It’s officially flu season, and a good time of year to get serious about Vitamin C intake, getting enough sleep and extra handwashing. Behavior matters, of course, but Kentuckians’ ability to get through flu season without a minor illness turning into a major event is largely predicated on bigger picture issues. How well are we doing as a society on research, development and roll-out of prevention and treatment? How do structural racism and geographic barriers impact folks’ economic ability to detect and treat illness early? In the absence of a state policy, do employers provide paid leave so folks can stay home when they or a loved one are ill?
This season is also a time to begin looking toward the biennial state budget process, and on the ways budget choices impact upstream health issues, also known as “social determinants of health.” As with handwashing and the flu, personal choices impact Kentuckians’ wellness, but we tend to overestimate their importance and ignore, for instance, the huge opportunities we have through the state budget to invest in healthy communities. Clean water, safe and efficient transportation systems and good schools, for example, are building blocks of healthy and prosperous communities.
Research shows that just 30% of health outcomes are determined by a person’s behavior, while 40% are based on social and economic conditions, 20% on health care activities and 10% on environmental factors. In other words, whether folks are healthy depends a lot on things like being economically secure and having access to healthy food and high-quality childcare.
Kentucky’s Medicaid expansion was a big leap forward, supporting the “health activities” of more than 400,000 of us while increasing health and economic vitality for all of Kentucky. We need to protect those gains, and we also need to turn our attention to areas where we’re making far too little progress – the policies and systems that create thriving social and economic conditions, healthier environments and larger impacts on health outcomes.
For instance, people with more education generally have better health outcomes. They tend to be more economically secure and live in neighborhoods with fewer health risks. But Kentucky doesn’t provide universal preschool, we have deeply cut K-12 funding over the last decade, and higher education cuts have led to increased tuition and deepened the debt and stress that Kentuckians take on in order to get a degree. In fact, food and housing insecurity are common at our community colleges, which are supposed to be a more affordable option.
There are many areas where smarter budget policy choices could make us healthier. For instance:
- Our Child Care Assistance Program could do a better job ensuring all Kentuckians – of all races, across geographic areas and income levels – have access to high-quality childcare in a sustainable facility where people providing care are compensated fairly for their important work.
- Getting rid of long waiting lists for Aging and Independent Living programs like Meals on Wheels would mean more people could stay healthy and happy living at home.
- Investing state resources in drug treatment and supports for re-entry would help reduce incarceration and recidivism and keep individuals and families healthy.
- Providing state housing assistance could help bridge the wide gap between what the federal government provides and the lack of safe, affordable housing in Kentucky, especially for people facing structural barriers to housing security.
Because all of these investments cost money, our tax policy and our health are inextricably linked. To become healthier – both physically and economically – we must ask Kentuckians to chip in towards important investments based on their ability to pay, and end the bad habit of diverting state resources to special interests in the form of tax breaks. Undoing 2018’s income tax cuts for the wealthy and 2019’s big tax cut for banks would be a good place to start. Just a tiny fraction of these costly tax giveaways would be enough to restore clean drinking water to the residents of Martin County, for example.
When legislators come to Frankfort this January to craft a budget, we’ll all benefit if their policy choices reflect the opportunities we have in the budget to thrive together.
This column ran in the State Journal on Oct. 21, 2019.