Public Health Initiatives Deliver Big Returns on Investment

During the internet boom of the 1990s, the stock index grew a record 417%. That’s a phenomenal return, but it pales in comparison with the return on investment, or ROI, of many public health interventions. For example, one study estimated that every dollar invested in programs that reduce children’s exposure to lead paint saved $17 to $221, a much higher return than the S&P’s best bull run.

Of course, stock yields and public health savings are as comparable as apples and syringes, but the fact is that small investments in public health save lives and money. As policymakers look for ways to rein in soaring U.S. health care costs, public health offers some of the most effective solutions.

For the same reason that people change their cars’ oil every 5,000 miles instead of replacing their engines every 15,000, it’s cheaper to prevent a disease than to treat one. And that’s what public health does: It promotes wellness and prevents illness across whole communities and populations.

By synthesizing data from 34 studies of a range of public health interventions going back decades, researchers looked at the United States and several other large economies and calculated that every dollar invested in public health saves about $14. For example, for every dollar invested in public health:

• One researcher at the School of Public Health of the University of California, Berkeley, estimated that California’s county departments of public health return $67.07 to $88.21 in health savings and economic benefits. The study, published in 2016, also estimated that these county departments collectively save 27,000 lives a year.
• Community-level public health investments could save an estimated $1.10 in Medicare costs alone, according to another study of national data, conducted by public health researchers at the University of Kentucky.
• Universal vaccinations for the Hib flu vaccine would save $2.46 in direct costs and $4.38 in societal costs. Looking back over the past 30 years, the Centers for Disease Control and Prevention (CDC) has calculated that routine childhood vaccinations in the U.S. saved $540 billion in medical costs and $2.7 trillion in broader social costs—and prevented about “508 million cases of illness, 32 million hospitalizations, and 1,129,000 deaths.”
• The CDC’s National Environmental Public Health Tracking Network saves $1.44 in health care costs by helping states collect data on the quality of drinking water in wells, the levels of mercury in fishing areas, and the impact of wildfires on air quality, among other things.

These and other studies also show that, from school nutritionists to state lawmakers, a wide variety of people contribute to public health’s impressive ROI. For example, for every dollar invested:

• City planners in Lincoln, Nebraska, generated $2.94 in direct health benefits by creating walking and bike trails that encourage exercise.
• A Chicago pre-K program that provides education and comprehensive support for children in low-income families (such as free breakfast and vision and hearing screenings) generated $10.83 in societal benefits, including “increased earnings and tax revenues and averted criminal justice costs.”
• Massachusetts’ Medicaid agency saved $2.12 in hospitalization costs thanks to programs that helped people stop smoking through outreach, counseling, and medication.
• And nationwide, state laws that require booster seats in cars for children ages 4-7 save $8.60 for every dollar invested by preventing injuries.

These studies also point to another solid investment: improving the quality of public health data. Looking at a system of five hospitals serving patients in Utah and neighboring states, researchers measured a 142% return on investment in electronic case reporting: the automated electronic technology known as eCR, which helps public health agencies collect the data they need to detect and prevent the spread of communicable diseases. At this rate of return, hospitals and health systems can recoup their IT costs in less than five years.

So, as policymakers, insurers, and health care providers look for ways to keep more people healthy and curb rising health care costs, they should remember that a dollar of public health prevention is worth about $14 of cure.

Josh Wenderoff works on The Pew Charitable Trusts’ health programs.