If you had the opportunity to overhaul how the United States allocates public health spending, what you would you do? That's the question the New York Times' "The Upshot" put before several top experts. Here's what they had to say.
"The Upshot" reached out to academics, leaders of funding organizations, and officials who oversee public health departments to see how they thought the United States could improve its public health efforts.
The 3 ways the US could improve public health
1. Investing in interventions known to work
According to "The Upshot," many of the experts noted that although the United States spends large sums on health care, those funds are not necessarily allocated toward public health interventions that are known to help address infectious diseases, obesity, substance use disorders, and other public health issues.
Karen DeSalvo, former health commissioner of New Orleans and former National Coordinator for Health IT, said, "Of the $1 trillion in federal spending, only 1% is on public health—an infrastructure that saves lives" and can "reduce suffering and improve community well-being and vitality."
Ursula Bauer, acting director of CDC's National Center for Chronic Disease Prevention and Health Promotion, said, the underfunding leaves many U.S. residents without access to potentially beneficial public health interventions. For instance, she said, "[n]ot all adults have access to appropriate cancer screenings," and the United States does not "do a good job of managing high blood pressure."
Many of the experts said the United States should invest more in interventions that have been shown to benefit public health. As an example, Bauer said the United States could use tax revenue and subsidies to help promote healthy eating. "There [currently] are more incentives and opportunities for people to consume unhealthy foods and beverages than there are for them to make healthy food and beverage choices," she said.
2. Addressing health disparities
The experts also said the United States could do more to address health disparities across income levels and racial and ethnic groups, "The Upshot" reports.
Sandro Galea, the Robert A. Knox professor and dean of Boston University's School of Public Health, said, "Public health needs to take a leadership role in confronting and influencing the social, political, and economic factors that determine population health."
Former New York City health commissioner Mary Travis Bassett separately added, "The patterns of disease and death track along this nation's deep divides of race and income."
According to "The Upshot," public health interventions targeting the needs of specific populations have led to substantial improvements in health outcomes. For example, research has suggested that nutritional programs for people with lower incomes have helped to keep people out of the hospital. In Boston, older and lower income residents saw improved health outcomes when they received specially formulated meals, which included soft and low-cholesterol foods, "The Upshot" reports.
But Bassett recommended that the United States could focus funding on other programs, as well. For example, she said the United States could divest from prisons and "put that funding toward new systems of justice, better housing or universal child care"—all of which can affect public health.
3. Targeting deadly public health issues
The experts said the United States also could do better at addressing public health issues known to cause death.
Monica Bharel, commissioner of the Massachusetts Department of Public Health, said investing in gun safety and education could lead to a decline in gun-related accidents and deaths. In addition, Bharel said the United States also could look to address the effects of electronic cigarettes, marijuana, and social isolation in the future.
One way the United States could improve how it addresses known causes of death is by shifting toward community- and school-based programs for mental health, the experts said.
Former U.S. Surgeon General Vivek Murthy said, "Such programs have been shown to reduce violence, smoking, alcohol, and drug addiction and mental illness." According to "The Upshot," Murthy in his 2016 Surgeon General's Report included several examples of evidence-based community- and school-based health programs, such as the Fast Track Program, which focuses on identifying children with high rates of aggression in an effort to help them improve their educational and social skills (Frakt/Carroll, "The Upshot," New York Times, 9/4).
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