Social Policies May be Key to Improving Health Outcomes
What if the biggest impact that we can have on health is not through health care reform? Recent evidence from the Yale School of Public Health has shown that countries that have higher ratios of social service-to-health care spending have better health outcomes as measured by life expectancy, infant mortality, potential years of life lost and other indicators of population health.
The idea that social factors are at the core of the health of populations is not a new one. Previous research has estimated that mortality attributable to social factors such as poverty, income inequality, low educational attainment, and racial residential segregation is on par with mortality attributable to physiologic or behavioral causes.
I recently attended this year’s AcademyHealth Annual Research Meeting, a premier forum for health services research. As a student with a concentration in public health in the midst of 2400 people and more than 150 health services-related sessions, it was natural for me to gravitate towards a session entitled “Social and Neighborhood Determinants of Health.”
Elizabeth H. Bradley from the Yale School of Public Health presented her paper “State Variation in Health and Social Spending and Impact on Health.” The purpose of her study was to understand how state social service and health service spending choices may be associated with state-level health outcomes.
The study found substantial state-level variation in the ratio of social services-to-health service spending from 2000 to 2009. States with higher ratios of social services-to-health services spending had significantly better health outcomes including heart attack mortality rates, neonatal death rates, asthma, and days per month of activity limitations. Bradley and her team concluded that state-level financial allocation decisions between health and social services can have important health effects.
Unemployment, housing and education
As Bradley and her team put it in their previous paper on the associations between health and social service expenditures and health outcomes, “greater attention and reform in broader domains of social policy, such as unemployment, housing and education, may be necessary to accomplish the improvements in health envisioned by the advocates of healthcare reform.”
To truly improve the health of populations at a time, we must confront “the causes of causes,” or the underlying influences of health and disease. It is important to make policy choices that address not only the more direct determinants of health but also the societal and structural forces that are perpetuating health disparities. Thus, we must closely examine allocation decisions between health and social services spending to maximize the health returns for the resources invested.