The term “social determinants of health” is trending in health policy circles. The general theory is that addressing external factors can improve an individual’s overall health. This seems logical. However, using this term to advocate for a new set of government programs and more government spending is not the answer. Here are some basic questions that should be answered.
Do these efforts to address social determinants of health overlap with existing programs and initiatives?
There is a massive safety net of government programs aimed explicitly at improving the welfare and well-being of individuals. More than 90 government programs scattered across various federal and state agencies provide a broad set of services to the poor, including cash, food, housing, medical and social services.
Efforts aimed at addressing social determinants of health should start with conducting an inventory of existing programs and the services they provide, including identifying where there is overlap, before layering new programs on top of existing ones.
Do these efforts to address social needs result in more spending?
Tethered to these government programs is government funding. Arguments for more upfront spending to achieve long-term savings is a fool’s errand. Rarely do new “investments” result in actual savings. There is already an abundance of money available. The federal and state governments collectively spend roughly $1 trillion to help the poor.
Advocates for spending more money on social determinants of health should first inventory funding streams associated with these programs. Some programs, such as those providing social services, already have funding flexibility. Rather than adding new funding streams, current resources should be spent more wisely.
Moreover, combining funding resources should not be exploited to facilitate new spending. Efforts to address social determinants of health by “maximizing” funding opportunities and, in particular, leveraging the Medicaid program to do so are troubling.
Unlike some other social welfare programs, Medicaid is an open-ended source of funding—i.e., the more services delivered, the more spending is allowed and required. Therefore, efforts to address social determinants of health should not be a backdoor way to add new spending through Medicaid.
Years of adding new programs and spending on top of old have created a complicated bureaucratic maze that has lost sight of individuals and their needs. Broadly speaking, organizing assistance around the whole person rather than through programmatic silos makes some practical sense. However, layering new initiatives and spending on top of existing programs ignores current programs and spending.