ethnicity (Hispanic, Non-Hispanic Black, Non-Hispanic White, Non-Hispanic Other, 2+ Non-Hispanic races); educational attainment (less than high school, high school, some college, Bachelor’s and beyond); census region (Northeast, Midwest, South, West) [ 41 ]; annual household income (under $10 k, $10 K to <$25 k, $25 K to <$50 k, $50 K to <$75 k, $75 K to <$100 k, $100 K to <$150 k, and ≥ $150 K); home ownership status (own, rent/other); metropolitan area (yes, no) [ 40 ]; and Hispanic origin (Cuban, Mexican, Puerto Rican, other, non-Hispanic).

Study-specific post-stratification weights

Once all survey data were collected and processed, design weights were adjusted to account for differential nonresponse. Using geodemographic distributions obtained from the U.S. Census Bureau's Current Population Survey and American Community Survey, we applied an iterative proportional fitting (raking) procedure to produce the final weights [ 40 , 42 ]. We used the following benchmark distributions of U.S. adults age 18 and older from the most recent Current Population Survey March Supplement (2019) for the ranking adjustment of weights, and we used the 2018 ACS language proficiency benchmarks to adjust weights for Hispanic respondents: gender (female, male) by age (18–29, 30–44, 45–59, ≥60 years); race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Non-Hispanic Other, Hispanic, 2+ Non-Hispanic races); census region (Northeast, Midwest, South, West) by metropolitan status (metro, non-metro); education (less than high school, high school, some college, Bachelor’s or higher); annual household income (under $10 k, $10 K to <$25 k, $25 K to <$50 k, $50 K to <$75 k, $75 K to <$100 k, $100 K to <$150 k, and ≥ $150 K); and language proficiency (Non-Hispanic, English proficient Hispanic, bilingual Hispanic, Spanish proficient Hispanic).

In the final step, we examined calculated weights to identify outliers at the extreme upper and lower tails of the weight distribution, and we determined no trimming of outliers was needed. The resulting weights were then scaled to aggregate to the total sample size of all eligible respondents. The design effect was 1.2487.

Statistical analyses

First, to understand the characteristics of the study sample, we assessed measures of central tendency and frequency distributions of specific measures of health, wealth, and civic engagement. Second, to verify the representativeness of our sample, we compared distributions of demographic, wealth, and health characteristics of our sample to those from the 2020 Current Population Survey [ 43 ]. In these descriptive analyses, we retained answers of “don’t know” or “refused” as separate categories (not treated as missing). Third, we used a structural equation model (SEM) to empirically assess the relationships among health, wealth and civic engagement constructs proposed in Fig. 1 . The purpose of using SEMs is to empirically test theoretical relationships among measured variables that are thought to represent related latent constructs [ 44 ]. In our illustrative example of a structural model (Fig.  2 ), we represented the health construct empirically using the self-reported physical health variables (Table  1 , shows all levels of the variables used for the SEM analysis). The health construct was a function of five other health variables: (1) body mass index; (2) smoked > 100 cigarettes ever; (3) diagnosed depression or anxiety; (4) substance use concern; and (5) self-reported diagnosis by a healthcare professional of chronic disease. Additionally, the health construct was a function of two latent variables, wealth and civic engagement, that were allowed to have a partial correlation with each other. The wealth latent variable was defined by three indicators: (1) income; (2) educational attainment and (3) home ownership (Table 1 ). The civic engagement construct was defined by four indicators: (1) self-reported likely voter; (2) self-reported personal efficacy to solve problems in community; (3) self-reported collective efficacy to solve problems in community; and (4) self-reported informal collaboration to solve a community problem (Table 1 ). The SEM was run using gsem in Stata v.16 with robust standard errors and survey weighting. We used a logit link function with a Bernoulli distribution for all dichotomous variables and a logit link function with an ordinal distribution for all categorical variables with ≥3 categories. We also generated a correlation matrix of coefficients within the SEM and we estimated separate logistic regression models to examine bivariate associations between each indicator variable (i.e., the measured covariates for health, wealth, and civic engagement from Table 1 ) and the self-reported physical health outcome variable.

Structural equation model relating health, wealth, and civic engagement. Values in parentheses represent beta coefficients. Ovals represent latent constructs and rectangles represent measured variables. Values = 1 were constrained

We assessed demographic (Table  2 ), wealth (Table  3 ), civic engagement (Table  4 ), and health measures (Table  5 ) in our nationally representative sample. Our weighted sample demographics largely mirrored the national distribution of all adults: 51.6% female, 71.4% aged 25–64 years, 63.1% non-Hispanic White, and 53.2% married. The frequencies and percentages for our demographic measures were comparable to those from the Current Population Survey in all categories (Table 2 ).

Similarly, the wealth and socioeconomic characteristics in our weighted sample largely mirrored the national distributions from the Current Population Survey: 49.0% earned less than $75 K, 65.2% employed, 56.1% completed high school or some college while 33.3% completed a Bachelor’s degree or higher, and 70.9% owned their home (Table 3 ).

We found that nearly two-thirds of our sample reported not being civically engaged (63.3%) in activities such activism or community organizing. Approximately one-third of respondents (32.9%) reported some or a great deal of personal efficacy, while 70.7% reported some or a great deal of collective efficacy, and 65.7% definitely planned to vote in 2020. In terms of political affiliations, about one-third belonged to either the Democratic (35.4%) or Republican (28.3%) party. Nearly 7 in 10 (68.5%) reported that they had never worked together informally with another person or group to solve a problem in the community.

Approximately half (49.6%) of our respondents reported excellent or very good general health (Table 5 ). Nearly one-third of participants reported being obese (31.9%) and one-quarter of respondents reported having been diagnosed by a medical professional with high blood pressure (24.1%). Approximately one in seven participants reported having been diagnosed with depression (14.2%). Approximately one in 10 participants reported having been diagnosed with anxiety (11.1%), diabetes or pre-diabetes (11.8%), and asthma, chronic bronchitis, or chronic obstructive pulmonary disease (11.0%), while 6.2% reported having been diagnosed with a heart attack, heart disease, or other heart condition, and 4.6% reported a cancer diagnosis. In assessing health behaviors, we found that one-third of respondents reported ever smoking (34.5%) and 17.1% had ever vaped. The vast majority (84.2%) reported having private or public health insurance.

We report evidence of both major and everyday discrimination experiences in Supplemental Table 1 . In general, the reported frequencies of everyday discrimination experiences were higher than those of major discrimination experiences.

Relationships among health, wealth, and civic engagement constructs

To empirically test the hypothesized relationships among health, wealth, and civic engagement constructs shown in our conceptual framework (Fig. 1 ), we generated the illustrative model results shown in Fig. 2 . The overall model structure that we hypothesized in Fig. 1 was supported in this illustrative example. For example, the covariance between the wealth and civic engagement indicators was significant ( p  = 0.013). Additionally, the wealth latent construct significantly predicted the general health indicator (β = 0.19; 95% CI = 0.01, 0.37; p  = 0.035). The civic engagement latent construct was constrained at 1 so the significance of the relationship between civic engagement and health cannot be determined in the main model; however, in a second version of the model where the wealth latent construct was constrained at 1, the civic engagement construct was a significant predictor of the health variable (β = 0.44; 95% CI = 0.11, 0.77; p  = 0.010).

In the full structural equation model (Supplemental Table  2 ), we observed moderately strong positive associations between the wealth construct and each of the indicators for civic engagement (coefficients between 0.38 and 0.47). The wealth indicators were each significantly associated with the latent construct for wealth (income was constrained to 1, β = 0.40 for education with p  = 0.026, and β = 0.34 for home ownership with p  = 0.001). Similarly, the civic engagement indicators were each significantly associated with the latent construct of civic engagement ( p  < 0.01 for each indicator). Additionally, the direction of each health, wealth, and civic engagement indicator was consistent with the hypothesized relationships, suggesting that our constructs were valid. For example, we observed that smoking was associated with a 46% lower likelihood of reporting excellent or very good health ( p  < 0.001), having been diagnosed with at least one chronic health condition was associated with a 39% lower likelihood of reporting excellent or very good health ( p  = 0.005), and each point increase in BMI was associated with a 9% lower likelihood of reporting excellent or very good health ( p  < 0.001). The effect estimates for having been diagnosed with depression or anxiety and having a substance use disorder were negative in relation to self-reported general health, as expected, but were not significant ( p  = 0.056 and p  = 0.359, respectively). For comparison, the results of the structural equation model were generally consistent with bivariate associations between each of the indicator variables and the observed overall physical health variable (Supplemental Table  3 ). At least one level of each wealth and civic engagement variable was significantly associated with the overall physical health variable ( p  < 0.05).

