THIS FALL, the Advanced Research Projects Agency for Health (ARPA-H), an agency within the US Department of Health and Human Services, announced that the Boston area had been selected as one of three regional hubs to drive innovation in developing  new ways to prevent, detect, and treat diseases like cancer, Alzheimer’s, and diabetes.  ARPA-H is an initiative launched by President Biden and one aligned with the White House’s Cancer Moonshot initiative.

There is no doubt that ARPA-H will spur innovation in life sciences and health care that will help countless lives in the years to come.  It is a big win for Massachusetts and one that we should be proud of.  Massachusetts will host the Investor Catalyst Hub aimed at helping to “navigate the complexities of the business and regulatory landscape and provide resources to help bring ideas to market,” according to Gov. Maura Healey’s office.

Once these innovations are brought to market, however, we must ensure that they are available to all who need them.  Under our current health care system, many still lack health insurance coverage and access to basic primary care; for them, breakthrough innovations have been and will be out of reach.

Even those with health insurance coverage face increasing challenges with affordability.  The Health Policy Commission’s 2023 Annual Health Care Cost Trends Report noted that the rapid growth in commercial health care spending, including health insurance premiums and cost sharing, strains residents’ ability to afford health care while meeting other essential needs. 

The investment and attention brought by ARPA-H are laudable, yet they are narrowly focused at the top of the Centers for Disease Control and Prevention’s health impact pyramid, which depicts the impact of different types of public health interventions and provides a framework to improve health.  The base of the pyramid indicates interventions with the greatest potential impact, and they are comprised of efforts to address socioeconomic factors, also known as social determinants of health.  Clinical interventions are near the top, indicating interventions designed to help individuals rather than entire populations.  Countless studies have found that medical care only accounts for 10-20 percent of the health of a population, with social determinants of health accounting for a far greater share.

The National Center for Health Statistics found that life expectancy at birth in the United States declined nearly a year from 2020 to 2021.  The 0.9 year drop in life expectancy in 2021 combined with a 1.8 year drop in 2020 represents the biggest two-year decline in life expectancy since 1921-1923.  Despite all of the health care advances over the last century, we are actually losing ground on important measures of population health.

A Boston Public Health Commission report released earlier this year found a 23-year gap in life expectancy between two city census tracts, one in Back Bay (91.6 years) and one in Roxbury (68.8 years).  Black residents in Boston experienced the greatest increase (37.3 percent) in premature mortality rate from 2017 to 2021.  These persistent and in some cases worsening disparities warrant urgent action.

The factors contributing to health inequities are complex.  These challenges can feel intractable, but they are the types of vexing problems that so-called moonshot initiatives are aimed at tackling.  At various points in history, landing the first human on the moon, developing COVID-19 vaccines, and launching delivery drones all seemed like impossible goals, yet they have all come to fruition because of targeted, collaborative, and breakthrough, innovation.  We can do the same when it comes to advancing health equity.

In order for all Massachusetts residents to have a fair and just opportunity to attain their highest levels of health, we must collaborate across sectors and invest in implementation of known solutions and development of new strategies that address the factors that have the greatest impact on population health.  These social determinants of health comprise the base of the health impact pyramid and include affordable housing, reliable public transportation, high quality education, healthy food, and economic opportunity to break the intergenerational cycle of poverty. 

Interventions targeting the base of the health impact pyramid have the greatest potential to improve health and health equity.  They are likely to be among the most cost-effective and sustainable ways to improve population health, yet they require public support and political will.

By affording all residents the opportunity to achieve their highest levels of health, we unlock the potential for the Commonwealth to achieve its full potential.  Harvard economist Raj Chetty has noted that there could be millions of “lost Einsteins,” individuals who might have become inventors and changed the course of American life, had they grown up in different environments.  His research has found that children who grow up in lower-income families have comparable talent and preferences to those in higher-income families, yet they lack resources or exposure to reach their full potential.  

There are likely many breakthrough innovations we have missed because of extreme inequality.  By investing in social determinants of health, we will enable future generations to live healthy lives, to pursue the opportunities they deserve, and to contribute to future innovation in Massachusetts and beyond.

Health equity must be our North Star.  We cannot resign ourselves to accepting health inequities; instead, we need a concerted moonshot effort to address the systemic barriers and social determinants of health that contribute to poor health and that hinder people from reaching their full potential. 

Amie Shei is the president and chief executive officer of The Health Foundation of Central Massachusetts, a health conversion foundation that will celebrate its 25th anniversary next year. She is also a member of the Health Equity Compact, a group of over 80 leaders of color who aim to advance health equity together in Massachusetts.