Though the United States spends more per capita on health care than any other country and has the highest health spending growth rate, we’re nowhere near the top of related health care rankings—in fact, U.S. statistics for preventable deaths, infant mortality, access to care, health care quality, etc. are pretty dismal.    U.S. investments into public health—estimated at less than 5 percent of total health spending—suggest that policymakers have low expectations for public health to reverse those trends. Or, at the very least, it signifies a health system culture that emphasizes health care over health promotion and disease prevention. To support public health investment and redesign the health system toward wellness, the prevention and public health community needs evidence that prevention can reduce costs.  In a tight fiscal climate, policymakers also need evidence that public health spending can deliver on its promise to improve lives and save money. Not only is there a dearth of research supporting the notion that prevention reduces costs, but a body of evidence linking public health spending to health outcomes is lacking. There is great potential for Public Health Services and Systems Research (PHSSR) to supply this body of evidence. Health Affairs recently published an article suggesting that public health spending may reduce preventable deaths – exactly the kind of evidence  the policy and public health community have been waiting for.   The findings are from a project funded in part through the Robert Wood Johnson Foundation’s HCFO program, which is housed at AcademyHealth. Investigators Glen Mays and Sharla Smith, of the University of Arkansas for Medical Sciences, found that mortality rates from preventable causes of death fell in communities where public health investments were made.  Specifically, over a 13-year period, increases in local public health spending were associated with reductions in infant mortality and deaths due to cardiovascular disease, diabetes, and cancer. Noting the current U.S. financial situation, Mays cautions, “Policymakers should avoid the temptation to cut back on public health in lean times in favor of seemingly more visible and immediate policy priorities, because the downstream health consequences can be significant…investments in public health activities may help them solve another vexing policy problem—the steady growth in medical care spending that is straining the budgets of governments, businesses, and families alike. Improving health through relatively inexpensive public health activities should be part of the policy strategy for bending the medical cost curve.” As a field committed to exploring the public health infrastructure, PHSSR is investigating how inputs (funding, workforce, training) relate to outputs (partnerships, programs, services) and their relationship to health outcomes.  Dr. Mays research illustrates how PHSSR can better inform our policy decisions in public health to improve outcomes. But, as we all like to say, “more research is needed.” To find out more about PHSSR, sign up for our free Interest Group and follow us on Twitter @PHSR_AH. Or send us an email at

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