The goal of the current study was to help fill a gap in the extant literature by assessing holistic connections across all three equity domains—health, wealth, and civic engagement. Whereas current literature has explored inequities in health and wealth, in health and civic engagement, and in civic engagement and wealth, to our knowledge, no prior research has explored the relationships among these three domains. We developed a conceptual framework and conducted a cross-sectional, online survey between May 29–June 20, 2020 designed to be representative of the adult U.S. population. Through our statistical models we explored the complex web of domains that contribute to and hinder equity.

We first noted that the demographic, wealth, health, and civic engagement characteristics of our sample were comparable to those of the U.S. population, as our frequencies and distributions for similar measures were in line with those from the U.S. Census Bureau [ 44 ]. We found that many forms of civic engagement were relatively uncommon, and that poor health outcomes were common, as also noted in the Current Population Survey. In our structural equation model illustrating one set of possible interrelationships among wealth, civic engagement, and health, we found evidence that all three domains together are associated with self-reported general physical health. We suggest that a complex web of factors across each of the health, wealth, and civic engagement domains affects individual and community health and wellbeing.

Traditional research has focused on singular or dual dimensions of equity, such as wealth or wealth and health [ 1 , 3 ], noting that inequalities in wealth are associated with inequalities in health [ 4 , 5 , 6 ], or health and civic engagement where, for instance, increased well-being, physical health and mental health are associated with increased civic engagement [ 8 ], and that poor health earlier in life is associated with lower levels of civic engagement during the latter years of life [ 9 , 10 ], thus examining equity through a narrow lens. To understand the complex drivers of equity, research must look at the connections among three important areas of equity: health, wealth, and civic engagement. We suggested one approach to doing so with our structural equation model. We found significant covariance between our wealth and civic engagement constructs. Associations between our wealth and health constructs were also significant, tying together our tri-focal equity domains, and they were consistent with recent research, indicating that associations among these domains may be bidirectional. As noted by Knapp and Wong, for instance, adverse mental health harms individuals’ economic circumstances, and poverty contributes to adverse mental health [ 7 ].

Our findings are consistent with those in the literature relating two domains at a time. For example, we observed significant associations between indicators of wealth and health in the SEM and in the bivariate regression analyses. Similarly, others have found that adults who have lower levels of income are almost five times as likely to report being in fair or poor health as adults with family incomes at or above 400% of the federal poverty level (Braveman & Egerter, 2008). When looking at life expectancy, the gap between rich and poor Americans has been widening since the 1970s [ 5 ] with the wealthiest 1% living 10–15 years longer than the poorest 1% of the population [ 4 ].

In support of our observations that health and civic engagement constructs were associated, and considerable previous research suggests that bidirectional relationships may exist. Engaging in various forms of civic life including voting, activism, community organizing, and direct community service provides an avenue for social change and is associated with positive health outcomes [ 45 ]. And conversely, prior studies suggest that increased well-being, physical health and mental health are associated with increased civic engagement [ 8 ]. While the ability to participate in civic life and its salutary effects on health may vary among people with different chronic conditions [ 46 , 47 ], positive associations hold across different types of engagement (e.g., voting, volunteering) [ 8 ]. Understanding health status is crucial to understanding who participates in civic action. For example, the few longitudinal analyses that have been conducted on this topic suggest that poor health earlier in life is associated with lower levels of civic engagement later in life [ 9 , 10 ].

Finally, we observed significant correlations between measures of wealth and civic engagement suggesting that a full understanding of the drivers for equity needs to consider both of these domains. Others have observed that these associations have persisted, and increased, over time. Declining trends in volunteering and associational membership in the United States, for instance, are associated with higher rates of income inequality (Costa & Kahn, 2003 [ 12 ]), and Lim [ 48 ] suggests that economic inequality negatively impacts civic engagement. In addition, other forms of social capital, such as trust, are strongly and negatively affected by income inequality, which in turn lowers rates of community participation [ 14 , 15 ]. Further, considering the wealth and civic engagement domains, and consistent with our findings, researchers have consistently found associations between wealth and social class, and civic engagement behaviors [ 11 ]. Americans impacted by income inequality are also less likely to participate in other forms of community engagement such as recreational, civic, and educational groups [ 13 ].

Limitations

Our findings should be considered in light of several limitations. The cross-sectional nature of our survey precludes assessment of causal associations. The SEM provided one illustrative example of how indicators of health, wealth, and civic engagement may relate, but should not be construed as the only or the most comprehensive way to capture the complex interrelationships among the three domains. Additionally, while racial/ethnic groups were sampled in proportion to their national distribution, some groups (Blacks and Latinos) had a lower survey completion rate, and thus are slightly underrepresented in the unweighted data. However, our data are weighted back to population dynamics in the U.S. Given the nature of the KnowledgePanel data, some core measures were collected prior to our equity-based survey, and some explanatory measures may have changed during the timeframe between the administration of the Ipsos profile surveys and the Tufts equity survey. In addition, not all of our measures were standardized or validated measures. Sampling bias is also possible for some of our measures as our sample was weighted on typical demographic measures but not on behavioral measures (e.g., smoking).

Despite these limitations, our study has several strengths. We employed a probability-based weighting approach, which further enhanced the external validity of our results. Ipsos’ Knowledge Panel recruitment methodology uses the same or similar quality standards as mandated by the Office of Management and Budget in the “List of Standards for Statistical Surveys,” which indicates that “Agencies must develop a survey design, including…selecting samples using generally accepted statistical methods (e.g., probabilistic methods that can provide estimates of sampling error)” [ 49 ]. Our survey was timely during the pandemic and the concurrent Black Lives Matter movement. Further, our proposed conceptual model is empirically supported by our data and analyses. We look forward to building upon this model to explore the multi-level and nuanced components of equity across the U.S. in the months and years to come as we add further waves of data collection. Additionally, a de-identified version of these data will be made available upon request to researchers who wish to explore different components of equity and associations that we have yet to explore. Exploration of some of the salient measures collected in our survey, as well as bivariate comparisons and visualizations of results are available at our public facing website ( https://equityresearch.tufts.edu/ ).

Through analyses of data from our cross-sectional survey designed to be representative of the U.S. population in 2020, we explored holistic connections across the domains of equity in health, wealth, and civic engagement. In our structural equation and regression models, we identified three-way relationships between these domains, consistent with the hypothesized relationships in our conceptual model. Given empirical associations among measures of health, wealth and civic engagement, future research should holistically consider assessing all of these domains, using additional sophisticated approaches, in order to generate a more comprehensive understanding of health equity. Understanding the mechanisms that tie health, wealth, and civic engagement together would have important implications for the development of policies and programs aimed at achieving equity in communities across the globe. It will also help us shift the paradigm from documenting inequity to identifying targets for change.

Availability of data and materials

A de-identified version of these data will be made available upon request to researchers who wish to explore different components of equity and associations that we have yet to explore. Exploration of some of the salient measures collected in our survey, as well as bivariate comparisons and visualizations of results, are available at our public facing website ( https://equityresearch.tufts.edu/ ).

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Acknowledgements

We wish to thank Kevin Lane and Keith Spangler for providing access to community-level environmental and sociodemographic data that we linked to our survey. We wish to thank Ric Bayly for assistance with literature reviews and feedback on an earlier version of this manuscript.

Thomas Stopka was supported by the by the Tufts University/Tufts Medical Center COVID-19 Rapid Response Seed Funding Program. Thomas Stopka, Peter Levine, and Jennifer Allen were supported by the Tufts University Office of the Vice Provost of Research for the equity priority research group. Laura Corlin was supported by K12HD092535 and by the Tufts University/Tufts Medical Center COVID-19 Rapid Response Seed Funding Program. Wenhui Feng was supported by the Tufts Data Intensive Study Center (DISC) SEED grant.

