I found my passion for health care policy not on US soil, but in Sweden, when I studied abroad in college. Studying the Swedish system was my first academic exposure to health care, and what I learned about making upstream investments to prevent downstream costs foreshadowed what has become a big part of my work at CCMU.
My course centered on both the health care system and the social policies that affected citizens’ health. On top of learning about the overall system—how citizens were covered and how different types of hospitals operated—we also learned about their generous maternity and paternity leave policies, affordable housing policy, childcare benefits, and long-term care infrastructure. To be fair, Swedes have some of the highest income tax rates in the world. What interested me most in my learning though, was not the structure of their tax code, but rather how they allocated the government dollars they collected. Based on what I learned, it seemed to me that Sweden was making more upfront investments in social infrastructure, with the goal of needing to spend less on providing downstream health care services.
My intuition was confirmed when comparisons were done between social spending and health spending of the US and other countries, as explained in this 2011 article from Yale. It was found that the US spends about half as much on social services as it does on health care, and many other countries were the inverse. This has an effect on health outcomes down the line. Specifically, Sweden spends 9.6% of their GDP on health care, and twice that on social services, while the US spends almost 17% on health care, and half that on social services. A look at health outcomes shows the results of these investments: Sweden’s average infant mortality is 2.6 per 1,000 babies born, and the US is almost twice that at 6.1 per 1,000 babies. Sweden’s obesity rate is 12%, and the US is almost three times that at 29%. While there are certainly additional factors at play, such as how the health care systems are structured, there is a statistically significant link between the ratio of a country’s investment in social services and health care, and its overall health.
This data presents an opportunity to question where we are investing our precious public resources and if there is an opportunity to reexamine our disjointed policy infrastructure so that we can make the right investments for our future. Despite the fact that the same populations are being served across different sectors, there is not enough cross-sector coordination and compromise to ensure our resources are best distributed. Housing policy is not necessarily aligned with childcare policy, nor is transportation policy aligned with education, yet each of these affects the others, and one coordinated investment across multiple sectors could have an overall bigger impact than separate investments in each. Sacrifice and compromise—two words that don’t get enough attention these days—will be necessary to break down the silos between sectors and advance policy that does the most good. This multi-sector approach is what we’ll be focused on at this year’s annual luncheon, and I hope you’ll join us.
My time in Sweden was limited, but its effects on me were, hopefully, lifelong. Just as providers work to treat the whole patient and not just an individual disease, we should work toward policies that strategically improve the lives and health of Coloradans as a whole, rather than piecemeal through each separate sector. With a shared vision and commitment, we can elevate everyone’s upstream health outcomes so that the need for downstream health care investments is decreased.