Monday, July 25, 2011

Health program spending linked to preventable death declines

Finally, a study (to be published in August by Health Affairs) has been completed that shows evidence of a link between increased spending on local health programs, and decreases in incidences of community mortality rates from a variety of causes. For those who are worried about the effect of increased federal spending on health programs, often for the poor and for those with limited access to health care, as mandated by the Patient Protection and Affordable Care Act (ACA), this should be terrific news. It would seem, as the study's authors purport, that increased public health spending could be a good investment, assuming a drop in mortality rates is viewed by most of us as a good thing.

The study's authors argue convincingly that increases in public health investments may result in better community health outcomes. For example, for every 10% increase in spending, infant deaths fell an average of approximately 6.9%, and for the same increase in spending, cardiovascular disease mortality fell an average of approximately 3.2%. In addition, diabetes mortality and cancer mortality fell by approximately 1.4% and 1.1%, respectively, for every 10% increase in spending. These mortality rates, as well as other used in the study, were expected by the authors to be most likely to respond to interventions via public health programs.

The study looked primarily at per capita spending by almost 3,000 local public health agencies, and at some measures of direct federal and state public health spending, over a 13-year period. The authors explained that they studied spending by local agencies partly because most federal, state, and philanthropic funding ends up getting channeled through local public health agencies.

The authors of the study estimate that the $15 billion in federal funds authorized under the ACA's Prevention and Public Health Fund could generate a substantial increase in public health, especially since other sources of funding for local public health programs have been reduced as a result of the recession.

The authors acknowledged that the study has its limits, and that factors other than public health spending may have influenced mortality rates, although their analytic methods apparently accounted for the effects of community characteristics that could have an independent influence on the health of the population. There were other variables that the authors noted had an effect on the incidence of mortality, but these were primarily social determinants, such as level of education, race, and having a certain percentage of the local population above the federal poverty level. Furthermore, the authors acknowledged that money, in and of itself, was not likely to create lasting health gains. Still, one of the most consistent determinants of preventable mortality was found to be public health spending.

The authors of the study also estimated that a 10% increase in public spending would result in a 3.2% reduction in cardiovascular mortality, and would necessitate $312,274 more annual funding for the average metropolitan community studied. Increasing the average number of primary care physicians in each area by 27, the number estimated to be required to bring about a similar mortality reduction, instead of adding to local public health funds, would cost far more than that, they pointed out.

Two control conditions, Alzheimer's mortality and residual mortality, showed no connection between outcomes for the population and public health spending. The study's authors have stated that this study provides a foundation for future analysis, especially of spending on more specific programs such as tobacco cessation, nutrition, and physical activity.

Source: Glen P. Mays and Sharla A. Smith, Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths, Health Affairs (2011), doi: 10.1377/hlthaff.2011.0196.


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