This work represents the perspectives of the authorship team. The study funders had no involvement in the research, writing, or decision to publish.

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TS led the study, including conceptualization and implementation. WS and LC performed the statistical analyses and helped interpret the data. PL contributed to the conceptual design and the civic engagement measures and interpretation. JA assisted with overall study design interpretation of results. JM assisted with development of the discrimination measures and interpretation. All authors read and approved the final manuscript.

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Supplementary Information

Additional file 1: supplemental table 1..

Discrimination experiences in the U.S., 2020 ( n  = 1267).

Additional file 2: Supplemental Table 2.

Structural equation model output.

Additional file 3: Supplemental Table 3.

Bivariate logistic regression associations between structural equation model variables and self-reported physical health.

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Stopka, T.J., Feng, W., Corlin, L. et al. Assessing equity in health, wealth, and civic engagement: a nationally representative survey, United States, 2020. Int J Equity Health 21 , 12 (2022). https://doi.org/10.1186/s12939-021-01609-w

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Health Is Wealth Essay for Students and Children

500+ words health is wealth essay.

Growing up you might have heard the term ‘Health is Wealth’, but its essential meaning is still not clear to most people. Generally, people confuse good health with being free of any kind of illness. While it may be part of the case, it is not entirely what good health is all about. In other words, to lead a healthy life , a person must be fit and fine both physically and mentally. For instance, if you are constantly eating junk food yet you do not have any disease, it does not make you healthy. You are not consuming healthy food which naturally means you are not healthy, just surviving. Therefore, to actually live and not merely survive, you need to have the basic essentials that make up for a healthy lifestyle.

Introduction

Life is about striking a balance between certain fundamental parts of life. Health is one of these aspects. We value health in the same way that we value time once we have lost it. We cannot rewind time, but the good news is that we can regain health with some effort. A person in good physical and mental health may appreciate the world to the fullest and meet life’s problems with ease and comfort. Health is riches implies that health is a priceless asset rather than money or ownership of material possessions. There is no point in having money if you don’t have good health.

Key Elements Of A Healthy Lifestyle

If you wish to acquire a healthy lifestyle, you will certainly have to make some changes in your life. Maintaining a healthy lifestyle demands consistent habits and disciplined life. There are various good habits that you can adopt like exercising regularly which will maintain your physical fitness. It also affects your mental health as when your appearance enhances, your confidence will automatically get boosted.

To live a healthy life, one must make some lifestyle modifications. These modifications can include changes to your food habits, sleeping routines, and lifestyle. You should eat a well-balanced, nutrient-dense diet for your physical wellness.

Further, it will prevent obesity and help you burn out extra fat from your body. After that, a balanced diet is of great importance. When you intake appropriate amounts of nutrition, vitamins, proteins, calories and more, your immune system will strengthen. This will, in turn, help you fight off diseases powerfully resulting in a disease-free life.

Above all, cleanliness plays a significant role in maintaining a healthy lifestyle. Your balanced diet and regular exercise will be completely useless if you live in an unhealthy environment. One must always maintain cleanliness in their surroundings so as to avoid the risk of catching communicable diseases.

Get the huge list of more than 500 Essay Topics and Ideas

Benefits Of A Healthy Lifestyle

As it is clear by now, good health is a luxury which everyone wants but some of them cannot afford. This point itself states the importance of a healthy lifestyle. When a person leads a healthy lifestyle, he/she will be free from the tension of seeking medical attention every now and then.

On the contrary, if you have poor health, you will usually spend your time in a hospital and the bills will take away your mental peace. Therefore, a healthy lifestyle means you will be able to enjoy your life freely. Similarly, when you have a relaxed mind at all times, you will be able to keep your loved ones happy. A healthy individual is more likely to fulfil all of his goals because he can easily focus on them and has the energy to complete them. This is why the proverb “Health is Wealth” carries so much weight.

A socially healthy individual is one who is able to interact effectively and readily connect with others. Without his ego, he can easily blend with the person in front of him, exuding a nice feeling and energy.

Every human being should participate in sports and activities to get away from the monotony of daily life. It is because sports and games assist in instilling a sense of oneness in people, build leadership skills, and make a person absolutely disciplined.

Moreover, a healthy lifestyle will push you to do better in life and motivate you to achieve higher targets. It usually happens that people who are extremely wealthy in terms of money often lack good health. This just proves that all the riches in the world will do you no good if there is an absence of a healthy lifestyle.

In short, healthy life is the highest blessing that must not be taken for granted. It is truly the source of all happiness. Money may buy you all the luxuries in the world but it cannot buy you good health. You are solely responsible for that, so for your well-being and happiness, it is better to switch to a healthy lifestyle.

Good Health for Children

Childhood is an ideal period to inculcate healthy behaviours in children. Children’s health is determined by a variety of factors, including diet, hydration, sleep schedule, hygiene, family time, doctor visits, and physical exercise. Following are a few key points and health tips that parents should remember for their children:

• Never allow your children to get by without nutritious food. Fruits and vegetables are essential.
• Breakfast is the most important meal of the day, therefore teach them to frequently wash their hands and feet.
• Sleep is essential for your child.
• Make it a habit for them to drink plenty of water.
• Encourage physical activity and sports.
• Allow them enough time to sleep.
• It is critical to visit the doctor on a regular basis for checks.

Parents frequently focus solely on their children’s physical requirements. They dress up their children’s wounds and injuries and provide them with good food. However, they frequently fail to detect their child’s deteriorating mental health. This is because they do not believe that mental health is important.

Few Lines on Health is Wealth Essay for Students

• A state of physical, mental, emotional, and social well-being is referred to as health. And all of this is linked to one another.
• Stress, worry, and tension are the leading causes of illness and disease in today’s world. When these three factors are present for an extended period of time, they can result in a variety of mental difficulties, which can lead to physical and emotional illnesses. As a result, taking care of your own health is critical.
• Unhealthy food or contaminated water, packed and processed food and beverages, unsanitary living conditions, not getting enough sleep, and a lack of physical activity are some of the other primary causes of health deterioration.
• A well-balanced diet combined with adequate exercise and hygienic habits, as well as a clean environment, can enhance immunity and equip a person to fight most diseases.
• A healthy body and mind are capable of achieving things that a sick body and mind are incapable of achieving, including happiness.
• It is also vital to seek medical and professional assistance when necessary because health is our most valuable asset.
• Activities such as playing an instrument, playing games, or reading provide the brain with the required exercise it requires to improve health.

Maintaining healthy behaviours improves one’s outlook on life and contributes to longevity as well as success.

Frequently Asked Questions

Question 1: What are the basic essentials of a healthy life? Answer: A healthy life requires regular exercise, a balanced diet, a clean environment, and good habits.

Question 2: How can a healthy life be beneficial? Answer: A healthy lifestyle can benefit you in various ways. You will lead a happier life free from any type of disease. Moreover, it will also enhance your state of mind.

Question 3: When is World Health Day celebrated?

Answer: Since 1950, World Health Day has been observed on the 7th of April by the World Health Organization (WHO), after a decision made at the first Health Assembly in 1948. It is observed to raise awareness about people’s overall health and well-being around the world.

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The deep connection between your health and wealth.

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Founder and CEO of  deVere Group .

“When health is absent ... wealth becomes useless,” the ancient Greek physician Herophilus once famously said. That might have been the case 2,300 or so years ago, but it’s a doctrine I live by today, specifically noting the benefits of regular checks for both your health and your wealth.

Every day, as an organization, we speak with individuals about building and safeguarding their money. But in my view, there is little use in accumulating wealth if you don’t have your health so that you and your loved ones can enjoy it.

The condition of your own health and wealth can be reviewed, analyzed and revised with a three-pronged approach. First, have your health and wealth assessed annually, at least, by experts. Second, ensure that you have the right professional offering the advice to you. And third, take action based on the advice you receive. This third point is arguably the most critical.

