Health and social services expenditures: associations with health outcomes

Bradley, Elizabeth H.; Elkins, Benjamin R; Herrin, Jeph; Elbel, Brian

doi:10.1136/bmjqs.2010.048363

Cited by 292 publications

(239 citation statements)

References 20 publications

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“…Public misattribution of credit may also partially explain why the United States neglects funding public health initiatives and fails to address the social determinants of health. Research shows that the United States increasingly lags behind other countries in life expectancy as other nations more fully address the social service needs of the population [30]. Given that almost a fifth of the national gross domestic product is spent on healthcare, it is difficult to find resources to address healthenhancing social service needs.…”

Section: Discussionmentioning

confidence: 99%

Explanations for 20th Century Tuberculosis Decline: How the Public Gets It Wrong

Merrill¹,

Davis²,

Lindsay³

et al. 2016

JTR

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Introduction: Historical analysis of health data indicates that the majority of the decrease in tuberculosis mortality during the past century was caused by improved social conditions and public health interventions. The purpose of this study was to assess lay public perceptions regarding why tuberculosis declined. Materials and Methods: A nationally representative sample of 705 adults was surveyed to identify their perceived reasons for the decline in tuberculosis mortality in the 20th century. Openended questions and responses were coded and placed into eight categories. Results: Approximately 52% of decreasing tuberculosis mortality was attributed to "modern medicine," and 220% to "vaccination." Comparatively few of the respondents attributed decreased tuberculosis mortality rates to public health or improvements in social health determinants of health. Males gave more credit to modern medicine and public health, with less to vaccination; the other racial group gave more credit to public health and less to modern medicine; Hispanics gave more credit to modern medicine and less to vaccinations; and the higher income groups gave more credit to vaccinations and public health, but less to modern medicine. Conclusion: The public overly attributes modern medicine as the primary cause of declining tuberculosis mortality rates, the second leading cause of death in the United States during the early 1900s, and gives little credit to the critical role played by public health and improved social conditions. These misperceptions may hinder societal efforts to address and fund important social determinants of health and public health interventions.

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Section: Discussionmentioning

confidence: 99%

Explanations for 20th Century Tuberculosis Decline: How the Public Gets It Wrong

Merrill¹,

Davis²,

Lindsay³

et al. 2016

JTR

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show abstract

“…Not surprisingly, the US fares poorly on most population-based health outcomes compared to other Organization for Economic Cooperation and Development (OECD) countries. 8 The same is true within the US, where states with a higher ratio of social to health spending have improved health outcomes across a broad spectrum of common illnesses, which in turn is likely to have an important beneficial impact on downstream medical expenditure. 9 Any discussion of how to improve health outcomes, and/ or to lower related healthcare costs, must extend beyond the "healthcare system" itself; we believe that adequate investment in social services is critical to achieving both these goals.…”

Section: Is Any Of This a Surprise?mentioning

confidence: 98%

“…Investment in social services that address inequality and/or inadequacy of income, education, housing, nutrition, transportation, and employment can greatly improve health outcomes. 8,9 The United States (US) spends much more per capita on health services versus social services than almost any other country, but the opposite approach-with greater investment in social services relative to health services-is associated with substantially better health outcomes. Not surprisingly, the US fares poorly on most population-based health outcomes compared to other Organization for Economic Cooperation and Development (OECD) countries.…”

Section: Is Any Of This a Surprise?mentioning

confidence: 99%

Hot-Spotters Aren’t “The Problem”...But They Are Emblematic of the Failure of U.S. Healthcare

Kanzaria

Hoffman

2016

J GEN INTERN MED

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“…30 Nationally, identifying where social service and public health expenditures can be augmented may also prove impactful. 31 The increased focus on clinical quality metrics and payment for health outcomes and disparity reduction, not simply for volume of care, would support a broadened approach to these types of health interventions. 49,50 Additional factors are also likely to affect and explain residual disparities.…”

Section: Figurementioning

confidence: 99%

“…Adding hardship to patient-and population-level assessments could determine where disparityreducing investments could be targeted, elevating financial and social screening and interventions to the level of medical tests and treatments. 30,31 Thus, we first sought to characterize racial differences in time to asthmarelated readmission in a populationbased pediatric cohort. Second, we aimed to assess the degree to which SES and markers of financial and social hardship explained expected racial disparities in readmissions.…”

mentioning

confidence: 99%

Role of Financial and Social Hardships in Asthma Racial Disparities

Beck¹,

Huang

Simmons³

et al. 2014

Pediatrics

150

132

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BACKGROUND AND OBJECTIVES: Health care reform offers a new opportunity to address child health disparities. This study sought to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models. METHODS: We enrolled 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing in a population-based prospective observational cohort. The outcome was time to readmission. Child race, socioeconomic status (measured by lower income and caregiver educational attainment), and hardship (caregivers looking for work, having no one to borrow money from, not owning a car or home, and being single/never married) were recorded. Analyses used Cox proportional hazards. RESULTS: The cohort was 57% African American, 33% white, and 10% multiracial/other; 19% were readmitted within 12 months. After adjustment for asthma severity classification, African Americans were twice as likely to be readmitted as whites (hazard ratio: 1.98; 95% confidence interval: 1.42 to 2.77). Compared with whites, African American caregivers were significantly more likely to report lower income and educational attainment, difficulty finding work, having no one to borrow money from, not owning a car or home, and being single/never married (all P ≤ .01). Hardships explained 41% of the observed racial disparity in readmission; jointly, socioeconomic status and hardship explained 49%. CONCLUSIONS: African American children were twice as likely to be readmitted as white children; hardships explained >40% of this disparity. Additional factors (eg, pollution, tobacco exposure, housing quality) may explain residual disparities. Targeted interventions could help achieve greater child health equity.

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Health and social services expenditures: associations with health outcomes

Abstract: Attention to broader domains of social policy may be helpful in accomplishing improvements in health envisioned by advocates of healthcare reform.

Cited by 292 publications

References 20 publications

Explanations for 20th Century Tuberculosis Decline: How the Public Gets It Wrong

Explanations for 20th Century Tuberculosis Decline: How the Public Gets It Wrong

Hot-Spotters Aren’t “The Problem”...But They Are Emblematic of the Failure of U.S. Healthcare

Role of Financial and Social Hardships in Asthma Racial Disparities

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