Prescription for healthier population: spend more on social services
January 22, 2018 4:20 AM   Subscribe

"Spending more on health care sounds like it should improve health," said Daniel Dutton, a post-doctoral scholar at the University of Calgary’s School of Public Policy. "But our study suggests that is not the case and social spending could be used to improve the health of everyone," said Dutton, lead author of a study published Monday in the Canadian Medical Association Journal.
posted by clawsoon (27 comments total) 25 users marked this as a favorite
 
Yuuuuuup. Though the fact that they found such dramatic effects per .01 additional "social spending" dollars per 1 "health spending" dollars is probably not unrelated to their study taking place at this point on (social, health) curve:
Average per capita spending on social services was $930, compared with $2,900 for health services, the study shows.
Presumably if you were starting closer to parity it would take moving more money to have the same sized effect. Unfortunately given that the data points are province-level and they're all in fairly similar ratios, this type of study can't tell us where we'd expect the optimal ratio to be - it could be that once you've moved $200 you no longer see any further effect, it could be that once you move $2000 you're still seeing meaningful gains from reassigning the next dollar.

(And presumably the politics are such that huge resistance would be put up to any attempt to reallocate spending that way but IANAC.)
posted by PMdixon at 4:32 AM on January 22, 2018 [2 favorites]


Why does an increased budget for one social good have to come from the budget from another social good? Why can’t it come from the budget for, say, police militarization? I also don’t see any recognition in this article about WHY healthcare costs are rising, and whether that is for a good reason or because of corporate greed. I’m not sure how similar the situation in Canada is to here in the US.
posted by zebra at 4:51 AM on January 22, 2018 [26 favorites]


FWIW, many doctors in Canada, particularly in the McMaster University system, are profoundly aware of social determinants of health and are advocating hard at the provincial and federal levels to advance funding for social spending. (Proud to be one of their alumni.)

I can't pretend there's no corporate greed in the Canadian system, but the major drivers of increased costs that I'm aware of are basically that as time goes on 1) we can keep sicker patients alive longer, 2) we have new, exciting, monstrously expensive therapies available, and 3) the population is growing. (Roughly in decreasing order of importance.)
posted by saturday_morning at 5:03 AM on January 22, 2018 [17 favorites]


I don't think it's that we should spend less on healthcare, but rather that healthcare should not cost so much. That is, if we spent more on social services, healthcare cost would go down. Which is, I guess, what the study found. The title of the article is just strangely worded.

Poverty and Health [self-link]
posted by hopeless romantique at 5:14 AM on January 22, 2018 [6 favorites]


Why does an increased budget for one social good have to come from the budget from another social good? Why can’t it come from the budget for, say, police militarization?

Strictu sensu it doesn't, but in the particular example of policing I found numbers suggesting that the entire budget for police forces in Canada inclusive of all levels is ~$13.5B vs the article implying totals of $105B for health and $35M for social spending. So in the words of Sutton, "because that's where the money is [that isn't shielded from tax collection]"
posted by PMdixon at 5:18 AM on January 22, 2018 [3 favorites]


In a world with more workers than jobs, the health of the poor population is no longer a major concern for the wealthy and powerful.
posted by MrVisible at 5:30 AM on January 22, 2018 [9 favorites]


I don’t think the $35 million can be at all correct. Federal social transfers (not healthcare) are almost 11 billion.
posted by warriorqueen at 5:40 AM on January 22, 2018 [1 favorite]


Yeah sorry typo - that should have been 35B. I was just taking the number from the article multiplied by population.
posted by PMdixon at 6:00 AM on January 22, 2018 [1 favorite]


I don’t think the $35 million can be at all correct. Federal social transfers (not healthcare) are almost 11 billion
Maybe it's about the part of social transfers that are directed towards the very weakest citizens. That would make sense here: the poorest people with the lowest education and the worst living conditions cost disproportionately more than everyone else in the health system. By helping them avoid disease by giving them access to better living conditions, many millions could theoretically be saved on healthcare for a much smaller investment in social services. It's more complicated than that, but people are saying that in this part of the world, too.
posted by mumimor at 6:01 AM on January 22, 2018 [1 favorite]


Duh. It took a study to figure this out??Look at 19 century social reforms and slums and the general improvement in health with better sanitation and safer food.
posted by mermayd at 6:33 AM on January 22, 2018 [6 favorites]


