Health Affairs November 21, 2022
Paul Hughes-Cromwick, Steven M. Teutsch, Frederick J. Zimmerman

For decades, researchers have worried about disappointing (and now negative) gains in American population health. The pages of Health Affairs are filled with these discussions. Kindig & Mullahy ask whether the “fantasy equation” can be solved and how, i.e., what is the optimal balance of investments in the determinants of average health and health equity? Besides a brief reference to gun violence and our inability to fully engage it as a matter of public-health research and policy “because of political restrictions,” the concept of culture does not appear. Yet culture matters deeply. It informs the way in which problems are perceived and limits our actions.

Our culture—in all its complexity and bi-directional causality—prevents meaningful progress on the fantasy equation, literally stopping us dead in our tracks. Although...

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