THE CONNECTION BETWEEN HEALTH CARE, EQUITY, AND INNOVATION
Political Scientist Andrea Campbell highlights the impact of equity on health outcomes
Andrea Campbell, photo by Stuart Darsch
"Any initiative to address health and health-care goals must address the enormous disparities that exist in health coverage, access, and outcomes across racial and income groups in the U.S. It’s as if poor and black Americans are living in a different country — and in terms of health insurance and health-care access, effectively they are. This is a political and social problem as much as a technical one."
— Andrea Campbell, Arthur and Ruth Sloan Professor of Political Science, and Head of MIT Political Science, 2015-2019
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As MIT works to advance solutions for global challenges in the realms of innovation, education, environment, and health, MIT’s School of Humanities, Arts, and Social Sciences (MIT SHASS) has tapped key scholars to provide insight into meeting these challenges from a wide range of disciplinary perspectives.
Andrea Campbell is the Arthur and Ruth Sloan Professor of Political Science, and served as Head of the Department of Political Science 2015-2019. Her research focuses on a broad sweep of critical political concerns from health insurance to taxation. The author of Trapped in America's Safety Net: One Family's Struggle (University Press of Chicago, 2014), Campbell served on the National Academy of Sciences Commission on the Fiscal Future of the United States, and has contributed vigorously to the national public debate surrounding health care and insurance. MIT SHASS Communications asked Campbell to share her thoughts on health care, equity, and innovation.
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What has your extensive experience as a political scientist taught you that can help us leverage innovations in health-care delivery and medical research to make care affordable and universally available? In particular, what kinds of “social” innovations might we need to support the successful implementation of any technical innovations in health care?
I attended the SOLVE session on leveraging information technology to increase health-care productivity, and the experience raised some interesting questions for me. The speakers noted, as one example, the fact that currently we collect many health indicators only sporadically rather than constantly.
Patients with high blood pressure only have their blood pressure monitored when they happen to go to the doctor’s office. Yet, ideal disease management would call for more frequent, even constant, monitoring — particularly if you were trying to detect the conditions under which someone’s blood pressure spiked.
The session was a fascinating one from a technical standpoint (how to collect the data; how to manage the enormous amounts of data that would be generated by constant monitoring). But, as a political scientist, my thoughts immediately went to the political and legal challenges, which weren’t the focus of the session.
Historically, it was imperative to keep one’s health data confidential because of the way medical underwriting worked in the old individual and small-group insurance market: Insurers might deny you health coverage for a pre-existing condition if you applied as an individual; if you worked for a small employer, an insurer might bump premiums up to an unaffordable level for the entire company based on the risk profile of one expensive employee.
The Affordable Care Act bans individual underwriting, but privacy remains a concern. Medical information that is revealed publicly might damage an individual’s reputation, or an employer might fire an employee who is battling an illness, fearing absenteeism or productivity loss. The challenge in a world of electronically gathered data is keeping that data safe.
"The Department of Political Science is spearheading a Public Policy Lab at MIT. The goal is to help foster interdisciplinary partnerships across the Institute.
— Andrea Campbell, Arthur and Ruth Sloan Professor of Political Science, and Head, MIT Political Science 2015-2019
What economic, sociopolitical, and/or cultural issues do you think need to be addressed to improve health-care outcomes?
To my mind, any initiative to address health and health-care goals must address the enormous disparities that exist in health coverage, access, and outcomes across racial and income groups in the United States. Of course there are huge disparities across the developed and developing worlds — the developing world experiences some 85 percent of the global disease burden, yet 85 percent of all health-care spending takes place in the rich democracies of North America, Europe, and Asia.
This rich world/poor world disparity is relevant for any infectious disease initiative. But the degree of disparity within the United States is astonishingly large and highly relevant for the mental health and cancer initiatives.*
Just this winter a group of economists confirmed a trend first detected in Social Security data a couple of years ago: that the disparity in longevity between Americans in the top 10 percent of the income spectrum and those in the bottom 10 percent has grown, from six years in the case of men born in 1920, to 14 years for men born in 1950.
Disparities by race are similarly enormous. Breast cancer survival rates for white and black women were nearly identical in the 1980s; since 1991, the gap has grown, as better screening and treatment became available — for some. It’s as if poor and black Americans are living in a different country, and in terms of poverty, health insurance and health-care access, effectively they are.
If MIT is to make meaningful contributions to cancer and mental health, we must do so in ways that will benefit all Americans, not just the rich and well-insured. This is a political and social problem as much as a technical one.
What is the key barrier you see to multi-disciplinary, sociotechnical collaborations, and how can we overcome it?
Political science has much to say about the kinds of economic and political disparities that undermine our ability to meet the great challenges of our time. We study which groups in society are organized, which have voice, and which are represented when it comes to policymaking. We examine the feedbacks between economic and political inequality: how economic inequality undermines the political voice of the poor, which in turn results in public policies that fail to raise them up.
We also study how groups with low levels of politically relevant resources (education, money, communication and organizational skills) can be mobilized to political activity despite these barriers. Hence political science, along with other social science disciplines, is key to understanding the context in which technical solutions are carried out.
I see two main barriers to multi-disciplinary collaboration, both of which I believe we can overcome. First, our disciplines are quite separate and siloed. Younger faculty, who often possess the most sophisticated and effective tools, face incentives to address narrow questions within their disciplines rather than engage in problem-solving across disciplines. We need to reward the latter type of work as well as the former. Second, researchers often have difficulty identifying scholars in other disciplines with whom they might partner to solve such complex challenges.
Hence, the Department of Political Science is spearheading a Policy Lab at MIT initiative. The goal is to help foster interdisciplinary partnerships across the Institute.
Suggested Links
Andrea Campbell website
Book: Trapped in America's Safety Net: One Family's Struggle"
Department of Political Science
Policy Lab at MIT CIS
Video: What is Political Science at MIT?
Video: Andrea Campbell discusses research by MIT Political Science on health and health care
Archive: Campbell named head of Political Science
Archive: Campbell interprets the Supreme Court's health care decision
A political scientist whose work was cited in one justice’s opinion weighs in on the ruling and its implications.
Archive: Caught in the Social Safety Net
More interviews in The Human Factor series
Interview prepared by SHASS Communications
Human Factor Series Editor: Emily Hiestand, Communications Director
Editorial Team: Kathryn O'Neill and Emily Hiestand
Photograph of Andrea Campbell: Stuart Darsch
Interview published in 2017