An academic study by researchers at the Urban Institute and Virginia Commonwealth University assessing the intricate connection between health and income backs up the approach. The main takeaway of the report published in 2015 is, in simple terms, that those who are healthier and who live longer tend to earn more. Health and income correlate across the socioeconomic spectrum. That is to say, the richest have fewer poor-health conditions than the upper-middle class, who in turn are fitter and healthier than the lower-middle class, for example, with the pattern continuing.

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The report took an in-depth look into health issues for which the Centers for Disease Control and Prevention (CDC) in the U.S. had noted by household income. In the vast majority of instances, the wealthier were healthier.

The BMJ has also reported on the connection between health and wealth.

The basics for creating a healthier lifestyle are widely accepted and known to many people. They include eating the right foods for your body, cutting out or limiting sugar, exercising regularly, not smoking or taking illegal drugs, limiting alcohol consumption, getting plenty of sleep and avoiding stressful situations.

The steps for devising, implementing and managing financial planning strategies are, arguably, not quite as simple due to the personal circumstances of each individual. That said, I believe there are some irrefutable cornerstones in this regard, too.

Savings are a fundamental part of a robust personal financial plan. By building a savings safety net, you will be able to financially meet the costs of unforeseeable emergencies without having to increase credit card debt, ask for loans from relatives or friends, or turn to other borrowing options that serve to increase unnecessary and avoidable hassle.

Growing and protecting your retirement income is also a critical pillar. Preparing sooner rather than later for your retirement positions you to achieve your objectives more quickly and more effectively so you can enjoy the retirement you desire. This is particularly the case because life expectancy has been increasing globally, meaning the money we put aside has to last longer. Additionally, in the future, governmental agencies and company pension schemes may not be financially able to support older people like they have for previous generations. There is also a burgeoning health and social care crisis.

In addition, investing some of your savings is recommended. A failure to do so can mean that inflation will erode your purchasing power in the long term. Tax efficiency should be prioritized, too, by making use of legitimate solutions, reliefs, initiatives and schemes. And finally, insurance, including life and critical illness, is another fundamental that will help protect what is precious to you for yourself and your loved ones.

The connection between health and wealth is deep, and it is therefore important to create and roll out strategies to manage both so you can truly enjoy life-enhancing benefits and opportunities.

The information provided here is not investment, tax or financial advice. You should consult with a licensed professional for advice concerning your specific situation.

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Health and Wealth

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Introduction Background Inequalities Breed Ill-health Ill-Health Breeds Economic Instability Inequalities Breed Stress The Way Out References

There is abundant proof that money does buy better healthcare, better health, and a longer life. On the other hand, good health is linked to the ability to create wealth, as well. Thus, there are strong links between several health indicators over the average life span of individuals and their available income.

Image Credit: Monster Ztudio/Shutterstock.com

Scientists have already summed up the results of multiple studies to show that wealthier people live longer, have less chronic disease, and maintain a higher level of function well into their old age. Reduced death rates, a longer life expectancy, and a lower risk of lifestyle conditions modified by income, such as obesity, smoking, hypertension, and asthma, are all concomitant benefits of having a high disposable income.

This is explainable in terms of the better living conditions available for the wealthy, coupled with better preventive and therapeutic healthcare, which means they do not become as seriously ill or remain so for as long as those who are poorer. Disability or chronic ill health resulting from such conditions may dog a person throughout life.

The effects of poor healthcare due to poverty and social inequalities may extend across generations to affect the unborn and children. For instance, a lack of vaccinations may leave the unborn prone to teratogenic infections such as rubella and measles. Malnutrition during pregnancy may cause low birth weight and developmental defects.

Similarly, maternal deaths may be higher for a lack of access to affordable quality healthcare. Increased spending on healthcare means less money for other expenses, reduced savings, and thus a state of unpreparedness for health and other emergencies. Poor health also reduces productivity, reduces earning capacity, impacts learning, and reduces emotional well-being.

Among high-income countries, American men and women live for an average of 76 and 81 years, respectively. Since they have the highest rates of injury and disease globally, their old age is medically and financially demanding. Interestingly, despite high incomes, Americans have high rates of homicides, vehicle accidents, sexually transmitted diseases, obesity and diabetes, alcohol- and drug-related deaths, lung disease, cardiovascular disease, and disabling autoimmune and joint diseases.

Inequalities Breed Ill-health

Social inequalities form a powerful weapon in keeping the poor in that condition, even while helping the rich get richer. It is noticeable that the disparity between the rich and the poor has become glaringly apparent in the USA. Poor households with negative or no wealth make up over a fifth of all households, according to 2016 data, which leaves them without resources in case of unemployment, an unexpected illness, or other expenses.

With healthcare being costly, many Americans lack insurance. Even so, lack of healthcare is responsible for one in ten deaths before the expected lifespan. The problems mentioned above cause the remaining premature deaths among poor Americans. Poorer adults are likely to have hypertension, obesity, infectious conditions, heart disease, and psychiatric illness.

Poverty is intimately linked to discrimination and systemic racism, that account for much of the difficulty experienced by the not-wealthy. For instance, poor or minority neighborhoods receive less investment and have lower property prices. The residents find it almost impossible to access bank loans and are at much higher risk of being unfairly suspected or treated by the police and judicial system.

Health inequalities are related to differences in the rates of various conditions like asthma, diabetes, obesity, and cancer, as well as of societal ills like violence, drug abuse, and alcoholism; to differences in the healthcare available to different groups and ethnicities; and differences in the healthcare insurance available. As a result, the poorest US counties have a life expectancy as much as three decades lower than those in the richest – a striking illustration that shows how near the poor in America are to the unhealthiest populations in the world.

Image Credit: Irina Strelnikova/Shutterstock.com

Ill-Health Breeds Economic Instability

Much literature shows that ill-health causes a direct impairment of the ability to work and earn, both for the worker and the related family, to act as consumers and participate in leisure activities. Indirect costs are also high, with reduced work productivity (“presenteeism”), absence from work (absenteeism), and early retirement or non-employment due to illness with debilitating conditions.

One dramatic illustration is the 40% cost of sustaining a person with multiple sclerosis that comes simply because of lost productivity because the person can no longer work.

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Another huge indirect cost is the need for caregivers for the sick, who may be unable to attend work as a result or may be less productive when at work.

Inequalities Breed Stress

Social inequalities, seen most sharply in the US among all developed countries, appear to be an independent factor that reduces life expectancy, overall health, and well-being, despite a higher income. Studies show that “ people in more egalitarian societies live longer, experience less violence, have lower rates of obesity and teen pregnancy, are less likely to use illicit drugs and enjoy better mental health than their counterparts in countries with a wide divide between rich and poor .”

Stress is a powerful weapon and is equally experienced by the rich and poor. The effects of social inequality, seen most sharply in the US, are mediated via chronic stress, which exerts a deleterious effect on the heart, blood vessels, immune responses, and brain.

In addition to the physical aspects of poverty, which can be seen, even the rich suffer from chronic performance anxiety, demands to keep up appearances and increase their wealth through fierce and unending competition, and loss of trust. Inevitably, such a society breaks down due to the impassable barriers of suspicion and mistrust between the people who make up the community.

Concerning children’s health, less unequal societies are notable for higher rates of childhood immunization, accidental deaths among children, lower rates of addiction to tobacco and alcohol, and higher rates of educational achievement.

Image Credit: Prazis Images/Shutterstock.com

The Way Out

According to social scientists, policies to reduce inequality are health- and wealth-producing policies. Entrenched commercial interests that market foods and products that foster ill-health must be fought and removed from decision-making areas at the top. This is unlikely to happen anywhere in the world, however, which means that individuals and communities must take their health and wealth into their own hands.

Thus, multipronged interventions will be necessary. Small Steps to Health and Wealth is one stepped program that provides life coaching for poor and/or sick people to help them change their habits to fit their long-term goals.

People should also take charge of their health as far as possible, with ongoing maintenance, regular scheduled check-ups, and building good habits. The same goes for wealth creation, especially since a longer lifespan implies the need to build enough capital to last one’s life.

Public attitudes to health and wealth are underpinned by public knowledge of what drives these entities. In turn, public attitudes drive public behavior. Behavior is one area that psychologists can help change, and their skills should be harnessed to drive healthy and productive behavior.

