Disparate Healthcare Outcomes, Trust, and Cultural Folkways

Can regional disparity in U.S. healthcare outcomes and spending be traced to centuries’ old migration patterns?

This intriguing article claims that “wasteful healthcare spending at the regional level is, in many cases, a symptom of underlying backwardness” and that this in turn traces its roots to low-trust societies that migrated from the British Isles. What’s not to like about an article that connects healthcare disparities to Albion’s Seed via country-level manufacturing productivity distributions?

I think the article is a step above the Gladwellian or Freakonomics camp of attention-grabbing counterintuitiveness and that the linkages are not as tenuous as they may seem. History casts a long shadow.

On a personal note, I’ve been working recently in Appalachia, towards the southern end. Though I was already familiar with Albion’s Seed and the cultural antecedents of that region, there’s nothing like spending time at a place, not just on vacation or passing through, but working side by side with the people. And so I leave you with this description of the region that rang true to me. Looking at other cultures from the outside in provides a reminder that the cultural impact of history can leave a mixed legacy. Changes in political, economic and technological conditions can create widening gaps between historically useful beliefs and customs and those needed to survive and thrive in the present. For example:

Entrepreneurship often suffers because of geography, the learning styles of entrepreneurs from this region, the workforce quality, the perceived negative attitude toward success, the regional insularity and the general information available about capital.

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