Health = Wealth

The World Health Organization recognizes health as a fundamental human right. But living a long, healthy life depends on access to economic resources that are beyond reach for millions of Americans. As our nation’s income gap widens, so too does our health gap.

Recently, a number of Adelphi faculty members have undertaken important work on the economics of health. They’ve sought to understand the financial burden of health events like chronic disease, physical inactivity, mental illness and even religious fasting. Through data analysis, computational models and qualitative interviews, they estimated the financial gains and losses that result from both positive and negative health outcomes.

Their discoveries etched society’s socioeconomic fractures in sharp relief. Perhaps the greatest toll on our healthcare system, they learned, is inequality itself.

All Health Outcomes Are Not Created Equal

For Alan Cooper, PhD ’95, MBA ’03, clinical associate professor in the Adelphi University Robert B. Willumstad School of Business, who began his career in the healthcare industry, it’s about time we reimagined the relationship between public health and economics.

Dr. Cooper co-authored “Risk Factors Affecting Life Expectancy Resulting in Premature Mortalities and the Accompanying Economic Losses” (Current Journal of Applied Science and Technology, July 2024),¹ which calculates the cost of preventable deaths in the United States, revealing the interdependency of people’s well-being and their potential economic impact. Research like this, Dr. Cooper maintains, can be used to improve health outcomes while reducing economic losses.

The study examines modifiable risk factors (MRF) for chronic disease—including genetic, behavioral, lifestyle, socioeconomic and environmental—that lead to higher rates of morbidity and premature mortality. To detect potential disparities in outcomes among the population, Dr. Cooper and his team stratified the data by race and gender. Then they estimated overall economic loss over the lifespan for each crosscut of population.

The results were sobering. As the paper notes, “Premature mortality due to modifiable risk factors is not only a personal and family tragedy, but an economic one as well.” Deaths due to MRF amounted to nearly 40 percent of the total deaths nationwide, but represented nearly 50 percent of the economic loss—totaling $400 billion in just a single year.

When broken down by race and gender, the gap widened even further. Along both racial and gender lines, Native Americans and Alaskan Natives showed the highest proportion of deaths due to MRF as well as economic loss. The lowest proportions were seen in Asian and Pacific Islanders and whites.

Though the paper calls the total cost of these deaths “almost beyond comprehension,” Dr. Cooper believes his work can begin to turn the tide. “Public health officials can target awareness and treatment campaigns to those demographics that the study shows have higher mortality levels based on specific risk factors,” he said. “By using this data strategically, they can make informed decisions that enhance the overall quality of life for their constituents.”

For Some Children, Maintaining a Healthy Weight Is a Privilege

Every child’s eating habits are influenced by the world around them. But for children from lower socioeconomic groups, making healthy choices—and maintaining a healthy weight—can be particularly difficult.

Paul Rukavina, PhD, professor in the Adelphi University Ruth S. Ammon College of Education and Health Sciences, has long studied how overweight and obese students can be better supported by their physical education teachers. But after years of research, “I came to understand that the problem is not just in the classroom,” he explained. “It’s a much larger structural problem. It’s children’s social interactions, it’s the quality of their school’s facilities, it’s the safety of their neighborhood, it’s their state’s educational policies. It’s a consequence of economic inequality.”

Dr. Rukavina turned his attention to the home, intent on bringing parents’ voices into the conversation. He and two co-authors, Xiao Ma of the Shanghai University of Sport and Weidong Li, PhD, of The Ohio State University, interviewed 44 parents of overweight and obese children, all of whom belonged to lower social economic classes in an urban area, for the article “Challenges encountered by parents from urban, lower social economic class in changing lifestyle behaviors of their children who are overweight or obese” (BMC Pediatrics, 2023).² The team asked parents how they engaged with their child’s lifestyle, including their expectations surrounding diet and exercise.

Parents with the best intentions were thwarted at every turn. “They lacked money and time to provide nutritious meals and physical activity opportunities, as well as the scientific knowledge to help their children lose weight,” Dr. Rukavina said. Parents also struggled to find affordable healthy food in their neighborhood grocery stores. Faced with so many structural barriers, parents cannot be expected to go it alone. According to Dr. Rukavina, schools can provide bias-free learning environments, healthy food options, parent education initiatives and even urban agriculture programs, while cities can build safe spaces for children to congregate and increase access to fresh produce. “We can’t necessarily reverse economic inequality,” he said, “but when institutions are aligned, children and families will have a much easier time developing healthful living strategies that prevent—rather than react to—health disparities.”

To Save Money, the United States Should Invest in Youth Sports

The amount of money our country could save by investing in youth sports might surprise you.

