Investing in Public Health: Q&A with Glen Mays

Nov 5, 2013, 9:58 AM


New research presented at the American Public Health Association (APHA) annual meeting in Boston today finds that when public health funding increases in a community, its rates of infant mortality and deaths due to preventable diseases decrease over time, with low-income communities experiencing the largest health and economic gains.

According to the research, conducted by Glen Mays, PhD, MPH, director of the University of Kentucky’s National Coordinating Center for Public Health Services and Systems Research, each ten percent increase in public health spending over 17 years led to a 4.3 percent reduction in infant mortality, as well as reductions of 0.5 to 3.9 percent in non-infant deaths from cardiovascular disease, diabetes, cancer and influenza.

However, these health gains were 20-44 percent larger when funding was targeted to lower-income communities. Increases in public health spending also correlated with lower medical care costs per person, especially in low-income areas. The study, which analyzed data compiled by the National Association of County and City Health Officials from 3,000 local public health agencies over a 17-year period, also found that lower death rates and health care costs were seen especially in communities that allocated their public health funding across a broader mix of preventive services.

“The results clearly show that better health and lower health care costs are possible if we simply change how and where we allocate public health funding, even if new money isn’t available, said Mays. “And it also shows that new resources, such as funding from the Affordable Care Act’s Prevention Fund, can have a larger impact if targeted to lower-resource, higher-need communities and if spread across a range of prevention strategies.”

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

NewPublicHealth spoke with Mays about the new study just before the APHA annual meeting began.

Glen Mays, PhD, MPH, Director of the University of Kentucky’s National Coordinating Center for Public Health Services and Systems Research Glen Mays, PhD, MPH, Director of the University of Kentucky’s National Coordinating Center for Public Health Services and Systems Research

NewPublicHealth: What are the key findings of the study?

Glen Mays: We’ve done prior studies that show communities that invest more on public health realize gains in health status and, over time, those communities see slower growth in medical care costs. So the goal of the study is to look at who benefits most from investments in public health.

What we found was that, not all that surprisingly, communities that are more economically constrained, that have lower income communities with higher poverty rates and lower socioeconomic status, tend to benefit the most from investments in public health activities over time. These low-resource communities see larger reductions in their preventable mortality, and they also see larger reductions in their medical care costs over time from investments in public health spending compared to more affluent communities. We expected to find that, but this is the first time we’ve been able to document the size of that effect. Those communities see about twenty percent higher rates of health and economic gain from their spending compared to more affluent communities.

NPH: How does this study build on previous work you’ve done?

Mays: Previously we’ve done work using the same kind of design, longitudinal studies examining public health spending levels and how they vary across communities. And over time, we’ve been able to show that communities that spend more on public health expenditures see larger health gains from that expenditure, including larger reductions in deaths due to preventable conditions. With our prior research, we were able to estimate just an average effect—on average what kind of a health gain did communities see per dollar of additional investment in public health expenditures.

But with this new study, we’re able to actually take a more fine-grained look and see what kinds of communities appear to benefit most from the spending, from a comparative effectiveness standpoint, which is one of the trends now in health and public health research. Not just estimating an average effect, but a more nuanced understanding of where we realize the largest gains in what kind of populations and what kind of communities? So this is the first study we’ve done and I think really the first in the field to show that some of our most vulnerable communities benefit most from spending. We really should be giving them priority when it comes to allocating public health resources.

NPH: Where do the allocations make the most impact?

Mays: What our data do show is that communities that spread these dollars across a broader range of public health intervention realize larger gains compared to communities that target them narrowly and spend them in traditional public health programmatic areas such as communicable diseases and environmental health. It’s important to continue investing in those areas, but our results show that communities that also allocate resources especially into newer public health targets such as chronic disease prevention and control appear to realize larger gains.

NPH: What needs to happen for the study to have maximal impact?

Mays: This research has some real direct implications for policymaking under the Affordable Care Act. The Prevention and Public Health Fund, created by the Affordable Care Act, is one of the first new federal programs investing new dollars into public health and prevention. There is still a lot of uncertainty about the return on investment from those kinds of expenditures. So the findings offer some reassurance that over time there should be some real health and economic gains from added investments, particularly if we can target them to this high-need, low-resource communities.

I think the study has real relevance to decisions that policymakers are making now at the federal and state levels in terms of priority setting, particularly in times when budgets are tight. My hope is that we can reach policymakers with the findings, and we’re doing a lot those sorts of briefings these days through briefings to policymakers at all levels of government as well as using our practice-based research networks to get these findings out to decision makers who are making resource allocations.

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