According to the World Health Organization, health is defined as the physical, mental, and social well-being of an individual. While the physical and mental aspects of health are easier to recognize, the social contributions to health can be more difficult to see. These social determinants of health include issues of unemployment and income, educational attainment, food and housing security, and many more. These factors affect an individual's ability to understand, improve, and sustain their health.

To help individuals overcome these social barriers, the U.S. government funds a variety of programs targeting these issues. These entitlement programs help low-income individuals battle the detrimental effects of poverty. But, with proposed reductions in federal support for such critical programs, these budgetary cuts will unfairly jeopardize the health of our most vulnerable populations.

As a physician in the city of Philadelphia, I regularly encounter these social determinants that adversely impact my patients' health. Mary (whose name has been changed for privacy reasons) was a patient who was transferred to our hospital for worsening kidney function nearing the need for dialysis. She also has sickle cell disease requiring whole body blood exchanges twice a month, a history of strokes, and untreated blood clots in her lungs. Her medical care is complex requiring multiple types of physicians to help manage her issues.

To further complicate her situation, Mary lives in public-assisted housing with her young children and receives assistance from federal programs to obtain food and other resources to live her life. She does not have a reliable means of transportation and has difficulty going to her medical appointments regularly.

For Mary, proposed budget cuts to programs that address housing or food insecurity could worsen her health. Reductions in funding for the Supplemental Nutrition Assistance Program or Temporary Assistance for Needy Families Program could reduce her ability to access healthy foods or other resources needed to obtain gainful employment. Cuts in funding for the Department of Housing and Urban Development could reduce accessibility to affordable apartments, which could worsen her health. Without a stable source of income, food, or housing, the already-vulnerable health of low-income individuals, like Mary, may worsen as they struggle to maintain their health with fewer resources.

While welfare programs are not the magical remedy for all social and health issues, they do play an important role in promoting healthier lives. Research studies consistently show that population health status improves with greater spending on social services. This finding was evident among U.S. states and in several developed countries that spent more resources on social programs. Yet, a Commonwealth Fund report showed that the U.S. spent the least on social services of all developed countries. Not surprisingly, the U.S. only achieved mediocre health outcomes despite spending the most money per person on health care of any developed country.

Unfortunately, Mary's circumstances are not unique. Many low-income individuals struggle to maintain access to food, housing, or employment with detrimental health effects. More people are likely to join this struggle as a result of the proposed budget cuts. Rather than cutting funds, U.S. lawmakers should consider how best to support and expand the impact of social programs associated with better health…that is, if they are truly serious about improving the health for all constituents.


James D. Park, MD, MPH, MSHP is a hospitalist physician at the Hospital of the University of Pennsylvania. He is an Assistant Professor of Clinical Medicine in the Section of Hospital Medicine and a guest contributor.