The situation that favors the creation and perpetuation of economic disparities can be corrected only by advancing wealth to invest among those who have been disadvantaged by all these factors, allowing them to move forward by providing opportunities in education, banking, the police, and justice systems, housing and including their input while framing policies.

Microloans for small businesses, help to rent better houses in better neighborhoods, or to buy their own homes, helping adults gain insight into financial management, coaching to help achieve specific goals and assistance with getting a minimum wage adequate to live a decent lifestyle while simultaneously providing assistance to climb the ladder where appropriate via on-the-job training.

Focusing on children is a highly effective strategy since it ensures a good start for each individual and has the most long-term ramifications of all. This includes universal quality prenatal care, early education with all kids entitled to attend good preschools, and improving the educational system to achieve high academic and learning skills. The classrooms are also the fertile ground where educators can instill healthy attitudes and behaviors that promote diligence and creativity.

Along with equalizing healthcare access, the quality of care given to the poor needs to improve. The most important thing is to target opportunities to promote health since this occurs earlier in the course of events rather than focusing on outcomes alone.

Better treatment for the sick would keep caregivers at work for a longer time, thus increasing overall revenues. Proper distribution of economic growth by investing in public services would benefit the poor and take the strain on safety-net services.

References:

• Braveman, P. et al. (2018). Wealth Matters for Health Equity. https://www.rwjf.org/en/library/research/2018/09/wealth-matters-for-health-equity.html
• Weir, K. (2013). Closing the Health-Wealth Gap. https://www.apa.org/monitor/2013/10/health-wealth
• Small Steps to Health and Wealth™. https://njaes.rutgers.edu/sshw/internal/
• Garau, M. et al. (2015). Is The Link Between Health and Wealth Considered in Decision Making? Results From A Qualitative Study. International Journal of Technology Assessment in Health Care . https://dx.doi.org/10.1017%2FS0266462315000616 . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824956/

Further Reading

• All Healthcare Content
• The Concept of Human Health and Disease
• Medical Ethics and Health Policy
• Proactive Health: The Shift Towards Preventative Healthcare
• Role of Real-Time Data in Healthcare

Last Updated: May 31, 2022

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

Please use one of the following formats to cite this article in your essay, paper or report:

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Health and Wealth

Simon szreter | 07 november 2005.

Executive Summary

• Hindsight: contemporary international policies to promote economic growth and development are too often premised on a view of the past distorted by hindsight and unwitting present-centredness.
• Disruption: history teaches that economic growth is a profoundly disruptive and uncertain process, particularly with respect to population health.
• Information: essential public-health intelligence and even the registration of individual identities is lacking in many poor countries today, unlike in the European past.
• Social security: a system is lacking in most poor countries, yet the English Poor Law was crucial in facilitating development in the world's first industrial nation.
• Democracy: the relationship between democratisation and development is not straightforward. Healthy democracies need representative, independent local government, balanced by national, central government, not just votes for all.
• Social capital: the diverse and changing structures of relationships of trust and respect in society have great influence over all forms of policy implementation.
• Time: history teaches respect for thinking with appropriate units of time. Development processes occur in generations- quarter and half centuries- not annual accounting units or 5-year electoral cycles.

History and Policy: the historicist perspective

As its title indicates Health and Wealth. Studies in History and Policy (H&W) is a volume of essays intended to exemplify the purpose of the History and Policy website and the new History and Policy unit established at the Centre for Contemporary British History. H&W demonstrates how history can be deployed extensively to re-think major topics in the social and policy sciences concerning economic change and health.

The chapters of H&W present a series of revisionist historical articles published since 1988 on mortality change in Britain during the last three centuries. These chapters challenge orthodox and conventional social and policy-science views of the processes that govern the relationship between modern economic change and population health. By providing distinctive historicist perspectives, they also suggest a number of positive alternatives for contemporary development and public-health policies, which will be summarised here.

The historicist perspective in H&W seeks to avoid the fore-shortening and 'straightening-out' of time through the distorting lens of hindsight. This is one of the characteristic flaws of the contemporary social sciences in their attitude towards the past. History is too frequently seen merely as the sign-posted path to the present, as if everybody in the past (or the most important and progressive elements) somehow knew that they were headed towards the society and economy which we currently inhabit. According to this viewpoint, the only real question is how long did they take to get here? How fast was the rate of economic growth in different periods and what interfered with it or promoted it? When did our society pass through the different stages of the demographic transition to arrive in modernity? The first and cardinal point to emerge from adopting an historicist perspective is to recover the prospective indeterminacy of the past.

The people who populated the past did not know where they were going, just as we cannot predict with any confidence at all what kind of society or economy our grandchildren will inhabit in a hundred years' time. Like us, people in the past had dreams and ideals, fears and aspirations, but they certainly were not the same as ours and they were mostly to do with the next year, five years or ten years ahead of them.

Economic change, disruption and uncertainty

Most of the articles in Health and Wealth explore the history of demographic change in Britain during and after the industrial revolution, c. 1750-1914. The first insight to emerge from adopting an historicist perspective is that the economic growth occurring in Britain during this period was intensively and extensively disruptive. It is argued in H&W that this is an important general characteristic of 'successful' national economic growth almost everywhere that it occurs. Societies, governments and international NGOs working today to promote economic growth in the world's many poorer countries frequently fail to appreciate that the very goal which they are striving to bring about, and which would count for them as an index of their success- consistently rising rates of growth of national income- will bring with it a wide range of profoundly de-stabilising forces. It is not just absence of economic growth that can be a problem: its presence will also cause numerous difficulties, though they will be different ones.

Widespread poverty, lack of opportunity for whole sections of society such as women and children, and the pain and loss of emigration may characterise life in societies lacking economic growth. However, the first and greatest economic 'success' story of all, the industrial revolution in Britain, also shows that the achievement of economic growth in such societies will exacerbate migration rates from some regions still further; cause local or even regional-scale environmental hazards, such as water shortages, occupational diseases and air pollution; and will divide communities, families, and generations as relative values of assets are altered and some adopt new ideals and models of behaviour, while others cleave to established norms. Changing economic fortunes for some will also produce intense political uncertainty and turmoil in a social landscape where there are frequently as many who perceive themselves to be directly disadvantaged and their conditions of life threatened by economic change.

The counsel of history is not, however, the Luddite one of rejecting the goal of economic growth as not worth the trouble. Human aspirations to escape material poverty and to pursue self-fulfilment are valid and, apart from ascetics, universal; they both entail the desirability of economic growth. The purpose and value of arming oneself with a thoroughly historicist understanding of the difficulties involved in taking this crooked path is precisely to make it possible to negotiate effectively the bewildering and un-signposted road ahead, fore-warned with a more realistic set of general expectations about the chaos and disruptions that must be faced.

The orthodox social-science and development models tend not to portray such a picture of an intrinsically disruptive process. This is for the simple reason that they are not constructed to do so. Part One of H&W deploys the methods of historical enquiry to show how some of the most influential social-science models in the post-war era, such as the theory of demographic transition and the 'Mckeown' thesis of nutritional improvements driving mortality decline, were developed and deployed to provide reasoned support for selective policy goals. They were constructed teleologically as guides to positive action in the present and the future, utilising selective accounts of historical change to show that history had apparently moved in the manner, which, they were advocating, should now be followed.

A genuinely historicist account does not portray such perfectly accomplished teleology. Historical research more typically uncovers false starts, paths taken then abandoned, unintended consequences, conflicts, uncertainties and plain old-fashioned mistakes. However, the fact that the historical path is so crooked and pot-holed that nobody in their right mind would want directly to attempt to emulate it does not mean that there can be no helpful advice to be gleaned from the study of history. Indeed, it is in order not to repeat in ignorance all the follies of the past that one can usefully study history. For instance, one such helpful piece of historicist advice is to be prepared for a rough and dangerous ride in a society embarked on the experience of rapid economic growth, especially if this is for the first time in its history. A second general piece of advice is that the civic and political institutions a country possesses at the outset will be extremely important in influencing just how rough the ride can get; and they will have to adapt to change more rapidly than can often be easily achieved.

