Public Health Spending Prevents Deaths

If you are as grateful as I am that the nonstop coverage of debt ceilings and deficits is behind us for a while, and want to talk about something even Congress should be able to agree is worthwhile, then just repeat after me these two magic words. (No, not those two!)

The words are "public" and "health."  There is a new article out entitled Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths. 

Source:  Mays and Smith, Health Affairs, 7/11

The article has been published online by Health Affairs, and is in the August 2011 edition of the print journal.  It was written by Glen Mays and Sharla Smith.

Spending on public health has long been one of our government’s great success stories.  It keeps our water clean, our air free of pollution, our food pure, our children immunized, and our homes and neighborhoods free of lead, rats, and violence.  It also promotes our health. 

I wrote in a previous column about what this means for individuals like you and me.  Our life expectancy in America grew by 30 years during the last century.

The Health Affairs article makes it clear that public health is still getting the job done today.

Here’s the bottom line.  When more money is spent on public health, death rates go down.  When less money is spent on public health, death rates go up. 

It can’t be much clearer than that.  The authors studied public health expenditures and death rates in a number of communities between the years of 1993 and 2005. 

Local health departments whose spending increased by an average of 10% per year during those years experienced significant declines in infant deaths, deaths from heart disease, deaths from diabetes, and deaths from cancer.

These declines were not inconsequential.  For each 10% increase in public health funding, there was a decrease of 3.2% in deaths from heart disease, a decrease of 1.4% in deaths from diabetes, and a decrease of 1.1% in deaths from cancer.

There was also a 6.9% decrease in infant deaths.

These percentages may seem small, but consider this.  In a county of one million people, a 10% increase in public health funding per year for twelve years means a decrease of over 1,000 deaths from heart disease alone. 

These are not avoided deaths among people who had heart attacks and were saved by advanced medicine.  These deaths usually occur among people who seem healthy.  If it weren’t for public health, these thousand people wouldn’t be playing with their children and grandchildren, walking and jogging along our streets, working at jobs, dining in our restaurants, shopping in our stores, and even serving as elected or appointed officials.   

It seems a no-brainer to invest in public health.  However, one-third of local health departments actually had their funding reduced during the twelve year time period of the study.  The communities they serve had an increase in deaths equivalent to 430 for every one million people.

We’ve all heard how tight our public budgets are as public officials work to reduce spending.  Can we afford to save this many people through public health?

The short answer is yes, and the longer one involves some embarrassment that we don’t try harder.  The average community spends about $40 per person per year on public health.  Increasing this expenditure by 10% would average out to $4 per person per year, about the cost of one movie rental or one beer per year.  

Local people have also already delivered a message about this to state and federal officials.  They don’t mind giving up a movie rental or a beer every year to save 1,000 lives. 

In states where counties or cities control their own local health departments, the authors note that public health spending is 24% higher than it is in states where the states themselves control the local health departments.  It turns out that local people are willing to give up a movie rental and a beer for public health.

The authors calculated that the ten percent increase in public health spending per community would increase local public health budgets by an average of only $312,000 per community each year.  Compared to the billions and trillions of dollars our elected officials have been talking about – or even the $9.2 million one hospital recently charged the estate of a dead patient – $312,000 doesn’t seem like a very big number to me. 

Public health is responsible for 50% of the gains in life expectancy in the United States during my lifetime.  We can certainly do better than to give it less than 5% of all health funding, as we do today.

Public health doesn’t need a lot to do its job.  Just 5.05% would make a measureable difference.  And 5.5% across the nation could save the lives of millions.   

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