A question as simple as “Are you taking your medicine?” could conceivably prolong your life, research shows.
A new study offers concrete evidence on the power of exposure to health-related expertise—not only in improving mortality rates and lifelong health outcomes, but also in narrowing the vexing health gap between the rich and poor.
The findings, which appear in a National Bureau of Economic Research working paper, show that people with access to informal health expertise, such as having a doctor or nurse in the family, are 10 percent more likely to live beyond age 80. They also are significantly less likely to have chronic lifestyle-related conditions, such as heart attacks, heart failure, and diabetes.
Younger relatives within the extended family also see gains: They are more likely to have received vaccinations, have fewer hospital admissions, and have a lower prevalence of drug or alcohol addiction.
In addition, the closer family medical source—either geographically or within the family tree—the more pronounced the health benefits, according to the findings.
The researchers used data from Sweden, which used lotteries in the early 2000s to break ties among equally qualified applicants for admission into medical schools. The researchers then compared the health of the family members of lottery winners against lottery losers—a setup similar to a randomized control trial.
The strong findings of health benefits funneled from a familial sphere of medical knowledge suggest ramping up access to health expertise in our health care system would benefit everyone, the researchers say.
A doctor, for instance, could prescribe statins—a type of drug known to lower the risk of heart attacks—but patients make the decision whether to take it from day to day.
“Our work shows that there is a lot of value in trying to improve people’s decisions about their investment in their own health,” says Petra Persson, an assistant professor of economics at Stanford University.
“If the government and health care system, including public and private insurers, could mimic what goes on inside families, then we could reduce health inequality by as much as 18 percent,” she says, referring to a main finding of the study.
Expertise from a family member who is a medical professional might include frequent nagging to adhere to prescribed medications, get vaccinations, or refrain from smoking during pregnancy. “These behavioral changes are—from a society’s perspective—simple and cheap,” the study states.
The study also highlights limitations to the impact of access to medical care, underscoring the importance of other health efforts.
The researchers compared mortality data of Sweden—where there is universal access to health care—to the United States. Overall mortality was lower in Sweden but the level of health inequality largely mirrored that of the United States.
In Sweden, despite its extensive social safety net, the rich also live longer and the poor die younger. Specifically, among people alive at age 55, more than 40 percent of individuals at the bottom of the income distribution in Sweden will have died by age 80—as opposed to fewer than 25 percent for those at the top of the distribution.
“This health inequality appears to be extremely stubborn,” Persson says. “We can throw a universal health insurance system at it and yet substantial inequality persists. So, is there anything else that can help us close that health gap between rich and poor?”
According to the latest research, yes.
Personal ‘health coach’
Having a medical professional in the family led to substantial health effects across the income spectrum, according to the study. And because the effects from the exposure to medical expertise was often even stronger for those at the lower half of the income distribution, the researchers estimated that information-driven behaviors could make a significant difference in getting rid of health disparities.
The findings suggest we should move back toward “old-fashioned primary care.”
The study did not examine the complexity of family dynamics or specific actions that led to the positive health effects, but the researchers hypothesize that the mere presence of a medical professional in the family translates somehow to either a heightened health culture or, at least, having a coach of sorts to encourage healthy, good-patient behavior.
While general public health campaigns (e.g., “Get Your Flu Shot Today!”) may not carry the same level of influence as intimate dinner-table discussions or persistent prodding among family members, other ways society can improve its exposure to medical expertise could lead to healthier, longer lives, the researchers say.
Community health worker or nurse outreach programs can perhaps lead to more targeted, personalized communication efforts, they say. Digital nudges delivered through mobile phone apps could potentially make healthy dents.
Old-fashioned primary care
Closer patient-doctor relationships and more consistent, longer-term ties to the same doctor could lead to more reminders of preventive care.
“The idea of continuity of care and developing a true relationship with your doctor, who becomes someone who pays attention to you as an individual and sees you and your family over a long period of time, is well known,” says Maria Polyakova, an assistant professor of health economics.
“Today, it’s what they might call old-fashioned primary care, where the whole family goes to the same doctor for many years. Many countries, the US included, appear to be moving increasingly away from this model, and our results suggest that we might want to do the reverse.”
The finding of how a closer family connection or closer proximity leads to even stronger health outcomes helps substantiate the potential difference a closer bond between any doctor and patient could make—improvements hard to glean from rushed and infrequent medical appointments, Persson and Polyakova say.
Communication-focused health initiatives don’t have to come with hefty price tags either, they say.
“We pour a lot of resources into getting even fancier machines inside hospitals, but the things that are making a difference here are not that expensive,” Persson says of the findings. “These are cheap, easily scalable preventative investments that are translating to gains in longevity, which is remarkable.”
Young health professionals and their parents
Using large-scale data from Sweden, the researchers focused on quantifying the role of informal exposure to health expertise via a medical professional in the family while avoiding results that would be muddled with other differences between individuals with and without a doctor in the family.
“People with health professionals in the family essentially make preventative investments that everyone should be doing.”
They used two different approaches. First, they took advantage of the fact that in some years, Sweden used lotteries to break ties among equally qualified applicants to medical schools. This allowed the researchers to use medical school application records and track the health of family members of applicants who won and lost the lottery.
The researchers looked at more than 30 years of continuous health and tax records spanning four generations of family members, and examined health-related outcomes of the extended family members of newly trained doctors and nurses—including their siblings, parents, grandparents, children, aunts, uncles, cousins, and in-laws.
Second, researchers sought to double-check whether higher income and higher social status associated with the medical profession had anything to do with the positive health benefits they found.
One of the ways they did this was to draw a comparison to lawyers, a similarly paid profession. The parents of doctors, they found, were 16 percent more likely to be alive than the parents of lawyers 20 years after their children matriculated. The parents of doctors also faced lower prospects of lifestyle-related chronic diseases.
In addition to the higher likelihood of their parents living past age 80 and the lower likelihood of heart diseases, the relatives of health professionals showed higher levels of preventive behaviors, including purchases of heart and blood-thinning medications, and vaccinations for HPV, or human papillomavirus. Younger family members also had fewer hospital admissions and addiction cases.
“People with health professionals in the family essentially make preventative investments that everyone should be doing,” Persson says.
Source: May Wong for Stanford University