Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths

Abstract

Public health encompasses a broad array of programs designed to prevent the occurrence of disease and injury within communities. But policy makers have little evidence to draw on when determining the value of investments in these program activities, which currently account for less than 5 percent of US health spending. We examine whether changes in spending by local public health agencies over a thirteen-year period contributed to changes in rates of community mortality from preventable causes of death, including infant mortality and deaths due to cardiovascular disease, diabetes, and cancer. We found that mortality rates fell between 1.1 percent and 6.9 percent for each 10 percent increase in local public health spending. These results suggest that increased public health investments can produce measurable improvements in health, especially in low-resource communities. However, more money by itself is unlikely to generate significant and sustainable health gains; improvements in public health practices are needed as well.

How Much Do We Spend? Creating Historical Estimates of Public Health Expenditures in the United States at the Federal, State, and Local Levels

“…These include, notably, the Public Health Activities and Services Tracking (PHAST) study, Bernet's database of Florida LHD spending since 2000, the Public Health Uniform National Data System (PHUND$; http://phunds.naccho.org/), and Brown's database of California LHD spending (11,14,18,83). Brown has published numerous seminal studies using these data to examine the value of local public health spending, whereas Mays has used NACCHO data to examine similar issues (18,70,93). These data sets continue to demonstrate substantial variety in local public health 478 Leider et al spending across the United States, driven largely by the extent of LHD public health activity (high/medium/low capacity), as well as by the level of clinical services provided by the LHD.…”

Communities of Solution: The Folsom Report Revisited

“…The contribution of medical care to premature mortality (10%) is less important than social circumstances (15%), genetic predisposition (30%), and behavioral patterns (40%.) 32 Public health spending, currently less than 5% of national health spending, is the strongest mutable determinant of community-level preventable mortality (increasing public health spending significantly decreases infant death and death from heart disease, diabetes, and cancer 33 ). Constrained resources demand more effective allocation.…”

“…Communities governed by a local board of health show increased public health spending, likely because they can better identify funding targets. 33 Ideally, federal health policy would more effectively enable local community-based reform efforts. For example, accountable care organizations, introduced in the Affordable Care Act as a pilot program within the Centers for Medicare and Medicaid Services, are a potential modern-day Community of Solution, but are politically uncertain and too hospital-centric.…”

Inequality of Health Spending and Public Health Outcome in Countries of the WHO’s Eastern Mediterranean Regional Office (EMRO)

“…These gains can be attributed to a number of factors, including better education, nutrition, sanitation, housing as well as greater access to health services [4,5]. Several studies have confirmed that there is a positive relationship between life expectancy at birth and health expenditure per capita worldwide [6][7][8]. A recent study by Joumard [9] in 2010 showed that an increase of total health spending is the possible reason for at least 40% of improvements in life expectancy since 1990.…”