January 30, 2012 | Posted By David Lemberg, M.S., D.C.

The unsatisfactory outcomes Americans obtain from our notoriously profligate annual expenditures on health care are well-documented. For example, life expectancy in the U.S. has not improved substantially from a high of 78 years, according to the United Nations World Population Prospects Report. Japan, Hong Kong, Switzerland, Israel, and Spain are among the Top Ten, with life expectancies ranging from 80.9 to 82.6. The U.S. is number 36. At the other end of the spectrum, several countries have infant mortality rates approximately 50% lower than that in the U.S. A recent New York Times article explores an out-of-the-box explanation for the weak U.S. performance on these key measures of overall health.

A study published recently in the journal BMJ Quality and Safety looked at spending on social services as a critical variable in evaluating a nation's health outcomes. The study found that government funding of employment training programs, old-age pensions, and rent subsidies has an overlooked (at least in the U.S.) and fortuitous benefit. Countries such as Denmark, the Netherlands, Sweden, and France spend 33-38% of their gross domestic product on combined health and social services. In the United States, we spend 29%. The study reported that, possibly counterintuitively for American public policy at present, countries with high spending on health care relative to social spending had higher infant mortality rates and lower life expectancies than countries that spent more on social services.

There is at least one bright spot amid the know-nothing and do-nothing character of U.S. domestic policy in the last 12 years. The Department of Veterans Affairs has begun to integrate the health and social services sectors. The VA has created Stand Down programs that address both the health and social needs of homeless retired military personnel. Stand Downs provide medical screenings, mental health consultations, employment support, and housing services to eligible homeless veterans.

Stand Down programs could represent the beginning of a public policy shift in the America. Outside the U.S., government spending on social service programs provides necessary support for health care delivery. Those who do not have a job, those who do not have certainty regarding where they will sleep at night, and those who are not able by their own resources to obtain sufficient food need the aid of a society and a government which, thankfully, is still wealthy. It is worse than mean-spirited for elected officials and political candidates to blather about "big government". The reality for each of us is that the long-term survival of our society depends on the welfare and well-being of every last one of us. Spending on social services is not only ethically and morally appropriate. Such spending serves self-interest, if we could only see it.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.