According to Meredith Whitley, PhD, professor of health and sport sciences at Adelphi University and research fellow at the Centre for Sport Leadership at Stellenbosch University, it’s in 11 figures.

Dr. Whitley recently co-authored several papers with members of PHICOR (Public Health Informatics, Computational, and Operations Research),³ based out of the CUNY Graduate School of Public Health & Health Policy, that calculate the economic benefits of a more active youth population. She worked with PHICOR colleagues to simulate a future in which the United States meets the targets identified in Healthy People 2030, an initiative of the U.S. Department of Health and Human Services. The team built a computational model that could track a cohort of 6- to 17-year-olds over their lifetime, measuring the benefits of higher activity levels on each individual’s physical and mental health. “Our study is the first time we’ve been able to quantify the potential health and economic impacts of these changes across the country,” Dr. Whitley said.

In “Benefits of Meeting the Healthy People 2030 Youth Sports Participation Target” (American Journal of Preventive Medicine, May 2024),⁴ Dr. Whitley and colleagues used their model to predict what would happen if the nation’s youth sports participation rate (currently 50.7 percent) reached Healthy People 2030’s target of 63.3 percent. The value, they discovered, was immense: an increase of 1.8 million more quality years of life for Americans, along with an $80 billion reduction in medical costs and productivity losses.

In March 2024, another paper was published by Dr. Whitley and colleagues—this time in JAMA Health Forum—entitled “Health and Economic Value of Eliminating Socioeconomic Disparities in US Youth Physical Activity” (JAMA Health Forum, March 2024).⁵ This paper addressed disproportionately low physical activity rates, both in school and in organized sports, among youth of lower socioeconomic status. By eliminating or reducing these disparities, Americans could avert 383,000 overweight and obesity cases and 101,000 weight-related disease cases (such as strokes, type 2 diabetes or cancer), resulting in more than $15.6 billion in cost savings over the model cohort’s lifetime.

As national rates of sports participation and physical activity continue to plummet, even a relatively modest investment in policies and interventions could get us back in shape. “We are hopeful that the economic impact of low sports participation and physical activity rates might motivate policymakers, health officials and local stakeholders to increase access and support for youth sports and physical activity,” Dr. Whitley said. “These investments would pay for themselves.”

The Cost of Untreated Anxiety

Approximately 19 percent of Americans experience anxiety, per the Anxiety and Depression Association of America, costing the American healthcare system nearly $100 billion annually. Yet anxiety often goes unrecognized by the system’s first line of service: primary care providers (PCPs). Many anxiety symptoms can masquerade as unrelated somatic symptoms, which can lead a PCP to order unnecessary, expensive tests and treatments.

Roni Berger, PhD, professor in Adelphi’s School of Social Work, is calling for a new model. “There’s a growing recognition in medicine that our bodies, minds and souls are interconnected,” she said. “We need to develop holistic approaches to understand what’s going on and help.”

Dr. Berger and School of Social Work adjunct faculty Alissa Mallow, MSW ’83, DSW ’00, collaborated with colleagues Lindsay Standeven, MD; Virna Little, PsyD; and Jian Joyner in a new study on anxiety with Concert Health, a behavioral health medical group. They reviewed data collected by Concert Health to assess the efficacy of collaborative care, an evidence-based healthcare model that treats behavioral health issues in, as Dr. Berger puts it, “the settings people most often use.” Their findings were published as “Not screening for anxiety? Costs and solutions” (Medical Economics, April 2023).⁶

So how can healthcare providers help patients manage their anxiety while reducing costs? Dr. Berger says it starts with simply paying attention. “PCPs need to know what they’re looking for. If they are screening specifically for anxiety, there’s a lot they can do without referring someone to a specialist.” The more patients can be screened and treated in settings they trust, the more patients, providers and organizations alike will benefit.

How Does Our Physical State Impact Our Financial Decisions?

Cem Karatas, DBA, clinical associate professor in the Adelphi University Robert B. Willumstad School of Business, was curious about the relationship between people’s well-being and their economic decisions.

He relied on data gathered during Ramadan, the Muslim holy month, to find out. Ramadan observers must fast from dawn to sunset, which leads to acute physiological changes, such as low blood sugar, dehydration and sleep deprivation. The psychological effects can be equally potent: upticks in mood, communal solidarity and sense of belonging.

Alongside Senay Acikgoz, PhD, a scholar from Turkey’s Ankara Hacı Bayram Veli University, Dr. Karatas published “Do psychological factors exert greater influence on investment decisions than physiological factors? Evidence from Borsa Istanbul” (Borsa Istanbul Review, December 2023),⁷ which analyzed earnings announcements made by Turkish companies during Ramadan.

