Many in the United States bemoan the fact that we spend such a large share of our GDP on health care. We argue that we could do it better and for less, and we point to other industrialized countries as proof. But we overlook the fact that those countries spend more on improving the social determinants of public health. It appears that the combined total of these two categories may be relatively constant across countries.
The Blue Ridge Academic Health Group has published a report entitled, The Role of Academic Health Centers in Addressing the Social Determinants of Health. (Go to this site and look for Report 14.) It contains a startling set of statistics.
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%
The report summarizes the situation as follow:
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.... That’s why the Blue Ridge Group believes that the U.S. health care delivery system, as currently constructed and funded, is the not the optimal foundation – even with more direct financial investment and dramatic changes in incentives and regulations – to improve the health status of Americans and thereby achieve greater societal happiness and progress. Similarly, we are concerned that current health reform activities are focused too narrowly on insurance reform without setting in play genuine reforms that also reflect the factors relating to social determinants of health.
Thanks to my friend and colleague Dr. Fred Sanfilippo, Executive Vice President for Health Affairs at Emory University, and Chairman of Emory Healthcare, for leading me to this report.