National Spending on Health Care May be Too Narrowly Allocated

Planning for a population health improvement leadership conference

In 2000, staff at the University of Wisconsin-Madison Center for Health Policy and Program Evaluation organized a conference on strategies to improve population health through the reallocation of national spending on health, education, and other concerns.

Some investigators increasingly advocate a broader population-based view of health, which uses measures of quality of life and daily functioning to define the health status of a group of people. The availability of health care services, social and economic conditions, and the general environment are among the factors that can influence population health.

Key Results

  • The conference, entitled "Practical Strategies for Cross-Sectoral Allocation of Resources to Improve Health," was held June 14–16, 2000, in New York, N.Y. The conference was attended by 22 academic and health care policymakers from the United States, Canada, the United Kingdom, and New Zealand (see the Appendix for a list of participants).

    The meeting's title, "Cross-Sectoral Allocation of Resources to Improve Health," refers to the idea that spending on the health care sector alone may not be sufficient to improve population health.

    In this view, targeted investments across many different sectors of society — including education, employment, and housing — may have more profound effects on population health as a whole.

    During the conference, attendees heard case studies of this approach as it has been applied in Oregon; on Prince Edward Island in Canada; and in New Zealand. These talks were followed by panel presentations and discussions of the issues, current policy, and research experience (see the Bibliography for more details).
  • In a conference report submitted to the Robert Wood Johnson Foundation (RWJF), conference organizers noted that in the United States, where spending on medical care now consumes 14 percent of the gross domestic product, it is not unreasonable to wonder if a more balanced investment among the other determinants of population health might yield a greater return in the future.

    They noted that although the empirical evidence remains incomplete, there is a strong association between education and income and health outcomes, leading many to believe that enhanced investments in education would yield greater returns to population health. Similarly, investments in child health may be more cost-effective than many expenditures made at the end of life.

    According to the report, meeting participants identified a number of next steps that could be made toward promoting cross-sectoral allocation of resources to improve health, including:
    • Document the best and the worst examples of existing cross-sectoral approaches to improving population health. Develop a list of politically feasible opportunities.
    • Identify reasons why other sectors should be concerned about health. Create a common language for academics, practitioners, and policymakers.
    • Assess the health impact of non-health activities. Explore the readiness for an alternative use of resources.
    • Market the concept of population health through articles, journal supplements, or meetings convened by an authoritative source, such as the Institute of Medicine of the National Academy of Sciences of the United States.

Although this grant originally was designed to fund meeting planning, with RWJF approval, grant funds were applied to convening the conference itself. The Milbank Memorial Fund, a New York City-based foundation supporting analysis, research, and communications on health policy issues, cosponsored the conference.

After the Grant

Milbank also sponsored a follow-up conference in Portland, Ore., in January 2001. "In Portland, Ore., in January 2001," a draft manuscript from that meeting, tentatively entitled "What New Knowledge Would Help Policy Makers Better Balance Investments for Optimal Health Outcomes," is being prepared.


RWJF supported the conference with a grant of $60,617 between June 1998 and August 2000.

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