June 4, 2018

The life-saving, cost-cutting interventions that America keeps ignoring

Daily Briefing

    The United States currently spends less on public health efforts than it does on health care services—something that perhaps should change, Aaron Carroll and Austin Frakt write for the New York Times' "The Upshot."

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    A history of success

    The United States has implemented a number of public health inventions with significant success, Carroll and Frakt write. By promoting vaccines, for example, the United States has completely eliminated diseases like polio and smallpox among its residents, while making others like measles and rubella very rare.

    Similarly, advances in motor vehicle and workplace safety, as well as efforts to ensure the United States has a clean public water supply, have gone a long way in making U.S. residents healthier, according to Carroll and Frakt.

    Efforts to boost family planning and contraceptive services have had a similar effect, Carroll and Frakt write, by helping to reduce infant and maternal mortality, as well as rates of sexually transmitted infections and unintended pregnancies.

    The United States continues to move forward with some public health initiatives, such as those focused on reducing lead exposure in children, increasing cancer and heart disease screenings, and introducing new vaccines—such as those for HPV.

    Low funding for a good ROI

    However, despite the United States' previous successes with public health interventions, funding for such efforts remains exceptionally low in the country, Carroll and Frakt write. They write that "the private sector can't make money" on public health interventions, leaving the brunt of the burden on public entities. While federal agencies such as CDC, the Health Resources and Services Administration, and the Department of Agriculture spend a few billion dollars annually on public health, Carroll and Frakt write that spending is "dwarfed" when compared with the amount of money the United States spends each year on health care services— which Carroll and Frakt write is surprising, considering "public health investments are often so valuable that they pay for themselves."

    In fact, Carroll and Frakt cite a systematic review published in the Journal of Epidemiology and Community Health in 2017 that found a number of public health interventions had a significant return on investment (ROI). According to the review, health protection interventions, which include vaccines, saved $34 for every $1 spent, while legislative interventions—such as taxes on sugary drinks—had a median return rate of $47 for every $1 spent.

    Further, Carroll and Frakt write that the United States should think of public health investments as the reason U.S. residents are living longer. "Americans can expect to live into their late 70s, on average, in large part because of public health investments," Carroll and Frakt write, noting that "from 1900 to 1999, life expectancy at birth increased from 47 years to 77 years." While  "much of that" increase "was because of significant improvement in the care of babies and children," Carroll and Frakt write, "experts believe that 25 of the 30 years gained can be attributed to public health advances."

    Overall, they conclude that when the ROIs on public health interventions are considered, "there's no reason not to" make investments in such efforts (Carroll/Frakt, "The Upshot," New York Times, 5/28).

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