Spending on Social Services Improves Health Outcomes

Canadian study finds that social service spending is associated with a decrease in mortality and increase in life expectancy


A new study from researchers at the University of Calgary, published in the Canadian Medical Association Journal, explores the connection between government spending on healthcare and social services and health outcomes. Their results suggest that increases in public spending on social programs are associated with decreases in mortality rates and improvements in life expectancy. The authors, led by Daniel J. Dutton, emphasize that increases in social programs may ultimately save money by preventing the overuse of medical resources.

“Healthcare costs are rising so fast in advanced economies that they will become unaffordable by mid-century without reforms,” they write.

Photo Credit: “Injured Piggy Bank With Crutches,” by Ken Teegardin (Flickr)

The authors of the present article cite reports from the Organization for Economic Co-operation and Development, stating that healthcare costs are rising quickly in advanced economies. Previous research finds that spending on both health and social programs is significantly related to health outcomes. However, the authors highlight recent data suggesting that “the health care system accounted for only 25% of health outcomes,” whole “socioeconomic environment is the most powerful of the determinants of health.”

A growing number of researchers are uncovering the significant impact that social determinants have on health outcomes. Research has demonstrated that providing social and economic supports results in more effective treatment while reducing the cost of healthcare. Even more specifically, researchers have shown that social factors such as social connection have a significant impact on length and quality of life. The authors of the present study undertook a comparative analysis of health and social spending to explore the relationship between social and health spending and health outcomes.

The researchers utilized data from expenditure reports spanning from 1981 to 2011 to look at the impact of social and health spending on avoidable reports of mortality, infant mortality, and life expectancy. The data included reports of government health and social spending. Health spending in public accounts was identified as “health,” “health and healthy living,” “health and wellness,” and “health and community services.” Social spending was identified typically as a variant of “social services,” such as “social services and assistance,” “family services,” “family and community services” and “social development.”

Measures of health outcomes included potentially avoidable mortality, infant mortality, and life expectancy. The independent variable was the ratio of government spending on social services relative to spending on health care. Variables controlled for included demographic and economic variables. The researchers controlled for age, gender, rural vs. city status, unemployment rate, the median after-tax income, the Gini coefficient (a measure used to describe regional income inequality), and total real expenditure.

Average per capita spending on health was approximately three times higher than average per capita social spending (2.90 vs .93; in thousands of dollars). Over time, the health variables had a positive trend across potentially avoidable mortality (431 per 100000 to 208.7 per 1000000), infant mortality (from 9.6 per 100 live births to 4.8 per 100 live births), and life expectancy (from 78 years to 81.1 years). Spending on health also increased over time. After controlling for time, the study found that social spending, rather than healthcare spending, was most significantly associated with health outcomes.

“A 1 cent increase in social spending per dollar spent on health was associated with .1% decrease in potentially avoidable mortality and a .01% increase in life expectancy. The relationship between the ratio and infant mortality was non-significant,” the authors report.

In addition, an increase of one standard deviation in the ratio of social to health spending was associated with a .0462 standard deviation decrease in potentially avoidable mortality and a .0819 standard deviation increase in life expectancy. Remarkably, their data suggests that the average life expectancy of a population may have more to do with social spending than mortality rates. The analysis also reports that unemployment rates are associated with worse mortality rates and infant mortality outcomes.

The authors take these results as evidence in support of shifting funding from health care spending to social spending. The analysis shows that increasing social spending may have a positive association with population health, while spending on health care may not have as great an impact. These findings are congruent with the burgeoning body of research showing the significant impact of social determinants on health outcomes.

“Social spending,” the authors write, “is a form of preventative health spending and changes the risk distribution for the entire population rather than treating those who present with disease. Redirecting resources from health to social services, at the margin, is an efficient way to improve health outcomes.”



Dutton, D. J., Forest, P. G., Kneebone, R. D., & Zwicker, J. D. (2018). Effect of provincial spending on social services and health care on health outcomes in Canada: an observational longitudinal study. Canadian Medical Association Journal190(3), E66-E71. (Link)

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Bernalyn Ruiz
MIA Research News Team: Bernalyn Ruiz-Yu is a Postdoctoral Fellow in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles. She completed her Ph.D. in Counseling Psychology from the University of Massachusetts Boston. Dr. Ruiz-Yu has diverse clinical expertise working with individuals, families, children, and groups with a special focus on youth at risk for psychosis. Her research focuses on adolescent serious mental illness, psychosis, stigma, and the use of sport and physical activity in our mental health treatments.


  1. Glad it’s beneficial for Canada and it’s what’s needed to best serve people. I agree with and support social spending in America however don’t we already spend quite a bit on social spending here?

    In America with baby boomer generation age increase there is not enough funds for primary and mental healthcare. This probably better to fund in America. In mental healthcare to do innovative peer run services and alternatives to hospitalization and so on.

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  2. Spending money to address poverty, the wage gap, the class war, sexism, ageism, and all other forms of causation to “mental health” problems won’t happen in the US because these problems create a vast, unending well of weath and job security for those at the top of the food chain (providers, judicial system, “social service” programs, nursing homes, etc). This is those in power preying on the weak and vulnerable from cradle to grave and creating more illness in the process. It’s really sickening what this greedy country has devolved into. Talking about and educating about issues is great work but we are way beyond a point where that is effective and it has now become not education/awareness but grooming.

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    • That doesn’t mean it won’t happen, it takes a lot of organising for things to change though. It takes a mass movement with clear aims. Bernie Sanders did well, though obviously not well enough, in the primaries against Clinton. The support for this kind of change is there, but not well organised.

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  3. i don’t hold out great hope for making American culture more live-able, humane, etc. even the churches are largely bought out by mega-corporations and the military industrial complex. a part of me hope that Trump is the product of a dying worldview, a sort of last hurrah for some of the uglier parts of American culture, but…I’m not so sure.

    its profit, its ideology, its a toxic, decaying culture that shuts up those who dissent, one way or another.

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  4. The US needs a socialist political party!
    They have a far right party that seems as feudal as the empire they tried to escape from.
    They have a middle party that desperate people sometimes have to vote for.
    But Bernie Sanders and Ralph Nader made me realize that you don’t really have a people’s party.
    Of course a socialist party can go too far and hurt the economy, but in a healthy country the electorate can hopefully change course, if they have the option, which I don’t think they now have.
    After our psychotherapeutic psychiatric units were closed in the US because we wouldn’t drug people, I had to return to Canada to get funding to give people psychotherapy.
    It saves money to get people better than to keep them drugged .
    I’m glad that the old saying is proving correct:
    An ounce of prevention is worth a pound of cure.

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    • Sanders is a social-democrat, not a socialist, though I believe he had a more genuinely Marxist past.

      A “socialist party” would be a betrayal of socialism in a sense, as socialism is supposed to replace capitalism, not vote in its elections. Nonetheless if “progressives” had any sense here they’d be busy trying to purge the ultra-right from the Democratic Party instead of 24/7 Russia-baiting. Trump is a blessing in disguise, as he’s creating internal chaos in both major corporate parties; leftists should take advantage of this instead of crying like liberals.

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