I mean, this is so self-obviously true that it shouldn't need to be spelled out in a medical journal, but here we are. In the US, at least, this pattern holds broadly true across all sorts of systems. Why does it cost $30K for an uncomplicated hospital birth? So that Aetna can pay its CEO tens of millions of dollars a year. Why is federal and state spending on emergency service subsidization so high? Because there's a massive underclass of people who use the ER as a primary care resource because we decided to tie health insurance to employment. Why do we spend twice as the rest of the civilized world much educating each student, with worse outcomes? Because we require schools to be function as de facto social workers, after-hour careworkers, and first-line mental health responders.

I'd bet that every dollar we funneled into social services would save between 3 and 10 dollars in educational/medical/criminal justice spending, but then there's a risk of someone extracting more value from the system than they put into it, and lord knows the modern GOP has put its foot down and told us we can't have that.
posted by Mayor West at 6:51 AM on January 22, 2018 [23 favorites]


Given that this is a study performed in Canada, maybe we could keep the conversation on Canada as well?
posted by GenjiandProust at 8:32 AM on January 22, 2018 [19 favorites]


It should probably be noted that U of C has a very strong reputation of being less an institution of higher learning than a conservative think tank (read: thinly-veiled front for corporate interests in the guise of “taxes r bad” libertarianism). Yes, duh, social spending would improve health, but that’s not the message they’re sending here. In the context of Canadian politics, and Albertan politics in particular — the province’s controversial hospital privatization scheme, in particular — this obvious conclusion has an obvious message: Public spending on health care is less important than you think. Fuck that.
posted by Sys Rq at 9:18 AM on January 22, 2018 [12 favorites]


Pretty sure we can have both. This is should not be an either/or choice.
posted by Kitteh at 9:33 AM on January 22, 2018 [4 favorites]


I understand, PMdixon, that $13B is a much small number than either $35B or $103B, but a $13B police budget is still a lot of money that could be repurposed. For example, just in terms of armored vehicles, here's $343K from Winnipeg, $14M from the RCMP along with another $365K each from Ottawa and Saskatoon, and $279K from Hamilton. That's over $15M, which isn't much in the grand scheme of the social services budget, but it's also just what I found in just five minutes on Google.

My point is that there are better places to look for the funding than healthcare; if the study was funding-agnostic but simply arguing for increased social services spending, that would be one thing. Instead, the study argues we should sacrifice currently-sick folks in order to prevent other people from becoming sick in the future. I just don't buy it.
posted by zebra at 9:56 AM on January 22, 2018 [3 favorites]


At this point there's enough evidence that most everyone in the field (that I interact with at least) acknowledges that money spent addressing social determinants results in long term savings and increased QoL for populations. That said, systems haven't found a way to profit from those savings, so even successful programs have trouble finding and sustaining funding.
posted by matrixclown at 10:40 AM on January 22, 2018 [4 favorites]


To expand a bit, there's a few programs (San Diego's RAP for one) that coordinate interventions between Police/EMT/Case Workers so that when a frequent utilizer pops up (enters the ER/has 911 called on them/etc), their case worker is notified and they can triage quickly. It's effective.

But programs for social good don't get funding. In my experience there has to be financial incentive that shows an ROI for systems. Collective impact models are one way to address this in the future, but they're new and immature and everyone is still trying to figure out how to make them viable.
posted by matrixclown at 10:56 AM on January 22, 2018 [4 favorites]


zebra:
I'm sure a tiny fraction of that $13B given to Canadian police is for anything we could call "militarization." Almost certainly, it's going overwhelmingly to salaries and vehicle expenses.

And not every scary piece of hardware a police department buys is bad. If the police don't have the equipment they need, then serious civil unrest will either go unaddressed, or the military will be called in, or we'll get vigilante justice. Canada is not the US, where police are vastly more militarized, in part because our crime rate is way higher and our civilian populace is armed to the tooth, plus some less savory reasons.

As far as cutting the Canadian military, that isn't actually a good idea. Canadian military spending peaked at 1.4% of GDP under the Harper government, which is still well below the 2% commitment Canada has to NATO. Under Trudeau, it's now around $16B, or 1.0% of GDP, making it lower than any other NATO country. Significant cuts to the Canadian military would mean some combination of increased reliance on the US and reduced security for Canadians. As with police, your point is more valid for the US, where military spending is 3.3% of GDP (and social services are much worse).

