An analysis of public health spending in Sedgwick County illuminates the consequences of public spending decisions. In particular, those calling for more spending on zoos and arts must consider the lives that could be saved by diverting this spending to public health, according to analysis from Kansas Health Institute.
Kansas Health Institute is concerned about proposed reductions in public health spending in Sedgwick County. Sunday it released a fact sheet titled Decreases in Public Health Spending Associated with More Deaths from Preventable Causes, subtitled “Analysis of how proposed public health funding reductions in Sedgwick County could lead to more preventable deaths over time.”
KHI’s analysis is based on the paper “Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths,” Glen P. Mays and Sharla A. Smith, Health Affairs, 30, no.8 (2011):1585-1593, available here. Excerpts from the paper are below. KHI summarizes the findings of the paper as: “In short, the research showed that increased spending by local public health agencies over the thirteen-year period studied was linked to statistically significant declines in deaths from some preventable causes such as infant mortality, heart disease, diabetes and cancer.”
KHI developed a model based on the paper’s findings to conclude that the proposed reductions in spending on public health in Sedgwick County would result in the deaths show in the nearby table from their fact sheet. The total of these numbers is an additional 65 deaths per year.
Perhaps in response to these findings, two Sedgwick County Commissioners have proposed eliminating the proposed cuts. To help understand the effects of this spending, I duplicated the analysis performed by KHI. I took the proposed increases in spending (or reductions in cuts) and subtracted the spending for public health, leaving $1,019,499 in spending that loosely qualifies as “quality of life” spending. It’s for things like the zoo, Exploration Place, economic development, and the like.
As can be seen in the nearby illustration, if this quality of life spending was instead spent on public health, we could save 43 lives per year. Based on the methodology used by KHI, this is the human cost of restoring only the proposed cuts to quality of life spending in Sedgwick County. If we were to use the totality of quality of life spending, or even just a subset like the $5.3 million spent on an elephant exhibit, the cost in human lives is large. This, of course, assumes that the KHI methodology is valid and reliable.
In its summary, the KHI report states: “Budget decisions have real consequences.” Those supporting spending on quality of life issues instead of public health have some explaining to do.
Excerpts from Mays et al.
“On balance, there is very little empirical evidence about the extent to which differences in public health spending levels contribute to differences in population health. Several cross-national studies have found weak and conflicting associations between spending and health outcomes at a national level.”
In a section titled “Limitations” the authors note “Several limitations of this analysis are worthy of emphasis. Although we used strong statistical controls to address possible sources of bias, it remains possible that factors distinct from, but closely correlated with, public health spending may explain some of the observed associations between spending and mortality.”
Also, “Local public health activities may have important and perhaps more immediate effects on these other indicators of health … this analysis may underestimate the health consequences of changes in local public health spending.”
In conclusion, the authors write: “Our analysis supports the contention that spending on local public health activities is a wise health investment. Increasing such investments in communities with historically low levels of spending may provide an effective way of reducing geographic disparities in population health. However, more money by itself is unlikely to generate significant and sustainable health gains.”