Larger investments in public health equal better health, fewer deaths and reduced medical spending — and the effect is especially pronounced in the communities that need it most, according to new research.
The findings are the latest in a series of studies that researcher Glen Mays and his colleagues at the National Coordinating Center for Public Health Services and Systems Research (PHSSR) are conducting on the health and economic value of public health spending. While Mays has authored previous research on the topic — such as this 2011 study that found public health spending is associated with reduced mortality rates from preventable causes of death — this most recent research was the first to examine how those benefits vary across communities. The findings were released last week at the 141st Annual Meeting of the American Public Health Association in Boston.
Mays found that health gains from public health spending were 21 percent to 44 percent larger in low-income communities than in more affluent communities, and 17 percent to 38 percent larger in communities that invested in a broader range of public health activities. While Mays told me that he and his colleagues had a “strong hunch” that some communities would benefit more from public health investments than others, the “strength of the patterns we saw were quite surprising.”
“The major finding is that spending targeted toward low-income communities has a significantly larger effect than in other types of communities,” he said. “It makes sense because these communities are facing larger socioeconomic burdens, larger socioeconomic threats to health…but the magnitude of the difference was certainly surprising.”
Specifically, the study, which used data from a 17-year period, found that infant mortality and deaths due to cardiovascular disease, diabetes, cancer and the flu fell by between 0.5 percent and 4.3 percent for each 10 percent increase in public health spending over 17 years, with the larger gains experienced by low-income communities. More public health spending was also tied to decreases in the per-person growth rate in medical care spending. In addition, the study found that the cumulative effects over a 10-year period were nearly twice as large as the short-term effects.
“If we compare that 17 years to the incubation period of many of the chronic diseases that public health is targeting…that’s a reasonable time frame,” said Mays, who is also a public health professor at the University of Kentucky, where the National Coordinating Center for PHSSR is housed. “We know if we’re going to be effective it’s going to take time, so 17 years is not that long to wait for benefits. On the other hand, it’s not instantaneous and that’s important for policymakers and the public to recognize — we have to be wiling to invest over the long term to realize the full benefits.”
To conduct the study, Mays and colleagues linked organizational and financial data from the nation’s thousands of public health agencies to mortality rates and medical care spending estimates over a 17-year period (1993 to 2010). He noted that the study was painstakingly designed so researchers could isolate the health gains associated to public health versus those associated with other factors, such as medical care.
“Prior research looked at the average effects (of public health spending) across the nation, so to really differentiate and detect different levels across communities required quite a lot more statistical analysis to tease those effects out,” Mays told me. “We invested a lot in a very strong research design and analytic technique that helps us control for many different factors…so we’re about as confident as you can be that the effect we’re measuring is purely attributable to investments in public health.”
And while the study can’t shed light on which specific public health activities — direct health services, health promotion, policy, etc. — led to the health benefits, it did find larger health gains in communities that support a more comprehensive array of services as envisioned in the Institute of Medicine’s report on the core functions of public health.
Mays said he hopes policymakers at all levels of government can use the findings when deciding how to allocate often limited and strained funding, and to help target resources where they’ll reap the biggest health returns.
To download findings from “Who Benefits from Public Health Spending and How Long Does It Take: Estimating Community Specific Spending Effects,” visit http://works.bepress.com/glen_mays/119.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.