In the News
In these times of economic downturn, it's often difficult to determine where and how health care dollars should be spent. Cutting funding to programs that serve communities is a popular recent approach to budget control at both the federal and local levels. Just two examples are the nationwide battles that heated up early in 2011 over federal and state funding of Planned Parenthood programs and the decreases in funding for community mental health services in New Jersey, among other states. As of 2010, state spending on preventive health care varied considerably, from a per capita low of about $14 in Ohio to a per capita high of $52 in Alaska, according to a report from the Robert Wood Johnson Foundation (http://bit.ly/qkDun9).
Although 65% of public health agencies show increases in public health spending from 1993 to 2005, 35% experienced reductions. A recent study suggests, however, that communities spending more on public health may see better outcomes, at least in terms of certain chronic-disease mortality rates and infant mortality.
The study team analyzed spending patterns and mortality rates in almost 3,000 local public health agencies over 13 years. They found statistically significant reductions in infant deaths and in mortality rates for heart disease, diabetes, and cancer in communities with larger increases in public health spending (see Figure 1). Total mortality rates and deaths from influenza followed the same trend, but those results weren't statistically significant.
Although the authors acknowledge the limits of their study's observational design, they concluded that the results provide "compelling evidence" of a connection between differences in public health spending and outcomes. Furthermore, they point out that the mortality reductions attributable to increased spending were sizable, and that increasing public health spending would likely be less costly than increasing the number of physicians (in an average metropolitan community) by enough to achieve the same result. One major caveat is that spending alone isn't the answer; also needed are more effective systems for tracking public health trends at local, state, and national levels; better dissemination of the health consequences of decreased public health spending; and evidence-based resource allocation.—Gail M. Pfeifer, MA, RN, news director
Mays GP, Smith SA. Health Aff (Millwood) 2011;30(8):1585-93.