Well, it says something very important about US priorities in two different ways. On that graph, you'll notice that in relation to France and Sweden, which have high levels of social spending than the United States, the relationship between a health spending and social spending, is exactly reversed. The proportion of social spending, is much much higher than health spending in both of those countries. What does that tell us? It tells us that in those countries, high levels of social spending, are associated with efforts to redistribute income and resources towards those in need with a view to improving overall population health outcomes. Those countries also tend to have lower levels of income inequality and use both health spending and social spending as ways of redistributing resources with a view to improving population health. As part of that allocation's spending, also reflects the goal of integrating health spending into overall patterns of social spending. So what does that mean? It means that poverty in any communities, is experienced in a multi-dimensional way and that any effort to alleviate poverty, has to be a multi-dimensional set of policies. So for example, on the most basic level in universal health coverage countries, when they address an issue like domestic violence, will do so in a way of providing a wraparound services. That is, domestic violence produces an aid for healthcare but it also produces need for legal services, for housing, for income support. The goal would be to make health part of the set of services that a woman and her family need at that particular moment in order to deal with the issue of domestic violence. The secondly, at a grander level, it can be as simple as how do you integrate the health system with income support systems and housing support systems so that they operate together rather than independently. So what do we know about the United States on both of those things? What does this graph tell us about US priorities both in relation to the redistribution of resources question and secondly, in relation to the integration of the healthcare system into broader systems of social support? What we note firstly, is that although the United States is a very high social spending country, so on this graph, it is one of the countries with the highest levels of social spending. However, social spending in the United States is not committed to redistributing resources in the same way. Greater proportions of social and health spending in the United States, are entitlement biased, which means that they are less concerned with redistribution of resources to those in need. Secondly, less concerned with redistribution of resources with a view to improving overall population health. Secondly, that particular lack of commitment to redistributing resources to improve population health manifest in also a much less of a commitment to integrate the health system and social support services. So in the United States, it's very hard to imagine. For example, a wraparound system of support for domestic violence on a state or national level, because it involves integrating all diffuse fragmented services. By contrast, in the United States, what tends to happen is that the health system is a way of addressing issues of poverty. So some of the innovative work in alleviation of poverty in the United States through Medicaid is concerned with ensuring that people who have medical needs, also have housing needs met, or people who are food insecure and in need of healthcare also have their needs for nutrition met. Now that's important, it has a really significant impact on people who receive those services, but on the other hand, it's indicative of a health system which is a source of funding for improving health. But it's a source of funding for improving health for particular populations of people and for individuals, not for the population as a whole. So the strength of using the health system to alleviate poverty in the United States, is balanced by weakness which is that the United States has great difficulty in integrating social service spending with health spending in ways to improve population health outcomes. In brief, that's where this graph was originally generated. It was part of a book by Elizabeth Bradley and Lauren Taylor called the American Health Care Paradox, which sought to show or which developed the thesis that countries that spend equal amounts or greater amounts on healthcare than social spending, would also have worst population health outcomes. That is the place to where we started addressing the United States healthcare system. That is it spends a lot on health but has worse population health outcomes. So this graph reflects priorities generally about our redistribution of resources with a view to improving population health, and it reflects priorities about the difficulty of integrating health systems with social systems with a view to improving population health.
