August 23, 2011

Public Health Spending Pays Off

A study of public health spending between 1993 and 2005 found spending a little more now saves money and lives later.

A 13-year study on the effects of public health spending concludes that money spent on public health is generally money well spent. The study found that for every 10% increase in local public health spending, deaths from heart disease, cancer, diabetes and infant mortality all dropped, with the decreases ranging from 1 to 7%.

The U.S. currently spends more on administrative costs for medical care and health insurance than it does on public health.

The researchers point out that the U.S. currently spends more on administrative costs for medical care and health insurance than it does on public health. And with budget cuts on the mind of most elected officials right now, the researchers hope that the study results will help spare public health spending from any further cuts.

There's been little solid evidence collected over the years on how public (government) health spending affects public health. One reason is the complexity of the system, which hampers research: public health spending is financed by a patchwork of federal, state and local sources that vary widely from community to community and from year to year. Another is the wide variety of activities that the money funds, from free flu shots and blood pressure screenings to subsidizing health insurance to anti-smoking commercials.

Levels of spending also vary greatly. In the year 2005, state public health spending ranged from under $4 per person in Nevada to over $171 per person in Hawaii. At the local level, spending ranged from less than $1 per person in some communities to over $200 per person in others. These variations make it hard to generalize findings from one state or community to the nation as a whole.

The current study looked at total public health spending between 1993 and 2005 by the nation's nearly 3,000 local public health agencies. It focused on the local level because local agencies have the most control over how public health money is spent and most federal and state funding ends up being channeled through local public health agencies. The researchers analyzed the relationship between local health spending and death rates from six different causes over this 13-year period.

The study focused on six causes of preventable death — deaths that could reasonably be expected to drop when public health spending increases. Deaths from cancer drop when more people get screened and fewer smoke cigarettes. Deaths from heart attack go down when people who are at risk take blood pressure or cholesterol medications and make lifestyle changes. Other studies have estimated that as much as 50 percent of the rise in life expectancy that has occurred in the U.S. since 1950 is due to public health attention to diet, tobacco exposure, and other measures.

By looking at spending variations over time along with mortality statistics, the researchers found that a 10% increase in local public health spending lowered community death rates from infant mortality by nearly 7%, from heart attack by over 3% and from diabetes and cancer by over 1% each. The death rates from flu and all-cause mortality also dropped, but by an amount that was too small to be statistically significant.

To put these numbers in perspective, the researchers estimate that an average metropolitan community could cut deaths from heart attacks by 3.2% by investing an additional $312,000 a year in public health spending. Based on another study, the community could also do this by hiring 27 additional primary care physicians. But unless these doctors were each paid less than $12,000 a year, they would cost the community a lot more money.

In other words, public health spending gives a bigger bang for the buck.

The study can't prove that increased public health spending was responsible for the decreases in deaths. But that's what it suggests.

One reason to believe that the linkage is real and not a spurious one is the researchers' finding that changing public health spending did not affect the death rate from Alzheimer's disease. There's no reason to expect it to: Alzheimer's has no cure and its causes are largely unknown, so there's no good way to prevent it or treat it.

The researchers caution that simply spending money on public health won't by itself lead to major improvement in health; the money has to be spent on effective programs. Future studies should concentrate on identifying which public health programs are the most effective ones.

An article on the study was published online by Health Affairs on July 21, 2011 and also appears in the August edition of the journal.

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