Every month about 30 researchers, policy makers, and practitioners from 4 different sectors—health, education, housing, and social services—meet at the Brookings Institution in Washington, DC. We discuss policy reforms that would boost collaboration between sectors to improve the health of households and communities. We are especially interested in “social determinants”—nonmedical social factors affecting health.
The focus of a discussion might be children’s mental health, housing conditions, or aging. But whatever the topic, it is never long before someone raises an example of a “wrong pocket problem” undercutting the incentives for collaboration. A wrong pocket problem arises when one organization or sector is best placed to make an investment, but it is another sector—another pocket—that benefits from the investment. As any economist would point out, when a potential investor incurs the cost but cannot capture the generated value, there will be underinvestment.
Wrong Pockets vs Social Determinants
This issue is important in health care because the research literature increasingly emphasizes the importance of nonmedical factors in health. For instance, the absence of quality medical care appears to account for perhaps 20% of avoidable deaths and genetics another 20%. But social, behavioral, and environmental factors may account for as much as 60%.
[For more on this story by STUART BUTLER, PHD, go to https://newsatjama.jama.com/20...pockets-hurt-health/]
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