In the U.S., we invest heavily in health care and not nearly enough on the support services and programs that affect health, sometimes called the social determinants of health. Yet, there’s good evidence to suggest it would be wise if states invested more money on public health services to support their populations. People living in states that invest more in public health and social supports, such as housing, nutrition and income-support programs, relative to health care, have better health outcomes than people in states with less focus on public health and social supports.
What are social determinants of health? Where we live, where we go to school, what we eat and drink, and our household incomes all factor into your health. In addition, not smoking, exercising, getting needed vaccines and social and economic opportunities help determine our health, as do our social relationships. Our goal as a nation should be “to create physical and social environments that promote good health for all.” And, some states do better than others on this front.
A new study published in Health Affairs on variation in health outcomes among states finds that higher state investments in social services relative to health care lead to fewer obese people and people with asthma, as well as lower death rates for type 2 diabetes, lung cancer and heart attacks and fewer reported mentally unhealthy days and days with physical limitations. Your community matters!
The study could not establish causality between greater investments in social supports and public health and better health outcomes. But, the data suggest it is worth looking more deeply at investing in social supports as a possible way to lower health care usage and improve population health. Past research has shown that seven in 10 of some cancer cases, eight in 10 of heart disease cases and nine in 10 of stroke cases result in some part from environmental, behavioral and social causes.
The United Health Foundation’s 2015 Health Rankings looked at quality of health care, percentage of primary care doctors, prevalence of diseases, obesity rates, chronic drinking, and preventable deaths among other factors in the 50 states. It ranked Hawaii as the healthiest state, Vermont as the second healthiest and Massachusetts as the third healthiest. Louisiana was ranked as the least healthy, with Mississippi ranking almost as poorly and Arkansas and West Virginia faring only slightly better.
A separate report looks at the healthiest and least healthy states for older adults. Hawaii and Vermont are still at the top of the list, with Vermont ranking as the most healthy and Hawaii ranking fourth after New Hampshire and Minnesota. Louisiana again ranks at the very bottom with Mississippi, Kentucky and Arizona right behind.
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