Both these pieces of historicist advice have very direct, practical policy implications, namely that just as much attention needs to be paid by those in government or by international NGOs to the form, vigour and adaptability of crucial civic and political institutions, as to the openness of the economy and its financial institutions or to the state of schools, roads and hospitals. They should be prepared in advance to cope with the eventuality that rising per capita national income will very probably be accompanied by social disruptions and health problems, so as not to be disagreeably taken by surprise once economic 'success' begins to exert these influences.

The chapters in Part Two of H&W investigate how and where such disruptive problems were precisely manifest in British history. It finds that among the English population there were grossly adverse health and mortality consequences of rapid economic growth. These were in fact concentrated among the urban proletariat in precisely the same locations where the new industrial wealth was being generated, the factory cities. Immigrants from both the rural hinterland and from Ireland (even before the famine added extra impetus) came to find work and higher wage rates; but equally frequently they and their wives and children also found higher death rates.

The importance of public-health information: vital statistics

Unlike many of the poorest nations in the world today, the English, by the beginning of the 1840s, did at least possess a sophisticated public-health intelligence system and these high urban death rates were increasingly analysed and denounced as 'preventable' by the government's own officials. One of the many important, albeit conditional, lessons of British history in the nineteenth century is that authoritative, universal and high quality public-health information is a necessary- but, alas, not sufficient- item of institutional machinery, which societies require in order to be able to address the epidemiological problems which economic growth, trade and increasing density of urban settlement inevitably produce. A comprehensive public-health information system is not a high priority among many of today's least developed nations and it is a great disadvantage which they labour under, neither knowing where and whom their worst health problems afflict, nor whether any remedial measures are truly taking effect.

H&W is able to show that, through the effective public-health propaganda machine of the General Register Office, the Victorian urban, middle and upper classes were never under any illusions as to the unhealthy state of their towns, even during the periods of relative respite between cholera visitations. By the 1830s and 1840s mortality was probably higher in most industrial towns than it had been at any point in the previous 100 years of their development. Since we can be sure that the Victorians were not simply ignorant of their predicament, this helps to identify other factors which prevented them from acting on this knowledge. It was not all towns, but especially those where the new industrial and commercial wealth was being made, which were especially unhealthy. Furthermore, health in such towns distinctly deteriorated in the 1830s and 1840s as diseases such as smallpox, almost eliminated two decades previously by vaccination, returned; and others, such as cholera, struck for the first time.

'Democratisation': not a simple panacea

The thesis developed in Part Two of Health and Wealth is that all manufacturing cities, such as Glasgow, Manchester and Liverpool, but also smaller ones such as Carlisle, Warrington or West Bromwich, became politically and administratively hamstrung for over half a century from the end of the Napoleonic Wars. This happened because of the unintended consequences of partial, 'democratic' reform of the polity. In common with the 1832 'Great' parliamentary Reform Act, the 1835 Municipal Reform Act gave votes to moderate property holders. Town government passed out of the hands of a narrow wealthy oligarchy and into those of a 'shopocracy' of petty bourgeois ratepayers. The highly restricted borrowing powers of urban corporations were already the source of serious problems, preventing these fast-growing towns from undertaking costly sanitary and environmental infrastructure projects: resulting, for instance, in the water supplies often being sold to private companies in the forlorn hope that they would make improvements to capacity, which the town's authorities were statutorily unable to undertake. For a whole further generation after 1835, while Britain's industrial towns expanded into crowded cities, their petty capitalist ratepayers refused to vote for anything except policies of do-nothing 'economy'.

Central government tried to force their hands with the 1848 Public Health Act but this was largely rebuffed. Borrowing and expenditure statistics clearly show that British cities did not really begin to invest in the expensive sanitary works which the 1848 Act hoped to encourage until the 1870s, when their electorates began to express support for such measures. This did not happen until after the municipal electorates were substantially extended in 1869. At that point a new generation of urban neo-patricians, led by the industrial magnate Joseph Chamberlain in Birmingham, realised that it was now possible to appeal with a municipal spending programme over the heads of the petty bourgeois to the non-rate-paying but voting working class. The largest employers and their workers both stood to benefit substantially from collective expenditure on the urban environment, which would boost the health and productivity of the workforces, while the petty bourgeoisie were now, finally, co-opted into helping to pay for it.

Although the exact course of historical events summarised here is specific to Britain in the nineteenth century and will never be precisely repeated again anywhere else, this does not mean there are not any generalisable policy lessons that can be drawn. In fact it is only by paying careful attention to this genuinely historicist version of British economic and demographic history- the crooked path of pitfalls, false turns and grubby local politics- that policy makers can learn anything they do not already know. The smoothly-surfaced high-road of models of historical change based on inspecting secular trends in national economic growth rates and aggregate demographic indices is, after all, merely a historical mirror reflecting back our own contemporary goals, wishes and assumptions.

There are, then, a number of specific but generalisable lessons about the relationship between economic change and population health, which can be gleaned from the historicist perspective on nineteenth-century British history, and these are elaborated in Part Three of H&W . These 'lessons' could be applied to societies undergoing rapid economic growth for the first time under political regimes that are at least moderately liberal and partially 'democratic', which probably covers most poor countries today, excluding those which are effectively one-party states or subject to dictatorial rule.

Firstly, the analysis in H&W demonstrates that the expansion of democracy per se under conditions of economic growth has no necessary beneficial health effects. Increasing degrees of 'democratisation' can have entirely diverse consequences. Careful attention must be paid to issues of representation, to the local details of franchise extensions and to the precise political means available for the opinion of the poor to be influenced and expressed (issues of public information media and party organisation). The interests of those who are given voting power and how this relates to those other sections of the population (children for instance in today's poor countries) who remain excluded cannot be ignored. Given the unavoidably expensive nature of maintaining- let alone improving- population health under the conditions of the large-scale urbanisation and migration which invariably accompany rapid economic growth, this can determine whether or not the political conditions exist at all for the required collective action to implement health-preserving technologies. In Britain the wrong kind of 'democratisation' of the national and urban electorates produced unbreakable political stalemate for a generation after the 1830s, while urban environments deteriorated and public health suffered.

Central and local government: a delicate balancing act

Secondly, H&W indicates that the exact relationship between central and local government may well be a crucial one. Imbalances of power in either direction may be counter-productive. Too much power and talent at the centre, as in Britain in the 1830s and 1840s, may result in a counter-productive, one-size-fits-all dictatorial style, undermining the vigour of provincial governments and only eliciting evasion or even rejection in the provinces of initiatives from the centre. Local representative and elected governments which are endowed with genuine independence, powers, status and resources, will very likely generate a competitive political forum across the nation of (literally) healthy rivalry among them. The centre may well be able to foster such productive competitiveness through a judicious policy of both financial and honorific carrots and sticks.

Relations between centre and periphery are probably optimal when characterised by a diplomatic and mutually respectful relationship based on genuine relative autonomy, rather than by relations of dependence (or complete independence), with the centre both prepared to learn from provincial innovations taken by energetic local authorities and to encourage and incentivise the spread of best practice where initiative is lacking. This characterised relations between central and local government in Britain over matters of health policy during the era of the Local Government Board, 1870-1919, when much was achieved in the improvement of the urban population's health.

The importance of public servants, professionalism and social capital

Thirdly, the effective delivery of health-preserving and enhancing services under the challenging conditions of rapid economic growth will require motivated bodies of trained and committed personnel at ground level. In British history this took the form of a combination of an expansion in long-standing religiously-motivated voluntary philanthropic organisations and the new growth of 'public service professions'. The latter were mainly employees of elected local governments, possessing specialist knowledge and training supervised by professional examining bodies (institutions licensed by the central state to exert independent and accountable control over an area of formal knowledge deemed to have direct, public importance). The generalisable point is the importance of creating a dutiful, committed, impartial and highly professional bureaucracy to serve elected local government, with rewards so scaled that professional talent does not leach away from the provinces to the centre.

