Futureproofing Social Support Policies for Population Health

Centennial Issue
Population Health

Policy Points:

  • In America, wages appear to be growing relative to purchasing power over time. However, while the ability to purchase consumer goods has indeed improved, the cost of basic survival needs such as health care and education has increased faster than wages have grown.
  • America’s weakening social policy landscape has led to a massive socioeconomic rupture in which the middle class is disappearing, such that most Americans now cannot afford basic survival needs, such as education and health insurance.
  • Social policies strive to rebalance societal resources from socioeconomically advantaged groups to those in need. Education and health insurance benefits have been experimentally proven to also improve health and longevity. The biological pathways through which they work are also understood.

From Aristotle to Fredrich Engels, great thinkers have hypothesized that access to resources, such as knowledge, money, health care, and housing, are more important for health than anymedicines a physician could offer.1–3 But Rudolph Virchow was the first to scientifically assess the association between poverty and health.4 He recommended enactment of universal free education as one cure for disease, hypothesizing that education would provide a means for earning a living.4

One hundred and fifty years later, Virchow’s hypothesis has been confirmed with randomized controlled trials (RCTs) of social benefits coupled with a deep understanding of how poverty produces disease by causing “wear and tear” on the body.5–7 For example, we now understand how poverty leads to a cascade of biological events that produce premature aging, disease, and death.8 This cascade of events can even be measured with laboratory tests, allowing policymakers to test whether social benefits also improve population health.9


  1. Modell SM. Aristotelian influence in the formation of medical theory. The European Legacy. 2010;15(4):409-424.
  2. McManus C. Engel, Engels, and the side of the angels. The Lancet. 2005;365(9478):2169-2170.
  3. Phelan JC, Link BG. Fundamental Cause Theory. In: Medical Sociology on the Move. Springer; 2013:105-125.
  4. Virchow R. Notes on the typhus epidemic prevailing in Upper Silesia. Arch Pathologische Anatomic Physiologic Klinische Medizin. 1849;2:143-322.
  5. Courtin E, Kim S, Song S, Yu W, Muennig P. Can social policies improve health? A systematic review and meta-analysis of 38 randomized trials. Milbank Q. 2020;98(2):297-371.
  6. Courtin E, Allen HL, Katz LF, Miller C, Aloisi K, Muennig PA. Effect of expanding the Earned Income Tax Credit to Americans without dependent children on Psychological Distress (Paycheck Plus): a randomized controlled trial. Am J Epidemiol. 2022;191(8):1444-1452.
  7.  Greenburg D, Shroder M. The Digest of Social Experiments. 3rd ed. Washington: Urban Institute Press; 2004.
  8.  Seeman T, Epel E, Gruenewald T, Karlamangla A, McEwen BS. Socio-economic differentials in peripheral biology: Cumulative allostatic load. Ann NY Acad Sci. 2010;1186(1):223-239.
  9. Muennig P, McEwen B, Belsky DW, Noble KG, Riccio J, Manly J. Determining the optimal outcome measures for studying the social determinants of health. Int J Environ Res Public Health. 2020;17(9).

Muennig P. Futureproofing Social Support Policies for Population Health. Milbank Q. 2023;101(S1): 176-195.