Let’s Talk Money: Barriers and Benefits of Investment in Public Health
November 1, 2022
Public health interventions are chronically underfunded, in significant part because policymakers are often reluctant to adopt policies necessary to fund them. Much of this reluctance can be attributed to the fact that returns on investment (ROIs) for public health interventions, while substantial, are difficult to accurately predict and are often realized many years down the line. Decision-makers and funders at all levels of government, and the public, need a mindset shift toward recognizing the long-term value of public health investments, and public health professionals can use advocacy to help them do so.
Public health interventions are chronically underfunded, in significant part because policymakers are often reluctant to adopt policies necessary to fund them. Much of this reluctance can be attributed to the nature of returns on investment (ROIs) for public health interventions: they are often substantial but can be difficult to accurately predict and are often realized many years down the line. Legislators and other policymakers are often more interested in saving money today and having an impact in the short term—that’s what keeps them in office.
ROIs for public health interventions are typically significant, and larger than those of other types of investments. Studies evaluating specific public health interventions have quantified their benefits, and a 2017 review of these studies found the median ROI for public health interventions was 14.3 to 1. For local interventions, the ROI was 4.1 to 1 and for nationwide interventions it was 27.2 to 1. Compare this to an investment increasing in popularity in the U.S. in recent years: house flipping (buying old homes to renovate and re-sell), which had an average ROI of 51 percent, or just 1.51 to 1 in 2017. For another popular investment, buying real estate to use as rental properties, a “good” ROI is 8-20 percent, or just 1.08-1.2 to 1.
Although many public health interventions have high ROIs, unlike flipping houses or buying rental properties, the returns for many types of interventions can only be fully realized many years down the road. For example, because 90 percent of daily tobacco smokers try smoking for the first time by the age of 18 and 99 percent try by the age of 26, ROIs for tobacco control and prevention interventions aimed at preventing youth uptake (i.e., education in schools, enforcement activity for youth-related sales restrictions) can only be measured about a generation later, when the targeted youth become adults. Similarly, because funding universal free meals for children in schools leads to better academic performance and attendance, which can lead to higher graduation and employment rates, ROIs for such interventions are best measured decades later after the children have had the time to graduate high school, attend college, and/or enter the workforce and become independent.
Adequately investing in public health interventions is one of the wisest actions a government can take to protect the health of its people and environment now and in the future: even small public health investments can have immense positive impacts. Unfortunately, political factors and competing interests often lead to undervaluation of the benefits of public health investments, whether intentionally or unintentionally. When possible, public health organizations and professionals should advocate for increased funding and bring attention to the immense benefits of public health investments using local and timely examples. Policymakers tend to support shorter-term disaster-response public health investments more eagerly in instances of great need and public support (e.g., post-9/11 terrorist attacks and anthrax attacks, the COVID-19 pandemic, natural disasters). These emergency response investments do not often lead to the higher ROI, longer-term investments in prevention that could prevent or mitigate disasters down the line, but advocates can utilize the increased attention and momentum to try to sway policymakers in the direction of prevention.
There needs to be a mindset shift for decision-makers and funders at all levels of government and the public toward recognizing the long-term value of public health investments, and public health professionals can use advocacy to help them do so. Some guidance on how to move that advocacy forward can be found in the Network’s recent report, Fighting for Public Health, designed to stimulate wide-ranging discussion and engage those who share a sense of urgency in collective, purposeful action to strengthen public health advocacy in the United States. Better understanding and articulating the ROI on funding public health interventions must be a part of the discussion.
This post was written by Brianne Schell, JD, MA, Staff Attorney, Network for Public Health Law – Eastern Region Office.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.