Health care has emerged as a central issue in the 2020 presidential election to no surprise as access to health care continues to be a major problem in the U.S., along with inequalities in health outcomes, and high healthcare costs. As presidential candidates continue to weigh in on these issues, they fail to recognize the missing link in these arguments: the relationship between spending on social services and health outcomes. 

The United States spends a significant portion of its GDP on health care. In 2017, the U.S. spent an approximate $10,000 per person in health costs – 50% higher than other industrialized nations. Comparatively, however, the U.S. continues to lag behind in an array of health care quality indicators. The Robert Wood Johnson Foundation posits that the benefit of the enormous spending on health care in the US is undercut by the nations lack of investment in social services. 

Research has shown that improvements in health tend to come from additional investments in good living environments in contrast to increased investments in medical services. The U.S. Centers for Disease Control, for example, approximates that medical care, and genes together consist of 50% of the influence on population health, while social and environmental factors also referred to as the social determinants of health (SDOH) influence the remaining 5o%.

SDOH, broadly defined as the “conditions in which people are born, grow, live, work and age“ are thus crucial to improving health outcomes. Programs that effectively address SDOH are shown to improve health outcomes and lower health care costs by providing access to proper nutrition and safe, reliable housing, which are vital to disease prevention.  Especially important are programs that focus on housing- one of the most researched social determinants of health. 

Two initiatives – one in Vermont, and the other in Oregon – demonstrate the benefits of the aforementioned social programs. The program in Vermont for example, resulted in the creation of Harbor Place, permanent and short term housing units for the homeless population through collaborations with housing, supportive services, and investment partners. Since its opening, it has resulted in decreased emergency room visits by 42%, cut inpatient admission costs by 81%, and resulted in an overall saving of $10,300 per person. The financial gain is profound; yet, there is a more far-reaching impact. Due to their partnership with supportive services, Harbor Place has also become a point of entry for case management. It has increased the chances of the individual ending up in a permanent home by upwards of 500%, thus successfully taking people off of the streets as well. 

The program in Oregon was similarly created while keeping the state’s population of nearly 10,000 individuals who are experiencing unstable housing in mind. They partnered with local housing contractors to provide secure housing and they too saw an immense improvement in health and an even greater reduction of health care costs. Medicaid expenditure decreased by 12%. At the same time outpatient primary care increased by 20%– a more reliable and consistent source of health care delivery. Moreover, emergency department use declined by 18% for this group and hospitals saved upwards of $23,000 per person. There was additionally a positive impact on measures of psychological distress and intimate violence. The effects of this intervention were felt all around and there was a clear improvement of the society altogether. 

These interventions are small scale but, their goal is to reform healthcare by improving health and economic outlooks of communities at large. They are supported by a growing body of literature that underscores the importance of social programs. The United States however continues to allocate only a small percentage of its health care expenditure on such programs while other developed nations who outrank the U.S. in a number of health care indicators, continue to commit far more to social services while spending far less on health care.

Overall, there is evidence to recommend that the U.S. look to re-balance the distribution of medical and social spending where social interventions have had a positive effect on health outcomes in order to improve the U.S.’s trailing health outcomes.