Math for the People

Subsection 7.2.1 Why is good health important?

Have you ever gotten sick and thought to yourself “I feel so bad that I can’t do anything. I have been taking my good health for granted!”

Dealing with health issues is a burden. Not only can they prevent us from being able to do the things that we love to do - they can make it harder to do the things we need to do to survive. Healthcare can be expensive and even harder to afford if our health issues prevent us from working. To take an extreme example, if you are injured in a way that prevents you from doing your job, you may lose both your job and have to pay a hefty sum for treatment. Without some kind of safety net, your situation can quickly become life or death.

So, as a society, we have developed mechanisms that serve as safety nets for us when we get sick or injured. In the modern age, the most fundamental of these is health insurance. We pay a monthly fee to an insurance organization, even if we are in good health. These fees are aggregated and distributed to those of us who need them: When we need to pay for healthcare, money is taken from this pot to help financially support our care.

Subsection 7.2.2 Access to healthcare

Different countries take different approaches to maintaining the health of their citizens. Before modern times, governments did not guarantee their citizens any form of health insurance. Instead, large family units, religious institutions, and/or community organizations played the role of the health insurance company, coming together to financially support community members when they got sick. Today, the government usually plays a role in making sure all of its citizens have access to health insurance. In some countries around the world such as Canada, Iceland, Kuwait, and South Korea (full list at [7.12.1.125]), all citizens are guaranteed affordable access to health care by the government through a system called universal health care, usually financed by taxpayers.

In the United States, the system is more complicated. What seems to be considered the ideal situation is to have your employer pay for your health insurance by deducting a certain amount from your paycheck each month. At the time of writing, the Affordable Care Act gives unemployed citizens access to health insurance, but they have to enroll themselves at https://healthcare.gov¹ and must find a way to pay for the insurance themselves or use assistance programs. How much they pay depends on their living situation and many other factors [7.12.1.135].

It’s worth noting that even with these programs, many Americans remain uninsured. If you’re uninsured and have a health crisis, your only option is the emergency room (ER). The ER provides care without proof of insurance but is expensive, and this option can quickly result in rapidly accruing medical debt.

In fact, data shows that the U.S. has among the poorest health outcomes in the world as compared to other developed nations. Among Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom, we spend the most on our healthcare system, and yet have the lowest life expectancy, highest number of hospitalizations from preventable causes, and highest rate of avoidable deaths (see e.g. [7.12.1.142]).

There is something wrong with our current system, and the government is not doing enough to maintain the health of our citizens. Everyone deserves to have their basic medical needs met, so why is the United States faring so poorly, and what can we do?

Subsection 7.2.3 Social determinants of health

Scholars argue that the problem lies in the connection between poverty and poor health outcomes. Whether or not you have insurance, poverty contributes both to lack of access to healthcare, and poor health in the first place. To give you some examples, imagine the following scenarios:

1. You may not be able to afford transportation to the doctor’s office.

2. You may not have received adequate health education resulting in poor health literacy.

3. You may only be able to afford foods which do not provide adequate nutrition, leading to worse health outcomes.

4. You may have been forced into a living situation contributing to poor health, such as an apartment with poor air quality due to a mold problem.

5. You may be forced to live in a neighborhood where drugs and/or crime are prevalent.

6. Your immigration status may limit your ability to work or receive healthcare.

Social determinants of health refer to those sociodemographic factors which correlate positively or negatively (see Chapter 6 ) with poor health outcomes. As you might imagine, income is a one of these. Others include employment status, highest degree of education, disability status, quality of affordable housing, etc.

The documentary Unnatural Causes: Place Matters gives concrete examples which show how an individual living in poverty can be stuck in a living situation adversely affecting their health. A stressful living situation can complicate issues such as heart problems, which may make it hard or impossible to work, which in turn makes it impossible to improve your living situation. Health issues and poverty can compound one another in a sinister feedback loop [7.12.1.130].

In other words, there is a vicious cycle: Living in poverty can make you sick, and being sick can keep you poor or make you poorer.

Subsection 7.2.4 The role of nonprofits

Not-for-profit free health clinics have cropped up across the country to improve Americans’ access to healthcare. Since poverty is the root cause, we can’t expect these clinics to be a complete solution, but they do offer an important service to uninsured and/or low-income residents of underserved communities, providing basic health services such as check-ups, medication, lab work, basic dental and vision exams, counseling, and referrals to specialists.

One issue some clinics face is that the patients who most need their services are not able to easily get to their clinic. Perhaps they do not have a car, perhaps they have a very tight schedule, or perhaps they have mobility challenges. Thus, nonprofits may strategically deploy mobile clinics within the geographical region they are able to serve. Such a clinic might operate out of an RV and offer a limited subset of clinical services including basic health check-ups, or COVID-19/flu vaccinations.

Since their monetary and human resources are limited, the health clinic must choose wisely in its deployment of the mobile units. How can they effectively choose where to concentrate their efforts? We will see in this module how mathematics can help these nonprofits use sociodemographic and geographic data to make informed decisions about resource allocation.