michelle ko md phd

social determinants + healthcare = disparities

Lives That Don’t Matter, Part 1.

Contributed by a user of the 4thBox kit and the Interaction Institute for Social Change

The American Health Care Act is impressively democratic in that it has something for everyone to dislike.
For those of us deep in social determinants of health, we have always struggled with our healthcare “system”:

  • how healthcare providers are so late to the game in recognizing how social (and environmental and just about everything else that happens to humans) factors shape health
  • how nevertheless, healthcare gets so much money thrown at it
  • and perhaps for those of us have been on the inside, how healthcare in the U.S. not only fails to address inequities, but simply replicates them all over again within our systems

Rather than hiding behind nuances (like some states expand Medicaid and others don’t), the AHCA conveniently spells out how we can do this explicitly.

In brief, those who are: older, sicker, poor and near poor, rural, living in an area where healthcare is expensive, has job/income instability, has disabilities,  a recent (legal) immigrant, and/or female will be, on average, worse off. To the extent that non-white people and those with lower levels of education overlap with these characteristics, all in all we can expect disparities will go up post-AHCA, if it becomes law.

In detail coming up: Lives That Don’t Matter, Part 2. The AHCA’s Greatest Hits

Links for the Kaiser Family Foundation summary and full text of the bill




After the long stretch of rainstorms, the flowers are bravely popping from the trees and construction around campus is picking up again. UCD is growing and growing. As you would expect, this has spurred a lot of debate on how to handle rising enrollment and whose responsibility (UCD? UC? City of Davis?) it is.

Some of us (i.e. new faculty hires such as myself) directly benefit from this growth, and so I am not about to pick a side in this debate.  However, what I do appreciate is that there is a discussion. As difficult as it may seem, a slower but more deliberative process is better than no structure to handle debate at all- and that’s more or less the way we often make healthcare policy.  We lurch from side to side, reactively rather than proactively.* We have not been having thoughtful, careful discussion on how to handle growth — particularly the growth in our older adult population.  For all the discussion on Medicaid caps, no one has been asked to lay out a plan on how we will balance substantial cuts in expenditures that will occur just when the need long-term care hits record highs. (And no, no one seems to make clear that Medicaid pays for more than half of the long-term care in this country.)   Cut first, figure it out later.  It is the opposite of smart growth. It guarantees that instead of having productive discussion, we will continue to have reactionary arguments for years to come.


*Even the months leading up to the ACA- the debate was to accommodate competing interests, not to craft a comprehensive plan that addressed the future needs of the nation

Davis, Alternative Facts Version

National rankings in agriculture and veterinary medicine: 1

National ranking in rural medicine: 15

% of rural California population that is Hispanic/Latino ethnicity: 36.4

% of UC Davis undergraduates who identify as Hispanic/Latino: 19

% of ladder rank faculty who identify as Chicano/Latino/Hispanic: 6.9



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