OK, you probably haven’t noticed, but April 1-7 2013 is National Public Health Week. The American Public Health Association is leading this week’s recognition and has created the above-linked spiffy website. Lots of Schools and some cities and towns are noting and doing something special this week. Though the Massachusetts Public Health Association seems not to have gotten the memo. And ditto for my own institution, the Harvard School of Public Health.
It’s always been true that public health is not good at celebrating itself and APHA is to be congratulated for giving it a push. And it’s too bad because public health in the U.S. deserves more attention, resources, and credit than it gets.
So let’s review a little.
The U.S Centers for Disease Control & Prevention has compiled a list of the 10 great public health achievements in the 20th century. Click the link for full details on each of these.
Many millions of lives saved, many injuries and illnesses prevented, much suffering and hardship averted, and many, many dollars not spent unnecessarily. On this last point, APHA is making an overdue push to document the return on investment (ROI) from public health interventions. Here are some samples from their Public Health ROI document:
• Routine childhood immunizations save $9.9 million in direct health care costs, save 33,000 lives and prevent 14 million cases of disease.
• A $52 investment in a child safety seat prevents $2,200 in medical costs, resulting in a return of $42 for every $1 invested. Similarly, a $12 investment in a child’s bicycle helmet can prevent $580 in medical costs, resulting in a return of $48 for every $1 invested.
• The cost of providing dental care for children enrolled in Medicaid and living in communities without fluoridation is twice as high as for children who receive the oral health benefits of drinking water fluoridation.
• Childhood health problems linked to preventable environmental exposures, such as lead poisoning, asthma complications and developmental disabilities, cost the U.S. $76.6 billion in 2008. Such costs have increased from 2.8 percent of total health care costs in 1997 to 3.5 percent in 2008.
• Every $1 invested in the nation’s poison center system saves $13.39 in medical costs and lost productivity, saving a total of more than $1.8 billion every year. Poison centers receive about 4 million calls every year, 2.4 million of which are about poison exposures.
• Every year, newborn screening efforts test nearly every baby born in the U.S. for health conditions that — if detected early enough — can be treated in time to prevent developmental problems, disability and death. For example, testing the 4 million infants born every year for congenital hypothyroidism costs $5 per newborn and prevents 160 cases of intellectual disability.
• By 2020, the direct benefits of the federal Clean Air Act will have reached almost $2 trillion, much more than the $65 billion it will have cost to implement the law. About 85 percent of the $2 trillion is attributable to decreases in premature death and illness related to air pollution.
• From 1991 to 2006, investments in HIV prevention averted more than 350,000 infections and saved more than $125 billion in medical costs.
• In 2009, seat belts saved about 13,000 lives and could have saved thousands more if all drivers and passengers had buckled up.
• Expanding the diagnosis and treatment of depression has an ROI of $7 for every $1 invested. Also, substance abuse treatment has an ROI of $4–$7 for every $1 invested.
And public health in the U.S. is not standing still or resting on laurels. In fact, I see the last 10 years as among the most vibrant and innovative in the history of U.S. public health. Some examples:
• The public health community has joined together to start a voluntary public health accreditation process, establishing basic standards for state, county and local public health agencies to meet to assure the best quality.
• A new research enterprise, Public Health Services and Systems Research (PHSSR), has triggered a new and growing wave of empirical research on the practice and structure of U.S. public health, helping to inform the practice of public health with real evidence.
• Embedded in the Affordable Care Act, as of June 2011, we have a National Prevention Strategy which provides a “health in all policies” blueprint to advance disease prevention and health promotion all over the nation.
• The “Triple Aim” for health system improvement — better patient care, lower costs, and better population health — has put public/population health into the middle of conversations about how to fix U.S. health care. The Triple Aim was pioneered by Dr. Don Berwick in 2005 at the Institute for Healthcare Improvement.
• New ACA innovations such as Accountable Care Organizations require that participating health systems focus on public/population health improvement.
• Eliminating racial and ethnic health disparities and addressing health inequities has become embedded in the thinking of public health and medical care across the nation.
• Public health advocacy has become much more sophisticated and smart with the arrival of new players such as the Trust for America’s Health.
• And special congratulations to the Robert Wood Johnson Foundation which has done more than any major organization in the nation over decades to improve and enhance America’s public health infrastructure.
Lots of good news and lots of dangers and threats. Dangers because the health of Americans continues to deteriorate with the growing epidemic of chronic disease — see this chart below showing changes in life expectancy for U.S. females between 1987 and 2007. The red zones indicate areas where life expectancy dropped:
Pretty shocking. And dangers because of federal, state, county and local cuts to basic and essential public health services. For public health, it is really the best and worst of times right now.
So congratulations to the many thousands of Americans engaged in the profession and practice of public health. Your work is worth celebrating.
April 4, 2013
By John E. McDonough