title: Variation In Health Outcomes: The Role Of Spending On Social Services, Public Health, And Health Care, 2000-09.
abstract: Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000-09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health-not only in health care but also in social services and public health-is warranted.
authors.affiliation: Elizabeth H. Bradley (Elizabeth.Bradley@yale.edu) is the Brady-Johnson Professor of Grand Strategy and a professor of public health at the Yale School of Public Health, in New Haven, Connecticut.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.affiliation: Maureen Canavan is an associate research scientist in health policy and management at the Yale School of Public Health.
authors.forename: Maureen
authors.initials: M
authors.lastname: Canavan
authors.affiliation: Erika Rogan is a doctoral candidate in health policy and management at the Yale School of Public Health.
authors.forename: Erika
authors.initials: E
authors.lastname: Rogan
authors.affiliation: Kristina Talbert-Slagle is a senior scientific officer and lecturer of health policy and management at the Yale School of Public Health.
authors.forename: Kristina
authors.initials: K
authors.lastname: Talbert-Slagle
authors.affiliation: Chima Ndumele is an assistant professor of health policy and management at the Yale School of Public Health.
authors.forename: Chima
authors.initials: C
authors.lastname: Ndumele
authors.affiliation: Lauren Taylor is a doctoral student at the Harvard Business School, in Boston, Massachusetts.
authors.forename: Lauren
authors.initials: L
authors.lastname: Taylor
authors.affiliation: Leslie A. Curry is a senior research scientist at the Yale School of Public Health.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
mesh_terms: D002908:Chronic Disease / Q000639:trends; D003695:Delivery of Health Care / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data* / Q000639:trends; D011634:Public Health / Q000191:economics*; D012189:Retrospective Studies; D012947:Social Work / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States
keywords: Health Outcomes; Population Health; Social Determinants