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

Exhibit 5: Social determinants of population health 13

ADDRESSED BY HUMAN SERVICES

20%

40%

30% 10%

Healthcare Access to care Quality of care

Socioeconomic factors Education Employment Income Family and social support Community safety

Health behaviors Tobacco use Diet and exercise Alcohol use Sexual health

Physical environment Quality of environment Home and built environment

Only 20% of health outcomes are attributable to actual healthcare. 80% is attributable to environment, behavior, and socioeconomic factors – all of which are addressed by human services

Source: Data from the Bassett Healthcare Network and University of Wisconsin Population Health Institute, http://www.bassett.org/education/research-institute/population-health/

The potential to improve health outcomes and reduce demand on the healthcare system could have a massive impact on societal finances as well as well-being. Recall that human services CBOs, in aggregate, receive about $240 billion in total funding per year. Now compare that to healthcare spending: in 2016, total United States healthcare spending was $3.4 trillion and will likely reach $5.5 trillion by 2025 given current trends. 14  Even a small impact on healthcare spending will be large in absolute dollars. We have relied here on Third-party research and acknowledge that comparability across geographies is made challenging by differences in data definitions (i.e., what is included in estimates of human services spending in different geographies) as well as the presence of factors other than human services spending which drive healthcare spending. Nonetheless, the research strongly suggests that spending on human services, if properly allocated to effective programs, results in reduced healthcare needs and expenses later. Even small impacts on total long-term healthcare spending will yield significant returns on investments in human services, given the current relative size of the two spending pools.

CRIMINAL JUSTICE AND CORRECTIONS SYSTEMS

Investments in human services also have the potential to produce significant societal returns by reducing costs in the criminal justice and corrections systems.

As in the case of health care, there is evidence that higher spending on human services correlates with much lower incarceration rates (and associated expenses). Countries that spend relatively less on human services (like Estonia, Chile, and New Zealand) tend to have much higher and costlier incarceration rates than countries that spend more on human services (like France, Denmark, and Finland). According to the International Centre for Prison Studies, US incarceration rates are very high even relative to other countries with similar levels of human services spending (for instance, the United States imprisons 716 people per 100,000 of population, compared with 238 in Estonia, or 266 in Chile).

26 |   A NATIONAL IMPERATIVE