Deciding Where To Invest Is Easier Than We Imagine: Portfolios Everywhere Ought to Prioritize an Equitable Economy and a Connected Society

Bobby Milstein, Director, System Strategy and Jack Homer, Senior Modeling Consultant | 02/07/2020

People are increasingly aware that it takes more than good health care for everyone to reach their full potential. Given the long list of interventions that could enhance health and well-being, decision-makers in counties across the country often struggle to figure out where to set priorities and how to get the most out of their investment portfolios.

Leaders commonly rely on complicated methods to assess county-wide strengths and weaknesses. They also turn to collaborative groups to determine which weaknesses to address first. Often, this approach leads counties to confront each problem individually as it commands attention, a piece-meal method that sometimes yields quick results but allows other threats to grow worse in the meantime.

What if there were a better way to set priorities for system change? What if such detailed analysis weren’t necessary to invest wisely? Most importantly, what if our collaborative energy and civic muscle could be directed toward the hard work of fulfilling our highest priorities and unlocking our trapped potential?

In a new study released by The Milbank Quarterly last week, ReThink Health’s Bobby Milstein and Jack Homer found that determining strategic priorities may be a whole lot easier than we think. They simulated the impacts of 12 potential intervention priorities over the next 20 years in 39 urban counties across the US, comparing how each intervention affects length of life, quality of life, and the costs of urgent services.

Despite many differences among these counties, the interventions with the most desirable impacts were strikingly similar. In every county, two priorities consistently stood out because they are more likely to deliver far better results. These included efforts to (1) reduce poverty (such as fair pay, college or technical education, employee stock ownership); as well as to (2) expand social support (such as youth mentoring, trauma-informed community building, and anti-discrimination). These two opportunities—to create a more equitable economy and more a connected society—came out on top for every country, every outcome, and every time period in this study!

Why are these two intervention priorities so powerful? Part of the reason is that they address systemic threats to well-being that are deeply entangled with many other threats that are often treated separately (such as inadequate health care, uninsurance, addiction, housing stress, limited education, violent crime, smoking, poor diet, physical inactivity, and air pollution). Unlike most research meant to inform investment decisions, the methods used for this study account for the way that seemingly separate threats are, in fact, connected. Looking across more than a dozen distinct threats, it was clear that efforts to reduce poverty and to expand social inclusion have stronger, more diverse, and quicker impacts than all other interventions tested.

Counties will always need to do some customization, but this analysis suggests that the task of determining investment priorities can be streamlined. Virtually all intervention portfolios ought to devote a significant concentration of resources in these two areas because they are so critical for expanding equitable health and well-being.

Want to dig into the details? We’ve ensured open access to the full paper in Milbank Quarterly:

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