Increased Public Health Spending Decreases Mortality
July 22, 2011 —
Increased public health spending produces measurable improvements in mortality from preventable causes, according to a study published online July 21 in Health Affairs.
Programs to prevent disease and injury constitute less than 5% of US health spending, and there is little evidence available to conclude whether such measures have a significant effect on public health.
Programs include monitoring community health status, investigating and containing disease outbreaks, providing public education regarding health risks and prevention, enforcing public health laws and regulations (eg, with regard to tobacco use), and inspecting the quality of water, food, and air.
The level of resources spent on public health strategies varies widely from state to state and across communities, but the consequences of these different levels of investment have not been well studied.
The Affordable Care Act of 2010 includes a projected $15 billion in new federal public health spending during the next 10 years. The funds target improvements in health, reduction of health disparities, and reduction in the growth of medical spending. However, there is little evidence regarding the efficacy of such measures, which has contributed to the political controversy surrounding the act.
The study authors, Glen P. Mays, PhD, chairman of the Department of Health Policy and Management at the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, and Sharla A. Smith, MPH, research associate, put together a database of local government public health spending, population characteristics, and community mortality rates and looked for associations between public health spending and health effects across communities. They looked at local health agencies because they implement a greater share of community health activities than states or the federal government.
The study encompassed nearly 3000 local public health agencies during a period of 13 years (1993 - 2005). Spending data came from census surveys conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005. The researchers linked these figures to data on population characteristics and health resources from the Health Resources and Services Administration's Area Resource File (a national county-level health resource information database). Other sources included federal and state spending estimates from the Census Bureau's Consolidated Federal Funds Report and Census of Governments, as well as cause-specific mortality rates obtained from the Centers for Disease Control and Prevention's Compressed Mortality File.
The researchers chose the outcomes that they deemed most likely to be sensitive to public health interventions: age-adjusted all-cause mortality rate, infant mortality rate, and age-adjusted mortality rates for heart disease, cancer, diabetes, and influenza. As a control, the researchers also included mortality from Alzheimer's disease and residual mortality that was not attributable to heart disease, cancer, diabetes, chronic obstructive pulmonary disease, influenza, cerebrovascular diseases, or unintentional injuries.
There were general trends of both a decline in mortality rates and an increase in public
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