Increased Investment in Social Services Linked to Better Health Outcomes

A new study established the association between variation in state-level health outcomes and the allocation of state spending between healthcare and social services. The new research found that states with a higher ratio of social to health spending had significantly better subsequent health outcomes for the following 7 measures: adult obesity, asthma, mentally unhealthy days, days with activity limitations, and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes.

Elizabeth Bradley, PhD, of the Yale School of Public Health, led the study understanding the variation in health outcomes. The detailed study is published in Health Affairs.

International comparisons have repeatedly proven that countries with higher social services spending relative to healthcare spending had significantly better health outcomes. This association in United States has not yet been established largely because of the difficulty of obtaining comparable data across states on social services spending.

“Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health—not only in health care but also in social services and public health—is warranted,” the authors wrote.

Study Method and Design

Part of the primary analysis included exploring the relationship between the ratio of social to health spending and subsequent health outcomes. Data on health care, public health, and social services spending across states was used from all 50 states in United States and the District of Columbia for the period 2000—2009.

The health outcome measures were adult obesity, asthma, mentally unhealthy days, days with activity limitations, and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. The researchers focused on these outcomes because they were the most prevalent and expensive conditions. They also used the data on spending on social services and public health relative to the spending on healthcare in each state for the study.

Better Social Services Spending, Better Health Outcomes

It was universally established that for the 10-year period, states with higher ratios of social to health spending had better health outcomes, compared to states with lower ratios. The better outcomes were visible within 1 or 2 years. Even though the study couldn't establish causality with the data, the persistent pattern across a range of health outcomes was notable.

In US in 2009, there were 78 million obese adults. The effect of the study would result in 85,000 fewer adults with obesity. Similarly, with nearly 23 million adults nationwide had mental health issues in 2009, the effect would result in 989,000 fewer adults with mental health issues per year.

“To support innovative health policies, research that includes spending and outcomes for investments in both health care and social services is critical” the authors wrote.