The federal government is confronted by a series of fiscal challenges for which public health is a crucial antidote. It’s time to recognize public health is a cost-effective way to consistently deliver returns on investment, with both financial savings and better health for the American people.
Health care in the United States is facing steadily rising costs, which will only continue to spiral upward – no matter how health care is provided – unless the health of the American people improves. For that, public health is the key.
Chronic disease, for example, has become stunningly prevalent in America – especially due to obesity. As of 2012, about half of all adult Americans had one or more chronic health conditions, according to the Centers for Disease Control and Prevention (CDC). Eighty-six percent of all health care spending covers people with chronic medical conditions, while the direct medical costs for chronic diseases and conditions exceed $750 billion annually.
Yet chronic diseases and conditions are largely preventable. Therefore, it is in the fiscal interest of the nation to invest in a public health strategy that invests in prevention and encourages a voluntary change in behavior. For such changes to take place, people need to live in conditions that enable them to be healthy, with cleaner air, places to walk and exercise, access to healthy and affordable food, and measures to decrease smoking. That’s just the beginning. We also need to invest in the nurturing conditions in which children can develop and lead healthy lives, setting the stage for a healthier future.
Relatedly, we are facing a staggering cost for infrastructure improvement. The American Society of Civil Engineers’ 2017 Infrastructure Report Card estimates that $4.59 trillion is needed by 2025.
These issues are very much connected. Half of the 16 infrastructure categories assessed by the Report Card have significant implications for public health directly or indirectly. Six out of those eight scored no better than a D+.
As infrastructure improves, public health will benefit as well. That’s true for infrastructure that directly affects public health – like water – as we saw clearly in Flint, MI. It’s also true for infrastructure that affects public health indirectly – like roads or transit. Construction and maintenance of sidewalks can make a difference in whether people choose to walk to work. Availability of transit allows people to leave their cars at home and benefit from exercise and clean air. Notably, none of those three categories scored higher than a D.
So, investing in public health would not only reduce the burden on health care, it could free up federal funds to improve infrastructure, which in turn would benefit public health. The cycle would then continue.
This year, the $39 billion total budget from the National Institutes of Health and the CDC demonstrate the current investment in both science and prevention for population health. But that figure is less than one-third of what America spent on medical costs linked to obesity in 2008 ($147 billion). Regardless of what budget ultimately gets approved in Washington, D.C., these health-related costs are clearly on the rise.
We’re also talking here just about the expenses of preventable chronic diseases and conditions. Imagine factoring in the added costs of lost lives, human suffering, and lost productivity – and public health becomes even more valuable.
As we mark National Public Health Week, it’s time to see public health not just as a mechanism for addressing health challenges but as a path to an America that is dramatically more healthy and cost-effective.