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Investing in social care has a greater impact on population health

increasing on social services rather than health care has a greater impact on population health

Ingrid Torjesen

Monday, 22 January 2018

Increased spending on social services was associated with health improvements at the population level, while health spending increases did not have the same effect, according to a large Canadian study* published in CMAJ (Canadian Medical Association Journal).

The study looked at data from nine of Canada's ten provinces over 31 years from 1981 to 2011 (Prince Edward Island and the northern territories were not included because of insufficient data) to see if social and health care spending ratios were linked to population health status. The researchers looked at three health outcomes: potentially avoidable mortality, infant mortality and life expectancy.

Average per capita spending on social services was $930 compared with $2900 -almost three times the amount- for health services. Health spending per capita increased tenfold over the study period compared with social spending. However, increased social spending per dollar spent on health care was associated with improved health outcomes at the population level by province.

"Social spending as a share of health spending is associated with improvements in potentially avoidable mortality and life expectancy," said researcher Dr Daniel Dutton, The School of Public Policy, University of Calgary, Calgary, Alberta: "If governments spent one cent more on social services per dollar spent on health by rearranging money between the two portfolios, life expectancy could have experienced an additional 5% increase and potentially avoidable mortality could have experienced an additional 3% decrease in one year."

He added: "If social spending addresses the social determinants of health, then it is a form of preventive health spending and changes the risk distribution for the entire population rather than treating those with disease. Redirecting resources from health to social services, that is, rearranging payment without additional spending, is an efficient way to improve health outcomes."

In a related commentary, Dr Paul Kershaw, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, wrote that the researchers found that increased health spending "is associated with lost opportunities to improve life expectancy and prevent avoidable mortality by comparison with a more even distribution between medical and social investments. These results add to evidence that should impel governments to seek better balance between medical and social expenditures."

Governments have increased health spending as the aging population has expanded. Dr Kershaw added that governments should allocate social spending fairly for both young and old to ensure that the younger generation is not being short-changed.


*Dutton D, Forest P-G, Kneebone R, et al. Effect of provincial spending on social services and health care on health outcomes in Canada: an observational longitudinal study.

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