The Most Bang for your Buck

There is a plethora of research on programs and policies that aim to positively impact public health. While there are great resources online that synthesize the evidence, such the County Health Rankings and Roadmaps, a gap still remains: how do we determine the cost of these interventions and decide if they are feasible in a specific jurisdiction? Public health departments and community stakeholders are left to weed through the information and attempt to make an educated guess about the impact and cost for their particular jurisdiction, whether it be neighborhood, city or state. Considering that 75% of the public health workforce agrees it is important to have the skills to influence policy, but only a third report having the ability to do so, cost-effective analyses are an important tool to gain support for a policy or program.


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Luckily, there are a number of recent projects aimed towards helping stakeholders identify which programs and policies are likely to positively impact a public health issue, while also being cost effective for local, state and federal government. While all of the projects’ methodologies differ slightly based on the outcomes they measure and the types of interventions or programs they analyze, we all have a similar goal: to identify interventions that are likely to positively impact population health and save more than they cost over a specified period of time.


One such project, called the CHOICES study, published their results in Health Affairs this month. The authors estimated the cost-effectiveness of seven interventions in reducing BMI and obesity prevalence using a microsimulation model that implemented the interventions on a national scale. They found three of these interventions to be cost-effective over a 10-year period: excise tax on sugar-sweetened beverages, elimination of the tax deduction for advertising unhealthy food to children, and nutrition standards for food and beverages sold in schools outside of the regular meals. The other interventions that were nutrition standards for school meals, improved early care and education, and increased access to adolescent bariatric surgery. Restaurant menu calorie labeling was found to be cost-effective, but there was a wide uncertainty interval around the estimated per meal reduction in calories ordered or purchased as a result of the intervention.


Perhaps unsurprisingly, the interventions that had the most reach were the most cost-effective. Eliminating the tax deduction for advertising unhealthy food to children would reduce a BMI unit for $0.66 per person. That means that the net savings to society after a decade would be $32.53 for every dollar spent. Seems like a no-brainer! Furthermore, it’s quite likely their estimates could be seen as conservative. The authors did not include the potential yearly tax revenue that this intervention could generate in their calculations of net costs – a substantial $80 million. Most importantly, the intervention would prevent 129,100 cases of childhood obesity.


The Win Win project, as part of the Center for Health Advancement, has also joined the effort to identify cost-effective programs and policies. We focus on interventions that have an impact across sectors (e.g. education, crime), are tailored to specific jurisdictions and can provide findings within smaller sub-geographies (e.g. zip codes or school districts). We anticipate that our findings, which will be released shortly, will also add to the research base and serve as an important tool for public health practitioners and community stakeholders wishing to improve population health.

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