Fourthly, H&W points to the manifold importance of 'social capital'. Social capital refers to the patterned structure of relationships which, often invisibly, criss-cross and structure society through the operation of networks and their associated norms. Social capital is a more general concept than 'civil society' because in principle it embraces all forms of networks, formal and informal, including nepotistic and 'hidden' ones - those which do not necessarily benefit the wider collectivity - as well as those which are more open, such as the many voluntary societies which exist to pursue harmless leisure activities or laudable, public aims. Social capital was significant in throwing up barriers to collective action by contributing to the mutually distrustful fissuring of British urban communities under the severe pressures of rapid growth during the first half of the nineteenth century. But social capital was also important in the changed context of the late 1860s and 1870s in enabling collective municipal action, providing both Chamberlain personally and the local Liberal party in the city of Birmingham with diverse means of communication and mobilisation to achieve electoral support for a new municipal politics of urban improvement and spending.

Social capital is also important in another way, in relation to the manner in which public-health and social services are delivered. Such services typically require extensive interaction between service providers and clients. Physical capital, facilities and medical science are of course also all involved, but maintaining or improving the health of whole urban populations which are having to adapt to the new environmental challenges thrown up by rapid economic growth requires much face-to-face interaction, especially between the poor, the displaced and the disoriented on the one hand, and various categories of officials and trained workers such as nurses and health visitors on the other. The quality of the human relationships characterising these interactions can be critical. The concept of linking social capital discussed in H&W emphasises how important are norms of respect governing this relationship, something which can be very difficult to achieve given the imbalance of power and expertise between professional and client in these circumstances. It is too easy for the possession of superior knowledge to become a stick with which to beat the poor. The vital ethos of professionalism in the public services has to include genuine respect for those with whom it works.

Systems of social security: a neglected lesson of history

Fifthly, there is the enormous significance in all polities of social security systems. At the minimum this is provided universally by kin and neighbours. Wider resources and agencies are, however, typically also involved in most societies, such as religious, philanthropic and mutual self-help organisations. Most economic, social, medical and policy scientists and NGOs operating in the 'development' field would assume that nationally-organised, government-based, official social-security systems are historically a relatively recent addition, famously innovated by Bismarck in the new German Empire in the 1880s, developed more extensively by Denmark and Sweden in the twentieth century and achieving their most developed form as 'the welfare states' of post-war western Europe. Such comprehensive social-security systems appear in this perspective to be the final fruits of decades of economic growth; and there are many economists who have serious reservations about their consequences for the vigour of national economies- doubts which have arguably prevented the USA from following the west European lead.

However, as the final chapter of H&W argues, a more thorough knowledge of British history transforms such assumptions about the historical relationship between national social-security systems and economic growth. Britain, the world's first and only example of self-induced rapid economic growth and industrialisation, possessed a fully-functional national statutory social-security system for two centuries before the industrial revolution. The Poor Laws, enacted in the reign of Elizabeth I, endowed the country with a uniquely comprehensive social-security system. Dutch historians have identified this as having given the British agrarian economy a crucial advantage in terms of the market flexibility and mobility of the primary factors of production, land, labour and capital. This was an important contributory factor enabling the British economy in the course of the seventeenth and eighteenth centuries to overtake the leader, Holland. Paradoxically the British 'free market' economy flourished as no other at the time because of the unparalleled strength not only of the central state in providing external military security and protecting the textile industries, but also because of the generous provision of domestic social security by the local state. The neo-liberal consensus that has emanated from the world's great financial institutions in Washington and New York for the last quarter century has been entirely ignorant of these lessons of history.

Identity and registration: back to the importance of information

A sixth lesson is the importance of civic-identity registration. This, like the social-security system, was another central-government-sponsored and locally-organised foundational element in the story of precocious economic and social development in England. The flowering of a widely-spread property-owning and property-disposing agrarian and commercial middle class of improving landowners, yeoman-farmers and merchants was a major feature of British agrarian capitalism. Access to a cheap and effective system for proving legal identity was as important for the smooth working of a society used to exchanging and inheriting property as it was for the smooth operation of the social-security system. For this aspect of British history to be emulated in today's poorer countries would require a government or World Bank-funded network of trustworthy and secure civil registers, proof from the possible abuse of such information by unscrupulous commercial or official agencies. Not easy to achieve. But without this, the citizens and would-be capitalists of poor countries are alike labouring under severe burdens of basic information deficits, like their public-health systems in the absence of public-health intelligence (something which in Britain's case was generated very economically as a by-product of its civil registration system).

The last lesson of history: the importance of time

Finally, an historical approach to studying economic and demographic change emphasises the importance of time. The social and policy sciences tend to have an unrealistic, almost frenetic conception of time. Policies are expected to demonstrate effects within a year or two. Partly the result of electoral cycles in democracies, five years is today considered a maximal time horizon by most governments or NGOs- ironically the same accounting unit envisaged by the proud and impatient planners of the USSR. But, being such a disruptive and chaotic process, economic growth and its evolving relationship with the environment and with population change and public health is a large-scale process, whose consequences tend to unfold in decadal and generational, rather than annual units of time. Policies designed to work at the appropriate scale and level themselves require to be conceptualised according to such time-scales.

Furthermore, as has been illustrated by the regionally-devastating HIV-AIDs pandemic of the last quarter century, when disruptive economic change does cause things to go wrong from a health point of view, it can be on a colossal scale, both temporally and geographically, with major economic consequences. It is questionable whether the world's international development institutions or the governments of poorer countries have ever truly understood this prime lesson of history. It was a wholly realistic assessment of the national insecurities and potential costs arising from such calamities, which was a part of the rationale behind the English state launching its pioneering, comprehensive social-security system in the sixteenth century, resulting in the historical fact that England achieved freedom from any famine-induced mortality well over a century before any other part of Europe. If this had been given the highest development policy priority, which history suggests it should have had during the last half-century, who can say how different the impact and cost of AIDs would have been? Would we have seen the recurring regional famines which are a blight on our age if the world's poorest countries had been encouraged instead to build for themselves a proper social-security system before being exposed to the necessary disruptions of the global economy?

• Szreter, Simon
• Medicine and public health
• Public services and social policy

Further Reading

Simon Szreter, Health and Wealth: Studies in History and Policy , Rochester Studies in Medical History (Rochester University Press 2005).

About the author

Simon Szreter is Reader in History and Policy, Faculty of History, University of Cambridge and Fellow of St John's College. With Alastair Reid, he is a founding editor of the History and Policy website. [email protected] .

Related Policy Papers

Democratisation: historical lessons from the british case, john garrard | 04 may 2004, a central role for local government the example of late victorian britain, simon szreter | 02 may 2002, papers by author, papers by theme, digital download.

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The University of Chicago The Law School

Innovation clinic—significant achievements for 2023-24.

The Innovation Clinic continued its track record of success during the 2023-2024 school year, facing unprecedented demand for our pro bono services as our reputation for providing high caliber transactional and regulatory representation spread. The overwhelming number of assistance requests we received from the University of Chicago, City of Chicago, and even national startup and venture capital communities enabled our students to cherry-pick the most interesting, pedagogically valuable assignments offered to them. Our focus on serving startups, rather than all small- to medium-sized businesses, and our specialization in the needs and considerations that these companies have, which differ substantially from the needs of more traditional small businesses, has proven to be a strong differentiator for the program both in terms of business development and prospective and current student interest, as has our further focus on tackling idiosyncratic, complex regulatory challenges for first-of-their kind startups. We are also beginning to enjoy more long-term relationships with clients who repeatedly engage us for multiple projects over the course of a year or more as their legal needs develop.

This year’s twelve students completed over twenty projects and represented clients in a very broad range of industries: mental health and wellbeing, content creation, medical education, biotech and drug discovery, chemistry, food and beverage, art, personal finance, renewable energy, fintech, consumer products and services, artificial intelligence (“AI”), and others. The matters that the students handled gave them an unparalleled view into the emerging companies and venture capital space, at a level of complexity and agency that most junior lawyers will not experience until several years into their careers.

