Pass Medicare for All --and More.

AuthorThomhave, Kalena

Typically, when politicians discuss health policy, they're talking about health care policy. The fixation on health care is obvious and understandable: We know that the United States spends more on health care per person than any other country in the world, even though it does not have the best health care outcomes.

Pharmaceutical companies, armed with patents, wield great power over prescription drug pricing and accessibility, and thus over our very lives. Families must often try raising money for their own medical care, through GoFundMe and similar crowdfunding platforms. Stories of people unable to receive medicine or a procedure due to cost are common; some of those people die.

We must change the structure of our health care system and guarantee health care as a human right. We need Medicare for All. But much more must be done than just guaranteeing insurance and access. Health care alone does not mean health.

In fact, researchers have found that only about 10 to 20 percent of health outcomes are related directly to care. The rest are due to what doctors call the "social determinants of health"--a mix of factors including housing stability, access to transportation, education, employment, food, and the built environment.

In other words, "The social and structural context in which health care occurs is more important than health care itself," Dr. Philip Alberti, senior director for health equity research and policy at the Association of American Medical Colleges, says in an interview. "That conversation--about the social influences of health--has largely been absent from our national dialogue."

Consider the city of Detroit, where an incinerator built in 1986 turned more than 3,000 tons of garbage into toxic ash each day while pumping pollutants into the surrounding neighborhood. Since 2013, according to the Great Lakes Environmental Law Center, it was flagged for violating emissions standards 750 times. The community near the incinerator, which is majority low-income and majority people of color, has some of the highest rates of asthma in the state of Michigan.

In 2015, the law center found, 66 percent of the waste came from the mostly white and very wealthy Oakland County, and just 19 percent from Wayne County, which includes the city of Detroit. Will Copeland, an organizer with Breathe Free Detroit, the campaign that arose to shut down the incinerator, calls what was happening "an environmental justice issue in terms of other people throwing trash away [that] was going straight to the lungs of black Detroiters."

In spring of last year, the company that owns the incinerator, bowing to mounting public pressure, agreed to shut it down. It was a health win that had nothing to...

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