New Research Presented at Public Health Meeting Makes the Case for Prevention

While critics of the Affordable Care Act use the problems of a newly launched website to discredit the law and the idea of expanded access to healthcare, new evidence keeps emerging of the benefits that real health reform and investments in prevention and public health can bring to the people who need it most.

The annual meeting of the American Public Health Association this week brought to Boston thousands of people who are deeply committed to reforming the health system and improving the public’s health. Attendees were treated to a rousing keynote speech by Sir Michael Marmot, who declared that health inequities are unnecessary, avoidable and unjust. He described meeting with the former Spanish Minister of Health soon after The Economist had pilloried his “quixotic” commitment to equity. The minister told him, “Ah, we need the idealism of Don Quixote the dreamer, but we need the pragmatism of Sancho Panza."

The conference included the presentation of numerous pragmatic and evidence-based strategies to improve health and reduce inequities. In particular, two studies released at the meeting examined the impact that public health investments and broad expansion of health insurance can have on low-income communities and people of color.

The first, led by Glen Mays of the University of Kentucky, showed that when public health funding in a community rises, rates of infant mortality and deaths from preventable disease fall. The findings were based on an analysis of data from 3,000 local public health agencies in the U.S. over a 17-year period.

For every 10 percent increase in spending on public health and prevention, the researchers found a 4.3 percent drop in infant mortality and declines of 0.5 percent to 3.9 percent in deaths from diabetes, cardiovascular disease, cancer and influenza. Communities that invested in prevention also experienced significant reductions in the growth of healthcare costs.

When public health and prevention dollars were invested in low-income communities, the health gains were 20 to 44 percent larger than when the investments were made in wealthier communities, the research found. Reductions in death rates and healthcare costs were especially pronounced in communities that spread their public health dollars across a broad mix of preventive services.

The results show that “new resources, such as funding from the Affordable Care Act’s Prevention Fund, can have a larger impact if targeted to lower-resource, higher-need communities and if spread across a range of prevention strategies,” said Mays, director of the University’s National Coordinating Center for Public Health Services and Systems Research.

A second study showed that the Massachusetts law that served as a model for the Affordable Care Act greatly reduced the number of people without health insurance in the state and improved the health of residents. Because of its similarity to federal health reform, the findings offer a preview of what the entire country may experience in the coming years.

The findings, compiled by John Auerbach, former Massachusetts Commissioner of Public Health, showed that the number of uninsured fell from 7 percent to 2 percent, with the rate of uninsured dropping from 8 percent to 4 percent among African-Americans and from 10 percent to 7 percent among Latinos.

Long-standing gaps in rates of disease and death between white residents and non-white residents didn’t close during the study period. Auerbach suggested these gaps may narrow over time as more people gain insurance and keep it for longer periods of time. But the study also suggests that insurance alone won’t eliminate health disparities. Doing that will require concerted efforts to transform communities to make them healthier places to live.

These two studies offer strong arguments in support of maintaining and strengthening the Affordable Care Act and the Prevention and Public Health Fund the ACA created. We invite you to use these arguments in submitting letters to the editor, Op-eds and blog posts.