The Value of U.S. Public Health Spending

There is a link between increased public spending and a decline in preventable deaths, but money is not the total answer.

Health Affairs

When expenditures by local public health agencies increased it led to a decline of community mortality from preventable causes of death, according to research in . The report shows that mortality rates fell between 1.1% and 6.9% for each 10% increase in local public health spending.

Six preventable causes of death were examined over a 13-year period: deaths due to cardiovascular disease, diabetes and cancer; infant mortality; total mortality; and influenza mortality. The study focused on the local level.

Infant mortality and cardiovascular disease mortality showed the largest changes with mortality rates falling 6.9% and 3.2%, respectively, for each 10% increase in spending.

In 2005, the average community was spending $40.84 per capita on public health, up from $34.68 in 1993. And of the six mortality rates examined, four showed significant reductions when public health spending was increased.

While public health officials and policy makers face uncertainty regarding the appropriate levels and targets of investing in public health activities, the report states that “more money by itself is unlikely to generate significant and sustainable health gains.” Instead, the quality and efficiency have to improve considerably and “progress in these areas could greatly increase the value of additional public health spending.”

There were also two control conditions — Alzheimer’s mortality and residual mortality — which had no association with public health spending. These were chosen to “rule out the possibility of spurious associations between spending and mortality.”