At a moment when every penny of public spending is under scrutiny due to continued public sector austerity measures, and public health budgets are being reduced each year, a new UK study shows every euro spent on public health actually saves an average of 14 euros in the long-term.
Cuts to public health budgets such as, practically speaking, programmes to tackle obesity or promote good mental health – while offering short-term relief to pressures on the public purse – may eventually prove to have been a false economy, leading to billions of additional costs to health services and the wider economy, the researchers found. They hope that other countries will learn the lessons from their findings when looking where to direct public expenditure savings in the future.
The study was undertaken by researchers from Public Health Wales, the Departments of Public Health at Halton and Wirral Metropolitan Borough Councils, the Department of Public Health and Policy at the University of Liverpool and the Centre for Health Economics, University of York. They wanted to show the potential long-term impact of cuts in funding to the English National Health Service. Although the NHS enjoys a high degree of public support, they argue individual voters do not often appreciate the benefits from population-level health expenditure, and many public health interventions which could make a significant difference to individual lives do not receive funding, as well as the fact that public health has been a particular target for recent budget cuts, as the OECD recently found.
Their findings were based on 52 studies published over four decades, covering 29 different types of intervention such as initiatives to protect public health, health promotion and legislation, in the UK, Western Europe, the US, Canada, Japan, Australia and New Zealand. Analysis showed that the average return on Investment (ROI) for a public health initiative was 14.3 for every unit cost spent. For every unit of spending on local initiatives, the ROI was 4.1, while even larger benefits ensued from national programmes, with an average ROI of 27.2, and average cost benefit ratio (CBR) of 17.2. The study also calculates additional CBRs, according to different types of health intervention, for example health promotion activities or legislation, and also finds that some of the interventions showed returns within 6-12 months.
Another way to look at the researchers’ findings is to consider the costs of this lost investment. So, every unit of spending cut from public health budgets represents lost opportunities in terms of improving public health. For example, the recent £200 million cuts to public health funding in England is likely therefore to actually be eight times higher, or £1.6 billion, with impacts on the wider economy in terms of for example lost productivity, from rising incidence in NCDs when programmes to reduce obesity are cut.
This is the first systematic review of public health investment, spanning a range of different interventions, and the lessons which are drawn can be applied elsewhere to public health systems outside the UK. If cuts to public spending must be made, governments and policy-makers should think very carefully, as cuts to public health budgets will cost us all more in the long-term.