Glen Mays Q&A: Public Health Dollars and Cents
You can talk policy and practice all you want, but like most things in life, public health is reliant on money. Glen Mays, a public health economist at the University of Kentucky, studies the organization and financing of public health, with a focus on estimating the health and economic effects of preventive health policies, services, and strategies.
In a conversation with Transmission, Mays offered a preview of his November 12 Grand Rounds, touching on topics from disparities in public health financing to his quest for a minimum package of public health services and how much it costs.
On a very basic level, how is public health funded?
It’s patchwork quilt. The resources that support public health activities in the United States come from a variety of sources, both in government and the private sector. They flow to institutions that do the work of public health. One thing that surprises people: it’s state and local government that invest most heavily. The federal government is a minority investor in public health.
What are the implications of local funding? Does this bring about disparities?
It’s similar to inequities in education funding, although it may be to an even greater degree in public health. In part, it’s because we haven’t decided as a nation to have the federal government play a larger role. Right now, state and local governments primarily rely on income tax and property tax. That means public health spending is going to reflect underlying inequities in income and housing.
You’re written about a minimum package of public health services? What is this package?
The concept of a minimum package comes out of a report by the Institute of Medicine that said every American should be covered by a core package of public health activities. An expert panel has been put together to identify the public health protections, programs, and services that should be available at a minimum regardless of where you live. Next we have to figure out the resource requirements to put those capabilities in place across the country.
Three cents of every healthcare dollar is spent on public health? Is this too little?
A majority of the almost $3 trillion we spend on health and healthcare is attributable to preventable diseases and injuries. We must be willing to spend a larger share of our resources on strategies to prevent those conditions.
Is there waste and inefficiency in the public health system?
There are probably large inefficiencies in public health delivery related to how our public health system is organized. For example, small communities are not able to afford a full array of public health protections. This can be redressed in part by pooling resources across low-resource areas to achieve economies of scale.
What about the decline in funding for public health research? What are the implications?
There is declining support for research in general and also the fact that the research is heavily skewed toward the treatment end of the spectrum, as opposed to the development of new public health strategies. Public health is facing a lot of pressure to innovate, but the R&D money isn’t there to do it.
What’s the role of the private sector in public health?
There is enormous opportunity for public-private alignment in prevention. The challenge is how we can coordinate efforts in the private sector with those underway in the public sector so we aren’t duplicating activities and not inadvertently creating or exacerbating disparities.
How much does public health cost? Is it a bargain?
At the aggregate level, public health is a very good buy. Looking over a 15-year time horizon at variation in public health spending levels and connecting those with health outcomes and medical costs, $547 is our estimate of the aggregate cost per every life year gained from expenditures made in public health at the local level. That’s a very attractive number.
Watch the Livestream:
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