Advancing health policy research and reducing social disparities in health

Paula Lantz, PhD, joins Michigan Minds to discuss the social determinants of declining birth rates, the role of public policy in improving population health and reducing social disparities in health, and the particular importance of recognizing Women’s History Month in 2023.

Lantz is the James B. Hudak Professor of Health Policy at the University of Michigan’s Gerald R. Ford School of Public Policy, and director of the Ford School’s BA program. She also holds an appointment as professor of health management and policy at the School of Public Health, and is currently engaged in research regarding abortion policy, housing policy, and how COVID-19 continues to exacerbate existing social, economic, and health inequities in the United States.

“My work is focused on the social, economic, and political factors, including public policy, that create patterns and inequities and health outcomes within communities and populations. I also focus on health disparities and health inequities within subpopulations including by race, ethnicity, gender, and socioeconomic status.”

In an opinion piece titled “The social determinants of declining birth rates: Implications for public policy and population health,” Lantz explains that the same social factors or social determinants that drive population health outcomes—like mortality, life expectancy, rates of illness, and injury—are also what drives birth rates within a population. For the past several years, she notes, researchers have been seeing a declining birth rate in the United States, meaning that the average number of children people have is declining, and also that more people are choosing not to have children at all. . 

“The birthrate in the United States has declined to a place where we will be losing population….This is being seen in many other middle- and high-income countries, but the rate at which birth rates are declining in the United States is pretty alarming.”

Lantz explains that birth rates in the US are actually below what demographers refer to as the “replacement level,” the number of births that need to happen for a population to maintain its size. She also emphasizes that birth rates are an important indicator of overall population health, as well as the status of women in a society. For example, when women’s education levels and labor force participation increases, birth rates tend to decline. 

“However, these are really dramatic and fast declines. Birth rates also reflect a number of factors that influence, and in fact constrain, childbearing decisions. So economic conditions influence birth rates—including things like recession wage levels, the cost of child care, whether or not people have paid leave, and other economic and opportunity costs of being in the labor market.”

Lantz explains how various social, economic, and political considerations impact the population-level phenomena that we’re seeing in regard to birth rates. She references the experiences of young adults, who are facing concerns that may affect their decisions about whether or not to have children, or how many to have, including climate change, student debt burden, and the rising cost of health care and housing.

As a researcher on public policy and health management, Lantz emphasizes the role public policy plays in creating change and shifting patterns to improve the overall levels of health within populations.

“Changes in public policy are the most efficient way to see changes in overall health levels in a population.” 

As far as advancing health policy research, Lantz discusses the significance of recognizing Women’s History Month, and why it’s important to learn about health care policy that affects women. She encourages people to go beyond social media and online forums and do their own research on women’s health, to gain an understanding of  the various complex issues that are arising. 

“I think in the year 2023, this is really a historic time for women’s health in the United States.”

“There’s been many gains in women’s educational attainment and economic opportunities and career opportunities, and that’s great. And I don’t think those gains should be taken for granted, and certainly because there does continue to be backlash and widespread discrimination and violence against women and girls in the US and worldwide.”

Lantz recommends that those who are interested in learning about or advocating for women’s health policy research elected officials and policymakers—not just legislative offices at the state and federal levels—but also elected officials like judges, local library boards, and school boards. Volunteering for nonprofit organizations that align with personal interests and whose missions resonate with you is another way people can get involved with advocating for women’s health care policy, Lantz explains. 

“The hard-fought gains and the rights and the life experiences of girls and women and people from sexual minority groups are having a terrible regression again right now in many countries….But I think Women’s History Month is a time where we all should do a bit more reflection about the ever-changing and tenuous nature of gender-based violence and discrimination in the world, and the important role that public policy reform and the legal codification of rights for all people—the important role that that change plays in historical change.”

Lantz concludes with the thought that public policy is about complex issues based on values, and it’s important to not only acknowledge but embrace opinions that differ from our own. She explains that one of the reasons she enjoys being in the field of public policy is for the debate, and having the opportunity to listen to the voices of others.

“The main point I’d want to leave the listeners with is that it’s important to be informed, and that includes talking to and listening to people who have opinions that are different from your own. We can all learn a lot from just opening our minds and discussing these tough issues with people who have opposing views from our own. And then, hopefully, we do learn from each other, and I think that’s the only way we’re going to move forward.”