Representative Engagements

While the Innovation Clinic’s engagements are highly confidential and cannot be described in detail, a high-level description of a representative sample of projects undertaken by the Innovation Clinic this year includes:

Transactional/Commercial Work

• A previous client developing a symptom-tracking wellness app for chronic disease sufferers engaged the Innovation Clinic again, this time to restructure its cap table by moving one founder’s interest in the company to a foreign holding company and subjecting the holding company to appropriate protections in favor of the startup.
• Another client with whom the Innovation Clinic had already worked several times engaged us for several new projects, including (1) restructuring their cap table and issuing equity to an additional, new founder, (2) drafting several different forms of license agreements that the company could use when generating content for the platform, covering situations in which the company would license existing content from other providers, jointly develop new content together with contractors or specialists that would then be jointly owned by all creators, or commission contractors to make content solely owned by the company, (3) drafting simple agreements for future equity (“Safes”) for the company to use in its seed stage fundraising round, and (4) drafting terms of service and a privacy policy for the platform.
• Yet another repeat client, an internet platform that supports independent artists by creating short films featuring the artists to promote their work and facilitates sales of the artists’ art through its platform, retained us this year to draft a form of independent contractor agreement that could be used when the company hires artists to be featured in content that the company’s Fortune 500 brand partners commission from the company, and to create capsule art collections that could be sold by these Fortune 500 brand partners in conjunction with the content promotion.
• We worked with a platform using AI to accelerate the Investigational New Drug (IND) approval and application process to draft a form of license agreement for use with its customers and an NDA for prospective investors.
• A novel personal finance platform for young, high-earning individuals engaged the Innovation Clinic to form an entity for the platform, including helping the founders to negotiate a deal among them with respect to roles and equity, terms that the equity would be subject to, and other post-incorporation matters, as well as to draft terms of service and a privacy policy for the platform.
• Students also formed an entity for a biotech therapeutics company founded by University of Chicago faculty members and an AI-powered legal billing management platform founded by University of Chicago students.
• A founder the Innovation Clinic had represented in connection with one venture engaged us on behalf of his other venture team to draft an equity incentive plan for the company as well as other required implementing documentation. His venture with which we previously worked also engaged us this year to draft Safes to be used with over twenty investors in a seed financing round.

More information regarding other types of transactional projects that we typically take on can be found here .

Regulatory Research and Advice

• A team of Innovation Clinic students invested a substantial portion of our regulatory time this year performing highly detailed and complicated research into public utilities laws of several states to advise a groundbreaking renewable energy technology company as to how its product might be regulated in these states and its clearest path to market. This project involved a review of not only the relevant state statutes but also an analysis of the interplay between state and federal statutes as it relates to public utilities law, the administrative codes of the relevant state executive branch agencies, and binding and non-binding administrative orders, decisions and guidance from such agencies in other contexts that could shed light on how such states would regulate this never-before-seen product that their laws clearly never contemplated could exist. The highly varied approach to utilities regulation in all states examined led to a nuanced set of analysis and recommendations for the client.
• In another significant research project, a separate team of Innovation Clinic students undertook a comprehensive review of all settlement orders and court decisions related to actions brought by the Consumer Financial Protection Bureau for violations of the prohibition on unfair, deceptive, or abusive acts and practices under the Consumer Financial Protection Act, as well as selected relevant settlement orders, court decisions, and other formal and informal guidance documents related to actions brought by the Federal Trade Commission for violations of the prohibition on unfair or deceptive acts or practices under Section 5 of the Federal Trade Commission Act, to assemble a playbook for a fintech company regarding compliance. This playbook, which distilled very complicated, voluminous legal decisions and concepts into a series of bullet points with clear, easy-to-follow rules and best practices, designed to be distributed to non-lawyers in many different facets of this business, covered all aspects of operations that could subject a company like this one to liability under the laws examined, including with respect to asset purchase transactions, marketing and consumer onboarding, usage of certain terms of art in advertising, disclosure requirements, fee structures, communications with customers, legal documentation requirements, customer service and support, debt collection practices, arrangements with third parties who act on the company’s behalf, and more.

Miscellaneous

• Last year’s students built upon the Innovation Clinic’s progress in shaping the rules promulgated by the Financial Crimes Enforcement Network (“FinCEN”) pursuant to the Corporate Transparency Act to create a client alert summarizing the final rule, its impact on startups, and what startups need to know in order to comply. When FinCEN issued additional guidance with respect to that final rule and changed portions of the final rule including timelines for compliance, this year’s students updated the alert, then distributed it to current and former clients to notify them of the need to comply. The final bulletin is available here .
• In furtherance of that work, additional Innovation Clinic students this year analyzed the impact of the final rule not just on the Innovation Clinic’s clients but also its impact on the Innovation Clinic, and how the Innovation Clinic should change its practices to ensure compliance and minimize risk to the Innovation Clinic. This also involved putting together a comprehensive filing guide for companies that are ready to file their certificates of incorporation to show them procedurally how to do so and explain the choices they must make during the filing process, so that the Innovation Clinic would not be involved in directing or controlling the filings and thus would not be considered a “company applicant” on any client’s Corporate Transparency Act filings with FinCEN.
• The Innovation Clinic also began producing thought leadership pieces regarding AI, leveraging our distinct and uniquely University of Chicago expertise in structuring early-stage companies and analyzing complex regulatory issues with a law and economics lens to add our voice to those speaking on this important topic. One student wrote about whether non-profits are really the most desirable form of entity for mitigating risks associated with AI development, and another team of students prepared an analysis of the EU’s AI Act, comparing it to the Executive Order on AI from President Biden, and recommended a path forward for an AI regulatory environment in the United States. Both pieces can be found here , with more to come!

Innovation Trek

Thanks to another generous gift from Douglas Clark, ’89, and managing partner of Wilson, Sonsini, Goodrich & Rosati, we were able to operationalize the second Innovation Trek over Spring Break 2024. The Innovation Trek provides University of Chicago Law School students with a rare opportunity to explore the innovation and venture capital ecosystem in its epicenter, Silicon Valley. The program enables participating students to learn from business and legal experts in a variety of different industries and roles within the ecosystem to see how the law and economics principles that students learn about in the classroom play out in the real world, and facilitates meaningful connections between alumni, students, and other speakers who are leaders in their fields. This year, we took twenty-three students (as opposed to twelve during the first Trek) and expanded the offering to include not just Innovation Clinic students but also interested students from our JD/MBA Program and Doctoroff Business Leadership Program. We also enjoyed four jam-packed days in Silicon Valley, expanding the trip from the two and a half days that we spent in the Bay Area during our 2022 Trek.

The substantive sessions of the Trek were varied and impactful, and enabled in no small part thanks to substantial contributions from numerous alumni of the Law School. Students were fortunate to visit Coinbase’s Mountain View headquarters to learn from legal leaders at the company on all things Coinbase, crypto, and in-house, Plug & Play Tech Center’s Sunnyvale location to learn more about its investment thesis and accelerator programming, and Google’s Moonshot Factory, X, where we heard from lawyers at a number of different Alphabet companies about their lives as in-house counsel and the varied roles that in-house lawyers can have. We were also hosted by Wilson, Sonsini, Goodrich & Rosati and Fenwick & West LLP where we held sessions featuring lawyers from those firms, alumni from within and outside of those firms, and non-lawyer industry experts on topics such as artificial intelligence, climate tech and renewables, intellectual property, biotech, investing in Silicon Valley, and growth stage companies, and general advice on career trajectories and strategies. We further held a young alumni roundtable, where our students got to speak with alumni who graduated in the past five years for intimate, candid discussions about life as junior associates. In total, our students heard from more than forty speakers, including over twenty University of Chicago alumni from various divisions.

The Trek didn’t stop with education, though. Throughout the week students also had the opportunity to network with speakers to learn more from them outside the confines of panel presentations and to grow their networks. We had a networking dinner with Kirkland & Ellis, a closing dinner with all Trek participants, and for the first time hosted an event for admitted students, Trek participants, and alumni to come together to share experiences and recruit the next generation of Law School students. Several speakers and students stayed in touch following the Trek, and this resulted not just in meaningful relationships but also in employment for some students who attended.

More information on the purposes of the Trek is available here , the full itinerary is available here , and one student participant’s story describing her reflections on and descriptions of her experience on the Trek is available here .

The Innovation Clinic is grateful to all of its clients for continuing to provide its students with challenging, high-quality legal work, and to the many alumni who engage with us for providing an irreplaceable client pipeline and for sharing their time and energy with our students. Our clients are breaking the mold and bringing innovations to market that will improve the lives of people around the world in numerous ways. We are glad to aid in their success in any way that we can. We look forward to another productive year in 2024-2025!