Health outcomes, patient experience and health care affordability vary widely across the United States, and new research from HealthPartners Institute and collaborators at the Nationhood Lab and Institute for Health Metrics and Evaluation, suggests centuries-old regional cultures may be one reason why. The research, published in the American Journal of Health Promotion, adds to a growing understanding that improving population health requires looking beyond clinical care to the cultural, social and geographic factors that shape how people experience health care.

To better understand regional differences in health system performance, researchers assessed all 3,110 U.S. counties using the Triple Aim framework, which measures health outcomes, patient experience, and affordability. Those findings were then mapped against the American Nations model developed by Colin Woodard, highlighting how cultural norms tied to historic settlement patterns may influence health outcomes across the country.

Researchers found differences in health system performance across cultural regions. Areas with communitarian values, including the upper Midwest, had higher life expectancy and better patient experience. Whereas areas with more individualistic values had lower average health care costs. Researchers noted that the significant variation across regions highlights the need for further research into how cultural differences may influence health.

“Health care doesn’t happen in isolation from the communities and cultures where people live,” said Nico Pronk, PhD, President of HealthPartners Institute and lead author on the study. “As health systems work to advance the Triple Aim, understanding and adapting to local context can be an important strategy for improving health beyond the walls of clinical care.”

The findings suggest health systems, employers and public health leaders may have more impact when they account for the cultural and geographic context of the communities they serve. Tailoring communication to distinct regional audiences can improve understanding, and refining those messages for local communities may make them more effective.