To Improve Health, Spend More on Social Services

Does a stronger safety net mean a healthier community?  Apparently so, according to recent research.

It’s a well-known fact that the United States spends 16% of its GDP on health, far more than any other country in the developed world.

It’s also a well-known fact that all of our health spending doesn’t give us an edge in life expectancy or a number of other indicators of the overall health of the population.  One of the reasons for this is that we spend so little on public health, compared to health care.

But there may be another reason, too. 

We spend too little on welfare and social services. 

To put this into context, it is important to remember – with a nod to the late George Carlin – that “welfare” wasn’t always one of the “seven dirty words” no politician could utter in public.  (The others today are “liberal,” “tax” and “increase” used in the same sentence, and “bigger,” “government,” and “spending,” also used in the same sentence.)

When I was a member of the Connecticut Legislature in the 1980s, the most common argument about welfare was whether we should increase welfare benefits by the same percentage as the increase in the cost of living (liberals held to this position), or whether we should cap them at something akin to the percentage increase in the overall state budget (conservatives held to this one).

President Clinton and Speaker Gingrich changed all that in the 1990s when they struck a bipartisan agreement never to promote welfare again unless it was coupled with the word “reform.”

However, if we care about health, it may be time to think about reforming welfare reform.

In an article entitled Health and Social Services Expenditures: Associations with Health Outcomes (the abstract is available using the link; the full article is available for purchase), Dr. Elizabeth Bradley of the Yale School of Public Health and three colleagues showed that more spending on social services may lead to even greater improvements in life expectancy, infant mortality, and potential years of life lost than more spending on health services.

They did this by comparing overall health and social services spending for thirty countries, including the United States, and linking this to five indicators of health.

Most of the other countries in the analysis spent about twice as much on social services, as a percentage of GDP, than they did on health.  The United States spent a little less (13%) on social services than we did on health (16%). 

Our combined 29% may seem high, but it is pretty close to the average for developed countries.  This is because we spend less on social services as a percentage of GDP than do others. 

But it looks like spending just a few percentage points more on social welfare could lead to lower death rates from infancy on.

These are the types of social services spending that are associated with longer, healthier lives:

• Public and private spending on old-age pensions
• Spending on support services for older adults
• Survivors’ benefits
• Disability benefits
• Family support
• Employment training and programs
• Unemployment benefits
• Housing support

This list of life-promoting programs reads like a “what’s what” on the state and Congressional chopping blocks these days.

What this excellent article suggests is that we’re not thinking through the relationship of welfare to health.   When we started cutting our social services programs many years ago, we didn’t realize that we were going to be paying the price in higher health care costs and lower life expectancy.

The authors drew the following measured conclusion:

“Although most health-reform efforts to improve health status focus on health expenditures, it may be that additional attention on social services is also needed. This approach is consistent with public-health frameworks, which have frequently highlighted the social over the biological and medical determinants of health.”

After reading the article, I’d say it’s hard to argue with that conclusion.

And I would like to suggest a second one.  In our Declaration of Independence, our nation’s founders asserted that we have an unalienable right to life.  When we knowingly make policy decisions that abridge this right, it is the essence of anti-Americanism.

So, channeling George Carlin once again, maybe it’s time to take a more liberal view of welfare, by supporting whatever tax increase is needed to support the government spending required for it to play a bigger part in protecting the lives of our people.

If you have questions about this column or wish to receive an email notifying you when new Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.