Public Health Basics
The COVID pandemic proved the value of public health to save lives and improve health. Public health is among the best investments to improve the health of Connecticut’s population, but it has been chronically underfunded. Connecticut spends about 1% of our state budget on public health for all 3.6 million residents, roughly equal to what we spend on medical care for about 10,000 prison inmates. California found that each dollar invested in public health returned $3.12 in savings to their states’ Medicaid programs. Unfortunately, public health’s savings go back into the medical care system; they are rarely reinvested in community health.
Public Health Deeper Dive
What is public health?
In contrast to medicine, public health is concerned with the health of populations and communities. According to the US Centers for Disease Control and Prevention (CDC), public health is “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.”
Public health focuses on preventing health problems rather than the treatment of patients when they are ill. Public health functions include vaccinations, tracking disease outbreaks, preventing injuries, and educating people about health risks such as tobacco and alcohol, among many others. Over the 20th Century, Americans’ life expectancy rose 62% and, contrary to public opinion, those gains were largely due to effective public health initiatives such as prevention and control of infectious diseases such as tuberculosis, tobacco control, safe drinking water, cancer prevention, and occupational safety.
However, more recently, progress has stalled. Americans’ rising life expectancy reversed course in 2014 and has been declining, even before COVID. The US is now far behind other developed countries in health status. Americans live four years less but we spend 177% more per person on healthcare than residents of other developed countries. Six in ten Americans rate the quality of care in the US as just average or below average compared to other countries.
There is good evidence that state policy can make an important difference in the health of state residents. Research has found a correlation between improved life expectancy and state policies on tobacco, labor, immigration, civil rights, and the environment.
What is the public health system?
Public health is largely sponsored by government, at all levels — federal, state, and local.
At the federal level, the Centers for Disease Control and Prevention (CDC) is the main sponsor of public health. Other agencies involved in public health functions including the Environmental Protection Agency (EPA), the Occupational Safety and Health Administration (OSHA), the Centers for Medicare and Medicaid Services (CMS), the Department of Agriculture (USDA), the Department of Transportation (DOT), the National Highway Traffic and Safety Administration (NHTSA), and the US Public Health Service, among others.
In Connecticut state government, the main public health agency is the Department of Public Health (DPH). Other agencies involved include the Department of Social Services (DSS) and the Department of Mental Health and Addiction Services (DMHAS), among others.
Connecticut has 63 local public health authorities. Large municipalities often have their own local health department. Smaller towns usually share public health responsibilities in a regional health district. Local health departments are responsible for monitoring the health status of their community, investigating local health problems and hazards, and educating residents about health issues, and connecting residents to healthcare when needed, among many other functions.
How is public health effective in improving the health of populations?
Investing in public health is smart, saving more lives for less money than other interventions. California found that for every dollar devoted to public health spending, its Medicaid programs saved $3.12. Unfortunately, those savings go back to the medical system, and not reinvested in communities and public health initiatives that could save more lives.
There is a great deal of research identifying public health interventions that are proven to improve health and lower total healthcare costs. Among the most effective are tobacco control, food safety, reducing infections in healthcare settings, motor vehicle injuries, teen pregnancy, and improving nutrition, physical activity, and lowering obesity rates. Searchable databases have made it easy to prioritize initiatives and identify best practices. There is help for state policymakers in using that research to implement proven interventions.
Are we spending enough on public health?
No. Historically the US and most states, including Connecticut, have not funded public health at levels sufficient to maximize the public’s health. In 2018, of every dollar spent on medical care, the U.S. spent only 2.5 cents on public health. From 2008 to 2018, U.S. spending on health care grew 4.3% while public health funding was flat. The neglect of public health funding has coincided with declines in life expectancy, rising health disparities, and the resurgence of diseases such as measles that we’d beaten in the past. Experts have called for annual investments of $4.5 billion at the federal and state levels to realize public health’s potential to improve health.
Connecticut spends only 1% of our state’s health budget on public health to improve the health of all 3.6 million state residents. We spend almost twice as much providing medical services for roughly 10,000 prison inmates.
Like the rest of the country, our state has recently thrown a lot of money into public health to combat COVID, because we needed to. But we tend to forget about investing when times are good, paying the price next time for our usual neglect, panic, repeat cycle.