Friday, August 5, 2011

More money, less preventable deaths

Public health activities, which are designed to promote health and prevent disease and disability, are a crucial component in reducing health disparities and improving community health. However, despite the increased focus on community-based health interventions (discussed in an earlier Bronx Health REACH post available here), national health spending on public health activities accounts for less than 5 percent of the total. The Affordable Care Act authorized a major expansion of federal public health spending ($15 billion over the next 10 years), but critics of health reform still argue that evidence linking public health activities to positive health outcomes is lacking. Public health professionals and community health advocates can attest that community-based interventions have been successful in changing unhealthy behavior, but a new study provides even greater evidence of the link between public health activities and better health. The study found that increasing public health spending lowers mortality rates from preventable causes of death. Though many of us in the field aren’t surprised by this news, it gives strong support to public health efforts in communities across the country.

The study, published this month in the journal Health Affairs, analyzed changes in spending patterns and mortality rates within the service areas of nearly 3000 local public health agencies over a 13 year period (1993-2005). The authors found that the degree of change in per capita spending varied widely across communities and only 65 percent of agencies experienced positive growth in the study period. However, in areas where public health spending increased, there were statistically significant reductions in mortality in four of the six mortality rates examined. Infant mortality and cardiovascular disease mortality were particularly affected: infant mortality fell by 6.9 percent and cardiovascular disease mortality fell by 3.2 percent for each 10 percent increase in spending. Diabetes mortality and cancer mortality also fell. The study’s authors concluded that public health spending was one of the most consistent determinants of community-level preventable mortality, even after accounting for differences in demographic and socioeconomic conditions.

By finding a clear association between spending and mortality, this study suggests that additional spending, such as that under the Affordable Care Act, would generate improvements in population health over time. It also warns against severe cuts in the health budgets of state and local governments. While health spending continues to be a frequent target for those against “big government”, this study provides the necessary evidence that our nation’s public health is a wise investment. Lowering mortality rates from preventable causes should be a top priority for the legislators and policymakers that are deciding how the federal government spends its money.

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