Results from the fourth annual World Happiness Report are in. Based on a worldwide Gallup poll, the results rank 156 countries according to their state of happiness. Unfortunately the United States, which ranked 13 in happiness, fell to 85 in the well-being rankings. Countries’ happiness scores negatively correlated with their population inequality, which was reflected in the well-being rankings.
Denmark claimed first place, and the other Nordic countries, (Iceland, Norway and Finland) were among the five happiest countries. Happiness was largely attributed to the strong social safety nets in the top rated happy countries. Can these findings inform U.S. policy aimed at addressing health, social, educational and other critical disparities that negatively impact our social and economic structure?
This past fall, sponsored by the Child Health and Development Institute (CHDI), I had the opportunity to take six weeks away from my positions at CHDI and the Connecticut Children’s Office for Community Child Health to learn and study in an area of special interest and relevant to my health policy work.
I chose to go to the Nordic countries (Iceland, Finland, Sweden, Denmark and Norway) to learn about health and social services for children. In addition to being happy, these countries are noteworthy because their populations are among the healthiest in the world and they spend fewer per capita dollars on health services than the U.S. does, which ranks at the bottom of developed countries in terms of life expectancy and infant mortality.
What keeps Nordic populations healthy? Elizabeth Bradley and Lauren Taylor (The American Health Care Paradox: Why Spending More is Getting Us Less, Public Affairs, 2013) present compelling evidence for the argument that when countries spend as much on social services as health care services, they have healthier people. They argue that spending on social services supports better utilization of and benefit from health services. The U.S. spends proportionately less of its gross domestic product on social services than 10 other developed countries do.
Over the course of my sabbatical I interviewed service providers, families, and policy makers and discussed the American health care system with students and faculty at several universities. I learned about national policies that contribute to healthy child development in the Nordic countries and enhance equality.
- For starters, we know that the early years, and particularly the development of strong bonds between infants and parents/care givers, are so important in setting the stage for life outcomes. In Norway, extensive parent leave policies for mothers and fathers, often up to 17 months combined for both parents, support the development of strong families.
- Universal preschool beginning at age 1 as a matter of national policy achieves something that the U.S. has been working on in pieces over decades beginning with Head Start for low-income children.
- Free child health services, delivered largely by public health nurses, provides home visiting, coordinated maternity and infant care, and well child care services comparable to the U.S.
- Families who have children with special needs receive subsidies to take time off from work and care for their children.
- Children at risk for delays due to health, social and family circumstances easily qualify for intervention services.
- There is no tuition for higher education, and university students receive stipends for living expenses.
Norway pays for all of their residents’ health and social services through high taxes and a flush national fund supported by the oil industry. Taxes run about 55 to 60% of personal incomes. Herein lies the connection to disparities: everyone pays in, and everyone uses the services. In the U.S., and particularly during the current political debates, we hear a lot about tax dollars subsiding the poor, but in Norway, they subsidize everyone.
If the road to happiness runs through forests of inequality, we need to look at the trees and think creatively about how the U.S. can address disparities and ensure children’s healthy development. I identified three ways that our service system in the U.S. prevents us from doing the kind of things that promote the healthy outcomes and equality achieved in the Nordic countries.
- One is our health insurance system, which has improved since passage of the Affordable Care Act in 2010, but still falls short in creating equal opportunities for all families to use health services. Access to subspecialists is often difficult for families insured by Medicaid, and families with commercial health insurance struggle to afford mental health services.
- Eligibility rules also impede our ability to meet families’ needs; too many children do not qualify for publicly funded early education and intervention services but are at risk of falling behind their peers in developmental and behavioral areas. Our system is geared toward providing services for children with extensive needs, thereby missing the opportunity to intervene early, when delays and problems are most amendable to intervention.
- The third structural impediment to furthering equality and early childhood outcomes is our disparate funding streams. These alienate health, early care and education and social services in silos that confuse and complicate families’ receipt of the full array of services that contribute to healthy development. Braided funding across sectors would support a more equitable and efficient service system.
Connecticut Children’s Office for Community Child Health is addressing disparities by tackling these issues.
- We recognize that health services account for only 10% of children’s life outcomes, and we consider the broad array of resources that contribute to children’s healthy development.
- We also bring together care coordinators from the various child serving sectors to make child rearing more seamless for families.
- As a final example, we support the Help Me Grow® National Center, which works with states to ensure early detection of children at risk for delays and linkage to services that do not have strict eligibility criteria.
Will we be a happier nation if we address inequities and build a stronger safety net for vulnerable families? We don’t know for sure, but we are certain that we will have a more resilient next generation work force and citizenry.
Lisa Honigfeld, PhD is the Associate Director of the Office for Community Child Health at Connecticut Children’s Medical Center and the Vice President for Health Initiatives at the Child Health and Development Institute (CHDI). Learn more »