Yes, measuring clinical outcomes sounds intuitively right. Still, I wonder if this is a case where inquiry is just as important as certainty. We think we know what determines health, and of course we should use best evidence to prescribe. But generally we don’t measure and act on non-clinical factors that are the primary determinants of health, because these are hidden by the current medical-model frame.

Accountability should begin with national recognition of the powerful role of social determinants of health. This must become central to the national dialogue (not just the health reform dialogue). We need to go beyond GDP with national health measures that bring these determinants to light, that allow us to continually see our progress and the impact of our policy and personal decisions.

The evidence is clear: where we live, work and play; our socioeconomic status; our sense of control, hope and belonging; and how we treat each other… these matter most to health. If we fail to see and act on this our health as a nation will not change.

Rick Brush
http://www.communitiesofhealth.org