A National Imperative: Joining Forces to Strengthen Human Services in America (Jan 2018)

and has been explored in books such as the aptly titled The American Health Care Paradox: Why Spending More is Getting Us Less, by Elizabeth Bradley and Lauren Taylor.

On average, other economically developed nations spend three times more on human services than the US, relative to healthcare spending

Research reveals that while the United States outspends its peers on healthcare, it massively underspends on human services. According to data compiled by The Brookings Institution, the average Organization for Economic Cooperation and Development country spends more on human services than on healthcare, whereas the United States spends more on healthcare than human services. Proportionally, human services spending relative to healthcare spending is three times larger in the average OECD country than in the US. 10  Research also suggests that the lower spending on human services contributes to the higher healthcare costs. While there are clearly other factors which drive United States healthcare spending, and which differentiate the United States from other countries, the relationship between social determinants of health and subsequent health spending and outcomes is strong. Provision of proper housing, for instance, has been demonstrated to lead to a wide range of positive long-term health outcomes associated with reduced lead and mold exposure, in addition to positive behavioral health outcomes associated with improved safety. Similarly, nutritional support during pre-natal and early childhood periods has been demonstrated to yield positive long-term health outcomes, and reduced long-term healthcare expenses associated with diabetes, hypertension, and other ailments. Similarly, research suggests a strong linkage between a person’s health and well-being as an adult and the presence of “Adverse Childhood Experiences,” or ACEs, during childhood. ACEs include emotional, physical, and sexual abuse; household dysfunction, in the form of spousal abuse, substance abuse, mental illness, separation or divorce, and incarcerated family members; and emotional and physical neglect. An increasing number of ACEs has shown to be predictive of an increasing array and severity of health and well-being-related challenges across the course of one’s life. Since human services and supports are targeted toward preventing and treating the impacts of ACEs, human services CBOs work to produce better health outcomes and ultimately lower healthcare spending. 11 Skeptics have argued that the disparity between human services and healthcare spending in the United States relative to other countries reflects broader differences between these countries and cannot be interpreted as meaning that increased human services investment would result in reduced healthcare spending in the US. While there clearly are many structural and demographic differences between the United States and other OECD countries, research suggests that the relationship between human services and healthcare spending holds true across different locations within the United States. A recent study published in Health Affairs journal concluded that “states with higher ratios of social to health spending had better health outcomes one and two years later.” 12 As shown in Exhibit 5, fully half of health outcomes can be explained by socio-economic factors and physical environment factors, including housing. Interestingly, only 20% of health outcomes can be attributed to actual healthcare access and quality.

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