Objectives To assess the effect of social spending on population health.

Design Multivariate regression analysis was performed to investigate the relationship between age-standardised cause-specific mortality rates and social spending. Mortality data were collected from the European Health for All Database 2009 edition. Social spending per capita in purchasing-power-parity were taken from the OECD Social Expenditure Database (including family support, old-age pensions, healthcare, unemployment benefits, active labour market programmes, and support for people with disabilities). These relationships were compared with gross domestic product per capita (GDP), general government spending per capita (including prisons, education and defence), and healthcare spending per capita. Models also included controls for country- and period-fixed effects and expenditure was adjusted for inflation and purchasing power parity.

Setting 13 EU countries, 1980–2003: Belgium (only to 1998), Denmark, Finland, France, Germany, Greece, Ireland, Italy, Netherlands, Spain, Sweden and the UK.

Participants n/a.

Main outcome measure Age-standardised all-cause and cause-specific mortality rates.

Results Each additional US$100 increase in social spending per capita is significantly associated with a 0.99% reduction in all-cause, age-standardised mortality rates (p<0.001). Healthcare spending per capita had no effect on all-cause mortality rates. Consistent with previous findings, we observed each US$100 increase in GDP was associated with a 0.28% fall in all-cause mortality rates (p<0.001), about one-fourth of the magnitude of the association of social welfare with mortality. After adjusting for social welfare spending, the association of GDP with all-cause mortality was reduced by over half (β=−0.11%, p=0.004). Healthcare spending was not associated with mortality. However, higher social welfare spending was significantly associated with reductions in alcohol-related deaths, cardiovascular disease and tuberculosis; findings which are biologically plausible.

Conclusion Reducing social spending could increase mortality rates. The majority of the benefits of wealth to health appears to be determined by the extent to which resources are invested in social welfare and healthcare systems. Investments in social protection seem to have greater protective effects on health than investments in health care. Stronger links between health and labour ministries offer an opportunity to take advantage of such positive synergies, especially important to protecting health during times of austerity.