INSIGHT & INSPIRATION FROM APHA’S 2012 MIDYEAR MEETING

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32 Survive All In This Friends Prevention, Strategies & Thrive Together For Health Opportunity & Equity for Health Fortunately, the ACA recognizes this connection via the Prevention and Public Health Fund. Still, the fund remains somewhat controversial, Mays said, because we don’t have a lot of sound evidence on the return on investments in public health. Mays and his colleagues are gathering that evidence, however, and here’s what they’ve found. Communities with higher public health spending saw larger reductions in preventable mortality measures, such as cancer, heart disease, diabetes and infant mortality. Also, communities at the bottom levels of per capita public health spending have the highest levels of per capita medical spending. The findings illustrate the real health returns associated with growing investments in local public health as well as the chance to offset medical costs. Mays projected that the additional federal spending authorized via the Prevention and Public Health Fund works out to about a 1.2 percent increase in public health spending in communities over 10 years. Every new dollar in federal public health spending will get back about 87 cents in Medicare spending over a decade — “that’s a fairly sizeable economic impact suggesting that, yes, public health spending can be useful in reigning in medical cost growth,” Mays told attendees. Such federal spending can also avert nearly 180 preventable deaths in an average community, resulting in about 1,800 life years gained. Public health, he said, “is a good buy.” “We’re certainly just at the tip of the iceberg in terms of our current research technology for estimating these benefits,” Mays said. “But we think this, in part, shows us what’s possible not only with expanded investment in public health, but also what’s possible with expanded research into helping us look at the benefits and return from investments in the public health system.” From session 3003, Public Health Funding: Why Should They Care?, June 28
33 Survive All In This Friends Prevention, Strategies & Thrive Together For Health Opportunity & Equity for Health Refocus on Social Justice Eliminating health inequities is a daunting task, even for the most well-funded health department. Such is the case in Boston, where black residents experience disproportionately higher rates of illness and death, despite near-universal access to health care services in Massachusetts. “Black residents have worse health and the neighborhoods in which they live also have the worst health outcomes,” said Barbara Ferrer, executive director of the Boston Public Health Commission, the nation’s oldest health department. To address the problem, the commission restructured its work to zero in on the social determinants that shape people’s health outcomes with a strong focus on racism, which Ferrer said has an “impact on pretty much every other social determinant of health, including people’s access to education and jobs, the healthy environments where they live.” In fact, eight years ago, Boston’s mayor convened a task force dedicated to ridding inequities in health outcomes. So, what does that mean for a health department? “We alone can’t fix much of anything,” Ferrer told meeting attendees. “It is our job to acknowledge that the reality is that it is those very conditions that’s going to affect people’s health status and then align ourselves up as institutions to really put our work in places where we’re going to make a difference in those social conditions.” The health department developed a set of core strategies and guiding principles to support activities designed to achieve equity through community, policy and systems change, with an explicit commitment to racial justice. To build institutional capacity, Ferrer said every program at the commission must now integrate the elimination of health inequities into their goals. The health department also realigned its resources to achieve three overarching goals within five years: reduce the gap in low birthweight rates, reduce obesity/overweight disparities, and reduce the gap in chlamydia incidence. In addition, all employees must take training focused on racial and social justice.
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INSIGHT & INSPIRATION FROM APHA’S 2012 MIDYEAR MEETING

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