There’s a growing consensus among policymakers and health planners that if we want to improve health outcomes and lower costs we must change community conditions in ways that support health and prevent illness and injury before they occur. In their article, Larry and Tony outline some of the essential elements of a sustainable funding mechanism. They argue that we need to “close the loop” by ensuring that when prevention efforts DO save money, substantial portions of that money get plowed back into prevention.  While many payment strategies rely on healthcare to foot the bill for emerging prevention efforts, a closing-the-loop strategy would ensure that much of the funding for prevention could emerge from taxes, fees, legal settlements and other measures,  reducing the burden on health care.  The paper begins on a provocative note:

“What would you say about an investment that returned 5,500 percent? If you were lucky enough to have made the investment, you’d probably look for ways to reinvest most of it to earn more  of those hefty returns.”

They point to a fascinating study released last year by UC-San Francisco researchers, which found that California invested $2.4 billion from cigarette taxes into the state’s tobacco control program—and got a whopping $134 billion return—5,500 percent—in the form of reduced medical expenditures. And yet, as the paper points out, very little of that $134 billion in savings went back into further efforts to prevent smoking.  That needs to change.