Faculty Research

Health and Social Service Expenditures: Associations with Health Outcomes
Objective To examine variations in health service expenditures and social services expenditures across Organisation for Economic Co-operation and Development (OECD) countries and assess their association with five population-level health outcomes. Design A pooled, cross-sectional analysis using data from the 2009 release of the OECD Health Data 2009 Statistics and Indicators and OECD Social Expenditure Database. Setting OECD countries (n=30) from 1995 to 2005. Main outcomes Life expectancy at birth, infant mortality, low birth weight, maternal mortality and potential years of life lost. Results Health services expenditures adjusted for gross domestic product (GDP) per capita were significantly associated with better health outcomes in only two of five health indicators; social services expenditures adjusted for GDP were significantly associated with better health outcomes in three of five indicators. The ratio of social expenditures to health expenditures was significantly associated with better outcomes in infant mortality, life expectancy and increased potential life years lost, after adjusting for the level of health expenditures and GDP. Conclusion Attention to broader domains of social policy may be helpful in accomplishing improvements in health envisioned by advocates of healthcare reform.  

Capstone: In the Field

Improving Housing Options for Youth Transitioning Out of Foster Care (2011)

Faculty: Ana Oliveira, Dennis Smith

Team: Aya Keefe, Rebecca Kirchheimer, Norma Peña, Jessie Ulsoy, Claire Vancauwemberge, Brandon West

In New York City approximately 1,200 youth ages 18­21 leave the foster care sys­tem each year. Because young adults tran­sitioning out of foster care are at greater risk of becoming homeless, the Deputy Mayor for Health and Human Services and the Administration for Children's Services engaged the Capstone team to improve housing outcomes for youth leaving foster care. The Capstone team examined existing support systems through extensive interviews, surveys, and focus groups. In addition, the team examined the policy environment and best practices for programs targeting youth in foster care. The team developed a final report that provides an indepth look at the support systems and housing options available to youth transitioning out of foster care, analyzes strengths and gaps in service, and presents recommendations to improve housing outcomes through changes in process, data collection, communication, and oversight.

Alumni in Action

Victoria Shire Deputy Director for Neighborhood Initiatives, Enterprise Community Partners in New York

Victoria Shire is Deputy Director for Neighborhood Initiatives at Enterprise Community Partners in New York. Through her work at Enterprise and in the previous positions she has held, she has had a far-reaching career as she has pursued the answers to questions she studied as an undergraduate philosophy student: how do we make communities better? What are our responsibilities to one another? What are we willing to do to make the community what it ought to be?

Read More

Just out of college, Shire managed federal child care funds and developed an outcome evaluation system for a multi-service community action agency. She then came to Wagner in search of the professional skills she knew she’d need in order to manage the programs she was evaluating. While in school at Wagner, Shire landed an internship through a fellow student with the Greyston Bakery in Yonkers. There she conducted feasibility studies for new business models and piloted an outcomes evaluation methodology and tracking tool to document the impact of employment on economic status of workers. Shire remained in the social venture field for a few more years when the same fellow Wagner student founded a social venture consulting firm and asked her to work with him on business plans and strategic consulting services. Additionally, during her second year at Wagner, Shire got an offer to run a new social venture business – a foot messenger service that exclusively employed formerly homeless, mentally ill adults. Shire saw it as “an incredible opportunity to practice her brand-new management and finance skills.” As she puts it, “it was a real chief-cook-and-bottle-washer job: I developed the business and marketing plan, negotiated contracts with customers, trained workers, kept the books, and painted the office.” Shire moved on to Enterprise in 2003. She believed the position there would allow her to continue to work on solutions to poverty at the city and national scale, and would give her the opportunity to deepen her skills in organization development. In her current role at Enterprise, Shire oversees the organization’s capacity building and the Green Communities programs with the goal of providing the capital and expertise necessary to create decent, affordable, sustainable homes and rebuild healthy communities. She also manages operations for the New York program. Depicting what she does on a day-to-day level, Shire explains, “I work with public and private funders, strategic partners, board members and volunteers to create resources for community based organizations; I create, manage and evaluate budgets; I conduct and review program evaluations and impact measurement studies; I engage with advocates and elected officials to promote and influence city, state and federal policy; and earlier this year I was responsible for the design and construction of a new 20,000 square-foot office space in lower Manhattan, and then moved a staff of 60 to that new office…a logistical challenge that drew on every piece of my Wagner training.” Her responsibilities keep her busy, and challenges are no doubt compounded in the current economic climate. “This is a difficult time,” Shire explains, “like none we’ve seen before – for housing, and for any organization like ours that is so deeply connected to the real estate and credit market, as well as to banks and financial institutions. But it’s also a time of real opportunity when new solutions are required,” she continues, noting Enterprise’s work in “creating a standard for green affordable housing, and then in further linking that housing to the carbon offset market.” Additionally, the organization is currently working on a retrofit fund to help keep existing affordable homes available to the next generation. In addition to the satisfaction that comes with finding new opportunities, Shire enjoys her work on a personal level as well. “I feel very connected to the challenges facing low-income New Yorkers, and yet I have this incredible network of knowledge being part of a national organization,” she says. “I’ve been able to work on something new every year, which has deepened my skills and broadened my experience. I also have the incredible fortune to work with really smart, creative people (including many Wagner alums) who bring an incredible amount of passion to achieve a mission I truly believe in: that we all have the right to a safe, healthy, affordable home.”

Read Less