The responsible way to increase social services in Canada is probably not to cut healthcare, or the police, or the military, or anything else. It is to raise another $15-30 billion or so in taxes, ideally from the rich or from something like carbon taxes. But really, from any normal tax source would be fine.

Not every justifiable expenditure is justification for slashing things progressives find icky.
posted by andrewpcone at 11:15 AM on January 22, 2018 [5 favorites]


lower than any other NATO country.

Sorry, I misread a chart. It is still very low, but Latvia, Lithuania, and Luxembourg are lower. But they are, like, not that comparable to Canada.
posted by andrewpcone at 11:39 AM on January 22, 2018 [2 favorites]


The obvious next step is to classify the most medically effective social services as health care.
posted by Easy problem of consciousness at 12:40 PM on January 22, 2018


Duh. It took a study to figure this out??Look at 19 century social reforms and slums and the general improvement in health with better sanitation and safer food.

Can we not do this anti-science reaction duh thing?
posted by MisantropicPainforest at 1:06 PM on January 22, 2018 [12 favorites]


Sys Rq: In the context of Canadian politics, and Albertan politics in particular — the province’s controversial hospital privatization scheme, in particular — this obvious conclusion has an obvious message: Public spending on health care is less important than you think. Fuck that.

On the other hand, if studies like this help inject the idea into Alberta politics that maybe heroic self-reliance isn't everything and maybe a little more social welfare is a good thing, it wouldn't be a bad outcome.
posted by clawsoon at 4:03 PM on January 22, 2018 [4 favorites]


My point is that there are better places to look for the funding than healthcare; if the study was funding-agnostic but simply arguing for increased social services spending, that would be one thing. Instead, the study argues we should sacrifice currently-sick folks in order to prevent other people from becoming sick in the future. I just don't buy it.

I don't know that it actually argues that: The claim applies just as well to additional dollars as current ones. And:

The responsible way to increase social services in Canada is probably not to cut healthcare, or the police, or the military, or anything else. It is to raise another $15-30 billion or so in taxes, ideally from the rich or from something like carbon taxes. But really, from any normal tax source would be fine.

is pretty much correct. If increased government expenditure is worthwhile, it's worth taxing for.
posted by PMdixon at 8:28 PM on January 22, 2018 [1 favorite]


Note to readers: the University of Calgary is a real public university in Canada, not actually a conservative think tank.

Yes, duh, social spending would improve health, but that’s not the message they’re sending here. In the context of Canadian politics, and Albertan politics in particular — the province’s controversial hospital privatization scheme, in particular — this obvious conclusion has an obvious message: Public spending on health care is less important than you think. Fuck that.

God forbid they apply analysis to maximizing use of tax dollars. Yes, we should spend more on both health care and social services. But tax dollars are limited so we have to be smarter than that.

I live in Alberta and I don't know what hospital privatization scheme you're referring to. It never happened in 44 years of PC rule, and to state the obvious it's not on the table for the current NDP government.
posted by Pruitt-Igoe at 12:26 AM on January 23, 2018 [5 favorites]


I don't see how this is different from the argument for Housing First that we can spend public dollars to house people and save more public dollars in the health care and justice systems. Other than it being tainted by being associated with the university of Calgary in the province of Alberta.
posted by Pruitt-Igoe at 12:43 AM on January 23, 2018 [2 favorites]


While I understand people are concerned about budget changes, in countries like Canada where medical and social services are funded by the government, we should seek to optimise that funding.
This can happen by, for example, reducing the budget for hepatitis treatment after demand drops because social services budgets were expanded to target at risk individuals for increased vaccination. Keeping such funding when unneeded would be wasteful.

Changes in budget priorities can and should be reflected by need and efficiency.
posted by bystander at 11:50 PM on January 24, 2018 [2 favorites]


Changes in budget priorities can and should be reflected by need and efficiency.

While I definitely agree with this prescriptively, it is not wrong to say that frequently changes in budget priorities resemble a bait and switch so I understand the distrust of moving money around from the fear that the promised benefit to one area's resourcing is not going to show up to counterbalance the cost to another's and won't say it's unreasonable.
posted by PMdixon at 11:58 PM on January 24, 2018 [1 favorite]


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