Association of Social Service Spending, Environmental Quality, and Health Behaviors on Health Outcomes.

Recent studies on state-level spending on social services have shown that states with higher ratios of social to health care spending were associated with better health outcomes. This study extends this work by examining the association of specific elements of social service spending and other determinants of health, such as health behaviors, education, and environmental factors at the metropolitan/city level, on several measures of health outcomes between 2005 and 2014. This study found that several potential determinants of health including exercise, air pollution, smoking, per pupil educational spending, and several types of social service spending were associated with improvements in health outcomes. These health outcomes included age-adjusted mortality, chronic disease prevalence, days of poor health, and obesity rates. The results suggest that a broader strategy beyond health care that includes investments in social services, improved environmental quality, and health behaviors could improve the health of communities.