Connecting Social Services with Health Outcomes

Is there a correlation between how much a state spends on social services and its population health outcomes? Are there ways for states to integrate social and health spending in order to improve population health outcomes?

That was the focus of a talk given by Elizabeth Bradley, PhD, Professor of Health Policy at the Yale School of Public Health and Director of the Yale Global Health Leadership Institute, at a Reforming States Group Steering Committee meeting earlier this month.

Co-author with Lauren A. Taylor of the 2013 book, The American Healthcare Paradox: Why Spending More Is Getting Us Less, Professor Bradley focuses on the relationship between health care spending and health outcomes—specifically why a country like the U.S. spends more on health care than other countries yet has poorer health outcomes.

“Health and health care are not the same thing,” she said, citing literature that maintains that health is determined by genetics (20%), health care (20%), and social, environmental and behavioral factors (60%). Her research reveals that countries with higher ratios of social-to-health spending have statistically better health outcomes. Spending on social services includes employment programs, supportive housing, education, parks and environment, and nutritional support and family assistance.

Recently, Professor Bradley began to ask the same questions of U.S. states. Looking at state variation in Medicaid spending and social services spending, she found that, not surprisingly, states with higher ratios of social-to-health spending had statistically better health outcomes, including obesity rates, neonatal mortality, mortality rates after heart attacks, and more.

Why might the U.S. spend more on health care than “health”? “Health care and social service sectors grew up fairly independent from one another,” said Professor Bradley. “Health care grew professionalized and fit into a marketable, valued commodity for purchase. Social services were conceived of as being for ‘the poor’ and an act of charity or government duty.”

She sees innovative programming as a possible step toward better health outcomes. She cites examples of projects in Portland, Oregon, and Los Angeles in which homeless individuals are given affordable housing with strong medical support and these projects have been found to reduce health care costs and improve health.

“One thing we have going for us in the U.S. is innovation,” she explained. “We no longer smoke in restaurants. That was a shift. There could be others. Imagine if the people working in housing and the people working in health care got together to talk.”

“If we know what improves health, can states orient public policies to reflect that?” asked Milbank Memorial Fund President Christopher Koller. “Professor Bradley’s research helps answer that question and gives us new evidence about what’s needed to improve health outcomes. It was a great discussion with a group of state health policy leaders, and the Fund looks forward to continuing the conversation in the service of informing state policymaking to improve population health.”