While many behavioral finance studies have investigated the impact of psychology on investments, far fewer have looked at physiological factors. Dr. Karatas’ paper is the first to explore the complex relationship between psychology and physiology—and, furthermore, integrate them into one unified model. “Separate models are insufficient, given the intricate interplay between human psychology and physiology,” he said. “The effects of sleep deprivation due to work should differ from those resulting from, for instance, sleep deprivation due to late-night game enjoyment.”

Despite a physiologically strenuous period of fasting, Dr. Karatas found that Turkish investors’ decisions were more heavily influenced by psychological factors during Ramadan. A collectively buoyant mood led investors to buy additional shares in companies that announced surprisingly strong earnings.

Those making financial moves like investments can use this knowledge to make informed—and more profitable—decisions. “Investors adopting a strategy of buying shares one or two days after positive surprises and selling after three months should take into account the Ramadan period,” Dr. Karatas and his colleague note in the paper. “While this strategy generally yields a positive abnormal return outside of Ramadan, … if the earnings announcement occurs during Ramadan, the strategy, on average, results in a negative abnormal return.”

Bios:

Alan Cooper, PhD ’95, MBA ’03, is clinical associate professor of management in the Robert B. Willumstad School of Business. He is a nationally recognized speaker in the areas of process improvement, customer satisfaction, leadership development and corporate learning, and is published on the subjects of leadership development and corporate education.

Paul Rukavina, PhD, is a professor of health and sport sciences in the Ruth S. Ammon College of Education and Health Sciences. He focuses his energy on three research interests: anti-fat attitudes toward obesity, inclusion of overweight and obese individuals in physical activity contexts, and comprehensive school physical activity programs.

Meredith Whitley, PhD, professor of health and sport sciences, explores the complex and multifaceted roles of sport and sport for development programs in the lives of youth from under-resourced communities in her research, along with the interrelated systems impacting youth and community development.

Roni Berger, PhD, is a professor in the School of Social Work and a licensed clinical social worker. Her primary areas of research are trauma and posttraumatic growth in cross-cultural context; immigrants and refugees; qualitative and combined research methods; remarriage and stepfamilies; and law guardianship. Dr. Berger is the editor of The Routledge International Handbook of Posttraumatic Growth.

Cem Karatas, DBA, is a clinical associate professor in the Department of Finance and Economics. He serves as the director of AACSB Accreditation and the chair of the Continuous Improvement Committee. Before joining Adelphi University, Dr. Karatas worked at several other universities across the U.S. as well as for a reserve bank, the military and a National Science Foundation-affiliated research center. His finance literature contributions focus on behavioral finance, climate finance and initial public offerings.

Footnotes:

1 Putzer, G. J., Cooper, A., & Jaramillo, J. R. (2024). Risk factors affecting life expectancy resulting in premature mortalities and the accompanying economic losses. Current Journal of Applied Science and Technology, 43(7), 80–92. https://doi.org/10.9734/cjast/2024/v43i74408

2 Ma, X., Li, W., & Rukavina, P. B. (2023). Challenges encountered by parents from urban, lower social economic class in changing lifestyle behaviors of their children who are overweight or obese. BMC Pediatrics, 23(1). https://doi.org/10.1186/s12887-023-04295-5

3 Martinez, M. F., Weatherwax, C., Piercy, K., Whitley, M. A., et al. (2024). Benefits of meeting the healthy people 2030 youth sports participation target. American Journal of Preventive Medicine, 66(5), 760–769. https://doi.org/10.1016/j.amepre.2023.12.018

4 Martinez, M. F., Weatherwax, C., Piercy, K., Whitley, M. A., et al. (2024). Benefits of meeting the healthy people 2030 youth sports participation target. American Journal of Preventive Medicine, 66(5), 760–769. https://doi.org/10.1016/j.amepre.2023.12.018

5 Powell-Wiley, T. M., Martinez, M. F., Heneghan, J., Weatherwax, C., Osei Baah, F., Velmurugan, K., Chin, K. L., Ayers, C., Cintron, M. A., Ortiz-Whittingham, L. R., Sandler, D., Sharda, S., Whitley, M., et al. (2024). Health and economic value of eliminating socioeconomic disparities in US youth physical activity. JAMA Health Forum, 5(3). https://doi.org/10.1001/jamahealthforum.2024.0088

6 Little, V., Mallow, A., Standeven, L., Berger, R., & Joyner, J. (April 28, 2023). Not screening for anxiety? Costs and solutions. Medical Economics. https://www.medicaleconomics.com/view/not-screening-for-anxiety-costs-and-solutions

7 Acikgoz, S., & Karatas, C. O. (2023). Do psychological factors exert greater influence on investment decisions than physiological factors? Evidence from Borsa Istanbul. Borsa Istanbul Review, 23. https://doi.org/10.1016/j.bir.2023.12.002