Social spending to improve population health — Does the United States spend as wisely as other countries?

On average, Americans have worse health outcomes than their counterparts in other high-income countries, even though the United States spends far more on health care than those countries do.1 This disparity is often attributed to social factors that influence health, such as housing, nutrition, and education. However, spending on social supports and programs as a percentage of gross domestic product (GDP) differs little between the United States and these other countries.2 If U.S. social spending levels are similar to those of other high-income countries and health care spending is higher, why does the health of the U.S. population lag behind that of other countries? We suggest, on the basis of an analysis of data from the Organization of Economic Cooperation and Development (OECD), that the problem is not the total amount spent on social supports, but how the United States spends these dollars. Specifically, the mix of social spending in the United States may be skewed in such a way that our investments have less impact on population health outcomes than they might otherwise have.