Great advances in the field of public health – sanitation, vaccination, food and workplace safety – have helped to reduce deaths and improve the quality of life for many Americans. Spending more for public health promises greater benefits.
Since the 1950s, public health programs have focused on the reduction of mortality from preventable causes of death and have been associated with a fifty percent increase in life expectancy for the American population. These preventable causes of death include cardiovascular disease, cancer, diabetes, and infant prematurity. However, the United States currently lags behind other industrialized nations in morbidity and mortality rates from preventable causes despite consuming vastly more resources for health care. Approximately five percent of the total national health spending is dedicated to public health programming. Given the country’s recent financial woes, this funding may become even more scarce. It has been postulated that increasing public health programming may further decrease the nation’s mortality rates.
This study evaluates the association between the amount of funding for public health programming and mortality rates for preventable causes of death. Data on per-capita public health expenditures were obtained from the National Association of County and City Health Officials data collection during their 1993, 1997, and 2005 census surveys and the Census Bureau’s Census of Governments and Consolidated Federal Funds Report. Mortality rates from the respective local communities over the study’s thirteen year period were obtained from the surveys by the Health Resources and Services Administration’s Area Resource files and the Centers for Disease Control and Prevention’s Compressed Mortality files. The mortality rates were divided between those sensitive to public health interventions (infant mortality; cardiovascular, cancer, diabetes, and influenza mortality) and those independent of public health interventions (Alzheimer’s and residual unpreventable mortality rates).
Multivariate regression models were used to estimate the effect of local public health spending on each mortality rate while controlling the effects of other community characteristics such as local economic conditions and local versus centralized state-governed health departments.
Infant and cardiovascular disease mortality rates fell by 6.9 percent and 3.2 percent for each 10 percent increase in spending (p< 0.05). Diabetes and cancer mortality rates fell by 1.4 percent and 1.1 percent for each 10 percent increase in spending (p< 0.05). Public health spending showed no association with the two control conditions, Alzheimer’s disease and the residual mortality rate, or with influenza deaths.
Local decision-making structures influenced public health spending levels considerably. Health departments governed by local boards had more than 17 percent higher per capita spending compared to communities without such boards (p< 0.01). Metropolitan communities tended to spend considerably less on public health than non-metropolitan communities (by over 38 percent; p<0.01). Communities with a federally qualified health center also spent less on public health by about 17 percent (p<0.01).
The association between increased public health spending and decreased mortality in preventable causes of death is intuitive. However, responsible spending must be considered. For instance, why wasn’t influenza mortality affected by public health interventions?
Given the rate of increasing health care costs across the country, our finite amount of health care resources will be depleted over time if spending increases continue unchecked. Funding for preventative public health programming should be increased to potentially decrease the future costs associated with treatment of these preventable causes. Difficult political and economic decisions are exacerbated by the time gap between the upfront cost of public health programming and future savings from decreased morbidity and mortality. A shift in the proportion of national health care spending devoted to public health should occur while decreasing funds for administrative services and price inflation. Although not easy, this challenge must be addressed before health care resources are depleted and our nation becomes helpless against the scourge of preventable illness.
Tyree Winters, DO
Ten Great Public Health Achievements — United States, 1900-1999
- Motor-vehicle safety
- Safer workplaces
- Control of infectious diseases
- Decline in deaths from coronary heart disease and stroke
- Safer and healthier foods
- Healthier mothers and babies
- Family planning
- Fluoridation of drinking water
- Recognition of tobacco use as a health hazard