Redefining Investment in Health: A Comparative Analysis of the Relationship Between Social Service Expenditure and Population Health Across OECD Nations

Abstract

The United States spends more on health care than any other developed nation per capita and as a percent of GDP, yet achieves relatively poor population health. This contradiction is naturally concerning, however, no explanation or solution has gained consensus in public health or health policy discourse.

A nascent body of research has linked social service expenditures to statistically significant improvements in population-level health outcomes as a potential explanation for this American health enigma. This thesis seeks to replicate and expand upon the existing body of literature to identify a relationship between social service expenditures and population health at the national level.

This thesis first performs a qualitative review of the existing literature on medical and non-medical determinants of health and their relationship to social service expenditures and health outcomes. Next, this thesis employs regression analyses to identify statistically significant relationships between social service expenditure and life expectancy, infant mortality and potential years of life lost across the 35 member states of the Organisation for Economic Cooperation and Development.

These analyses predict that a 1% increase in government social service expenditure would be associated with an 8 week increase in life expectancy, one fewer infant death per 7,500 live births, and a decrease in potential years of life lost of approximately 1 year per 10 million inhabitants. These analyses next found that a 1 point increase in the ratio of government social expenditure to government health expenditure was associated with a 10 month increase in life expectancy, a reduction of 1 infant death per 1,400 live births, and 6.7 fewer potential years of life lost per 10 million inhabitants. Similarly, a 1% increase in total net social expenditure was associated with an 8 week increase in life expectancy, a reduction of 1 infant death per 4,000 live births, and a 6 month reduction in potential years of life lost per 10 million people. A 1 point increase in the ratio of total net social expenditure to total net health expenditure was associated with a 1.35 year increase in life expectancy, 1 less infant death per 342 live births, and 3.119 fewer potential years of life lost per 10 million inhabitants.

This thesis continues by reviewing the history of the American social sector and comparing the American welfare state with examples from abroad, thereby finding that the American social sector is less inclusive, programmatically broad, and generous than models that have produced better population health in peer states. This thesis goes on to establish the political feasibility of increased social investment by examining the effects of political messaging on opinion about increased social sector investment, finding that arguments appealing to both conservative and liberal moral values have the power to augment support for increased social service investment in the U.S., particularly at the state level.

This thesis concludes by recommending that the United States improve its population health and resolve its spending enigma by prioritizing social service provision as a more effective means for addressing social determinants of health and investing in long-run population health gains.