Public health operates in the shadow. Surveilling and preventing disease, as well as promoting and protecting health are the missions of public health, but these missions result in outcomes mostly unobserved: diseases and deaths that are avoided. For these reasons, only a small fraction of health expenditures is allocated to public health. Assessing the value of public health expenditures is a necessary endeavor to ensure that public health is sufficiently well funded, especially since public health expenditures are the usual target for cuts in period of fiscal restraint.
In their new paper, Associate Professor & PhD program supervisor Mehdi Ammi and Adjunct Research Professor Antoine Dedewanou, together with Sara Allin and Emmanuelle Arpin from the University of Toronto, investigate the value of public health expenditures in Canada. They consider a specificity of public health expenditures: that they take a long time to produce effects. They focus on avoidable mortality from preventable causes, which is amenable to public health programs and services. They find that in the long run, increasing public health expenditures by 10% is associated with a reduction in avoidable mortality from preventable causes by 2%.
Published in Social Science & Medicine, one of the leading journals in interdisciplinary health research.
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Do expenditures on public health reduce preventable mortality in the long run? Evidence from the Canadian provinces
by Mehdi Ammi, Emmanuelle Arpin, F. Antoine Dedewanou, Sara Allin
published in Social Science & Medicine, Volume 345, March 2024, 116696, https://doi.org/10.1016/j.socscimed.2024.116696
Highlights
- Literature on health expenditures and health outcomes rarely separates long-run and short-run.
- Public health requires time to produce health effect, hence a need to model the long-run relationship.
- Expenditures on public health are associated with a long run reduction of preventable mortality.
- This long run relationship is stronger for preventable mortality among males than females.
- There is a limited influence of curative expenditures on treatable mortality.
Abstract
Background :Investments in public health – prevention of illnesses, and promotion, surveillance, and protection of population health – may improve population health, however, effects may only be observed over a long period of time.
Objective: To investigate the potential long-run relationship between expenditures on public health and avoidable mortality from preventable causes.
Methods: We focused on the country spending the most on public health in the OECD, Canada. We constructed a longitudinal dataset on mortality, health care expenditures and socio-demographic information covering years 1979–2017 for the ten Canadian provinces. We estimated error correction models for panel data to disentangle short-from long-run relationships between expenditures on public health and avoidable mortality from preventable causes. We further explored some specific causes of mortality to understand potential drivers. For comparison, we also estimated the short-run relationship between curative expenditures and avoidable mortality from treatable causes.
Results: We find evidence of a long-run relationship between expenditures on public health and preventable mortality, and no consistent short-run associations between these two variables. Findings suggest that a 1% increase in expenditures on public health could lead to 0.22% decrease in preventable mortality. Reductions in preventable mortality are greater for males (−0.29%) compared to females (−0.09%). These results are robust to different specifications. Reductions in some cancer and cardiovascular deaths are among the probable drivers of this overall decrease. By contrast, we do not find evidence of a consistent short-run relationship between curative expenditures and treatable mortality, except for males.
Conclusion: This study supports the argument that expenditures on public health reap health benefits primarily in the long run, which, in this case, represents a reduction in avoidable mortality from preventable causes. Reducing public health expenditures on the premise that they have no immediate measurable benefits might thus harm population health outcomes in the long run.