Combining social programs and sick care

Paul Levy posts striking data from a report by The Blue Ridge Academic Health Group. A breakdown of healthcare spend (public health, medicine, the two added together) as a proportion of total GDP follows:

Country — % of GDP on Social Programs | % of GDP on Sick Care | Total % GDP

United States — 2.3% | 16% | 18.3%

Canada — 5.8% | 10% | 15.8%

Netherlands — 9.6% | 9% | 19.6%

Sweden — 11.6% | 9% | 20.6%

That’s striking. Though I’m unsure what to make of it. The report says:

Our current health care system is costly and ineffective to an increasing degree each year because it has too limited a focus – sick care delivery – and pays inadequate attention to health promotion. Moreover, the health promotion programs that are in place rarely focus on social determinants of health such as jobs, housing, education, etc. Instead, the focus largely remains on the health problems and concerns of individuals, rather than on the problems endemic to a population.

We know that public health has much to do (most?) with extending life expectancy to its current peak. Medicine, or sick care, has much to do with extending the lives of individuals.

If a fairer distribution of health spend between public health and medicine is the answer then we have a long way to go. The reality, of course, is that public health doesn’t make money. I guess that just needs to be mentioned.

Also worth noting is the report’s mention of a lack of attention to environmental factors contributing to health (of which health services play a relatively minor role) in health promotion programs. Currently jobs are tough to get. Efforts to get anyone and everyone in a house have proved disastrous. Education is great in this country…if you’re in the right community, even that statement is debated.

Rambling is most of what this is. But I think an important consideration to think about is how we, as a country, approach reimbursing for wellness programs. It works. It prevents things. Though it may not save any money on total health care dollars spent, it’s good for people.