From health to wealth: translating health outcomes to socioeconomic impacts

On the whole, our model aims to show that the ‘where’ and ‘how’ of investment in health matters more than the ‘how much’. This research aims to bring more objective clarity to relationships between health investment and outcomes, ultimately providing clearer direction and defining more effective health resourcing strategies for policymakers and stakeholders. Broadly, our model confirms the common understanding that better health is linked to stronger socioeconomic outcomes, although we found that the strength and nature of this link can depend on the health outcome measure used.

Our analysis shows that there are clear links between life expectancy and socioeconomic status. For example, improving the life expectancy of older people (specifically, life expectancy at age 60), shows a strong positive impact on both per capita income and tax revenue. This could be because older people participate in the workforce in the US and/or act as caregivers to enable family members to do so. However, the US has experienced a slow-down in longevity since 2014 compared to peer countries.¹ The main driver of this seems to be poorer health among poorer working-age individuals—as one gets larger, so does the other. The bidirectionality of the impact suggests that efforts targeting both would help to ensure that people are protected from poor health and economic poverty. Such efforts may include expanding early childhood health and educational investments, increasing the scope of workforce skill-building programs, reinforcing social safety nets, and improving the reach of public health efforts.²

In our model, decreasing infant mortality shows a strong relationship with an increase in personal income, high school graduation rates and fewer children in poverty. This is in line with existing evidence that there is a significant relationship between reduction in infant mortality rates and economic growth. Despite this, the infant mortality rate in the US is higher than peer countries, with a rank of 33 out of 36 OECD countries.^3,4 It is largely an outcome of the persistent patterns of racial and ethnic disparities in the US, which have been recorded for more than a century.⁵ Although challenging, the National Institute of Child and Human Development suggests that preventing birth defects, addressing preterm birth and low birthweight, prenatal care, safe sleep environments and newborn screening are all useful tools to manage risks of infant mortality.⁶

Our model also shows that the reduction of mortality amenable to healthcare leads to notable increases in high school graduation rates and tax revenue. To put this into context, the US has the highest rate of deaths amenable to healthcare among comparable countries.⁷ For example, a systematic review of low-quality health systems found that 15.6 million excess deaths from 61 conditions occurred in low- and middle-income countries in 2016, which included deaths that may otherwise have been prevented through public health measures, improved quality of care (8.6 million) and better utilization of health services (3.6 million).⁸

Our model demonstrates a strong inverse relationship between DALYs and the size of the labor force. Although this might seem fairly obvious, targeting the reduction of DALYs is more complex than it seems. Measuring quality of life (QOL) relies in part on patient reported outcomes, which can be a challenging metric in terms of clinical relevance.⁹ Moreover, generalizability across health conditions is a significant challenge in disability measurement, as current measures don’t often capture the breadth of the disability spectrum.¹⁰ The WHO has spearheaded such efforts by developing a model that enables disability comparisons across diseases.¹¹ For example, a recent WHO study found that global DALYs due to infectious disease have decreased by 50% since 2000, whereas DALYs due to diabetes and Alzheimer’s disease have more than doubled in the same time frame.¹² To preserve a strong labor force, it is important to prioritize management of the conditions that are the largest contributors to DALYs, including ensuring equitable access to screening, treatment, rehabilitation and monitoring, as well as health behavior support to manage risk and increase prevention.

This model also showed some unexpected results. A higher number of poor physical health days is positively associated with high-school graduations. This could be because a higher number of high-school graduations is indicative of fewer people moving into physically active jobs, which may lead to poorer physical health. Also, a higher number of poor mental health days was associated with more tax revenue. Further analysis would need to be done to understand these results. It may simply indicate that broad physical and mental health status may not be the strongest predictor of the selected socioeconomic indicators.

Conclusion

This model shows that effective resource allocation in health can indeed be an impactful tool in producing desired socioeconomic outcomes. In other words, improving socioeconomic outcomes can be targeted through investment in healthcare, without necessarily increasing the amount of funding. Leaders can utilize this model to make proactive, well-informed decisions regarding resource allocation in health systems for optimal health and socioeconomic outcomes.

The expansiveness of this model opens the door for a potential lifetime of additional analysis. The most obvious place to start would be to take each of the modeled outcome measures and conduct sub-analysis for each of the relationships that show impact. This may include state-level analysis or the inclusion of further input variables to gain a more precise understanding of the relevant components of each relationship. A more granular analysis (e.g., at the municipal or other population subgroup level, such as within different insurance markets or the uninsured), would yield more variation and nuance to explore. Adapting this model to explore other geographies outside of the US would also be a valuable step forward.