New report: Increased spending on public services linked to community health “dividends” in Texas

A new EHF-sponsored study shows how increased government spending on areas like parks, libraries and housing may lead to better health outcomes for entire communities.

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Increased public spending on services like public health, fire and ambulance, housing and community development, and libraries would likely lead to improved health outcomes for Texas counties. That’s just one of the findings of a new report sponsored by EHF that examines the health impacts of increased government investment in public health and social services.

Researchers analyzed per-capita government spending on areas like education, housing, parks, police and public health in Texas. Then, they compared those public spending rates with county-level health rankings that are based on obesity rates, premature deaths, overall health status and more.

Read the complete report
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Using the data and new models, researchers predict that a 10-percent increase in per-capita spending on certain public services could improve a county’s national health ranking by one to seven spots within just four years.  

“It’s possible that your county’s health could improve by spending just $5 more per-person on something like libraries,” said J. Mac McCullough, an assistant professor at the School for the Science of Health Care Delivery at Arizona State University and co-author of the report. “We believe our model shows there clearly can be health dividends for many kinds of increased social service investments.”

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J. Mac McCullough presents his “Investments in Community Health” study at the Bioscience Research Collaborative building at Rice University.

McCullough said the report did not find that increased spending on one “magic” service area lead to health improvements in every county. However, researchers say that they did find that increased public service spending in any area never worsened a county’s overall health ranking.

“This report highlights the possibilities of what can happen when we focus on improving health, not just healthcare,” said Elena Marks, EHF’s president and CEO. “Right now, we’re spending almost all of our health dollars in the U.S. on medical services and very little on social services that truly drive health outcomes. For Texans to become healthier, we have to move the focus from healthcare delivery alone to investing in health and wellness in different ways.”

Marks says she hopes local and state governments will use the report to better understand the link between public spending and health, and then consider how different budget and investment decisions could impact community health.

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See an interactive dashboard showing county-level spending on social services in Texas


The report found that counties differ in their social service investments. Some healthy counties prioritize a smaller number of larger services, such as education, while other healthy counties allocate higher spending across a number of “smaller” services, such as parks, libraries and more, researchers found.

Along with showing the level of total government social service spending by county, the report’s model estimates how increased investments by dollar amounts and/or social services categories could change a county’s health ranking.

The report was co-authored by Jonathon Lieder with JP Leider Research and Consulting.