Study: Increased spending on social services improves health

States that increased spending on public health and social services programs between 2000 and 2009 saw significant improvement in health outcomes in areas such as adult obesity and asthma, according to a new study from Elizabeth Bradley, PhD, a public health professor at Yale University, and her coauthors published in Health Affairs.

Using data from CMS, the U.S. Census Bureau and the Centers for Disease Control and Prevention, the study calculated the sum of state public health and social services programs divided by the sum of their spending on Medicare and Medicaid, and then explored that ratio’s association with health outcomes one and two years later in eight areas: adult obesity, asthma, mentally unhealthy days, days with activity limitations, mortality rates for lung cancer, acute myocardial infarction, type 2 diabetes and postneonatal infants.

“States with higher ratios of social to health spending had better health outcomes one and two years later, compared to states with lower ratios. The effect of the ratio was significant for seven of the eight health outcomes we assessed,” Bradley and couthors wrote.

The study found, on average, states spent $3.09 on public health and social services for every $1 allocated to healthcare between 2000 and 2009.

States that increased healthcare spending as a percentage of their gross domestic product saw worse health outcomes in all eight areas in the study. Bradley and her coauthors said one possible explanation for this association could be poorer health outcomes requiring additional Medicare and Medicaid spending—and therefore reducing the ration between spending on social programs and healthcare—but that interpretation doesn’t account for all their findings.

“It does not explain the observation that the ratio was also associated with health outcomes one and two years later,” Bradley and coauthors wrote. “Furthermore, we also found a positive association between social services spending and better health outcomes.”

The study argued the effects of increased spending on public health and social programs could be substantial if applied nationwide. In one example, a 20 percent change in the median ratio of social to health spending led to a 0.33 percent drop in the number of obese adults the following year. Using the 2009 nationwide figure of 78 million adults with obesity, this change would have reduced the obese adult population in the U.S. by more than 85,000.

While Bradley and her coauthors suggested these findings could be used to merge public policies on value-based care “with experimentation with interventions that address housing, nutrition, transportation, legal and other social services,” they argued against using the study as a reason to take funding away from Medicare and Medicaid.

“Although it may be tempting to interpret this finding as a demand for the reallocation of state monies from health care to social services and public health, it is important to reiterate that we have reported statistical associations and could not infer causality,” Bradley and her coauthors wrote. “Nevertheless, our findings suggest broadening the debate beyond health care spending to include investments in social services and public health.”