NewPublicHealth Q&A: Glen Mays

Jul 28, 2011, 4:05 PM, Posted by

Glen Mays, University of Arkansas

A new study in the journal Health Affairs finds that increased spending by local public health departments can save lives currently lost to preventable illnesses.

NewPublicHealth spoke with study co-author Glen P. Mays, M.P.H., Ph.D., professor, chair and director of research for the Department of Health Policy and Management in the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences.

NewPublicHealth: Your study looks at the impact of increased spending by local health departments between 1999 and 2005. What did the research show?

Glen Mays: This is an ongoing study that looks at public health financing issues and investments in public health services. In this study, we track spending by approximately 2,800 public health agencies on public health services. We track that spending over thirteen years, and we link our measures of public health spending with measures of health outcomes, particularly mortality from preventable causes of death at the local level. Basically, we found that there are strong and significant associations between spending on public health and outcomes in terms of reductions in mortality from preventable causes, over the study period. We look specifically at deaths – infant mortality and deaths due to cardiovascular disease, diabetes, and cancer. The majority of public health agencies around the country support activities that target those kinds of outcomes over the long run, whether it’s tobacco control, nutrition, physical activity support, maternal and child health services, or chronic disease screening.

NPH: The study ended in 2005. If you had continued on to 2011, do you think there would have been different numbers? Would your study have been able to show that in some cases, local health departments were not able to spend as much?

Glen Mays: That’s a very good question. This is part of an ongoing research project and certainly, we do know that over the last couple of years, a growing number of agencies have had to cut back on their spending and service delivery as a result of the economic downturn and the resulting constraints on government spending. So we know that the recent shocks have resulted in more agencies curtailing their spending in certain areas. We have not yet done work to look at the downstream effects of the spending reductions on outcomes. We certainly can use our estimates to project the kinds of effects – the positive outcomes – associated with new spending. And we’ve begun to implement the public health provisions of the Affordable Care Act, which include a projected 15 billion dollars in new public health spending over the next decade. Our findings suggest that level of investment would have significant benefits in terms of bringing down preventable mortality rates, particularly infant mortalities and deaths from cardiovascular disease and diabetes. But the flip-side is also true. The kinds of cutbacks in state and local support driven by the economic decline for public health activities – if we’re not able to find some solutions for ways to fill those gaps, we can also expect greater avoidable deaths in some of those areas.

NPH: How might a budget director of a health department use the data in this study to advocate for more funding, particularly if they’re in danger of having their budget cut?

Glen Mays: Hopefully, our findings are of relatively immediate use for that kind of decision-making. Our estimates can be applied to public health agencies and the budgets that a state or local public health official is currently negotiating. If they’re looking at a twenty percent cut in their budget, for example, they can take our estimates and project that out in terms of mortality effects – what that’s likely to mean and therefore what the benefit may be for finding other ways to meet a budget shortfall that has less severe health consequences for the population at large.

NPH: How might the data inform a policy-maker who is deliberating a funding or related decision around public health?

Glen Mays: The fundamental implication of our research is that resources allocated to public health are wise investments – over time, these resources can produce substantial gains in health per dollar invested. For policy-makers who are facing tight budgets and revenue short-falls, our findings highlight the importance of policy solutions that ensure adequate funding for public health activities. Policy-makers should avoid the temptation to cut back on public health in lean times in favor of seemingly more visible and immediate policy priorities, because the downstream health consequences can be significant. Our findings also suggest to policy-makers that investments in public health activities may help them solve another vexing policy problem – the steady growth in medical care spending that is straining the budgets of governments, businesses, and families alike. Improving health through relatively inexpensive public health activities should be part of the policy strategy for bending the medical cost curve.

NPH: What’s next?

Glen Mays: We now have updated data through 2010 on public health agency spending patterns. It will be a while before we’re actually able to estimate the downstream health effects for these more recent spending patterns, but we have a parallel line of research looking at the relationships between investments in public health and potential cost savings in medical care delivery.


This commentary originally appeared on the RWJF New Public Health blog.