You often hear that it costs more to imprison a person for a year than to send them to Harvard with full tuition, room and board for a year. On the basis of factoids like this, people often claim cities and states can save money by investing in programs that prevent violence and crime, rather than punishing them. But is this true? And if so, how much money is at stake? And is it just crime, or do public-health initiatives also have a high return?
A short-term therapy program called Functional Family Therapy, helps juvenile offenders overcome adolescent behavior problems, and has been shown to improve high school graduation as well as reduce substance abuse and crime. An asthma home remediation program reduces exposure to multiple indoor asthma triggers through home visits by trained personnel, which helps to improve school attendance and leads to fewer emergency department visits. Programs to enhance physical education have been shown to promote fitness in elementary- and middle-school children, reduce obesity, and improve scores on standardized tests of math and reading. In these examples and many more, programs that are good for education, juvenile justice or another sector are also good for health.
They are also good for the public’s bottom line. If a functional family therapy program was implemented in Houston, it would pay for itself by year 3 after a single investment. By year 50, the savings to local, state and federal governments would be approximately $13,000. An asthma home remediation program, if expanded in Philadelphia, would return $4.00 to local and state government for every $1.00 invested. In San Antonio, a multi-component school-based obesity program would return $1.17 to government for every dollar invested.
When sectors recognize the potential for mutual benefit, major advances can occur through collaboration and support.
The Win-Win Project, a long-term initiative of the Center for Health Advancement at the Fielding School of Public Health, UCLA, recently published the long-term impact of six cross-sector interventions on their new website. The Project provides a standardized, unbiased economic analysis of interventions to help public-health officials make informed policy and program decisions and engage in cross-sectoral collaboration. The Win-Win model results are unique because they are evidence-based, can be tailored to any jurisdiction and provide real-world impact and costs.
An overview of the interventions and their impact on health, education, crime and other outcomes and their value to governments is detailed on the website. The interventions modeled so far include:
- Nurse Family Partnership Program in Los Angeles County, CA
- Functional Family Therapy for juvenile offenders in Houston, TX
- Cognitive Behavioral Therapy Program for juvenile offenders in Houston, TX
- Multi-Component School-based Obesity Program in San Antonio, TX
- Asthma Home Remediation Program in Philadelphia, PA
- Universal Pre-School in San Diego, CA
To determine the interventions long-term impact, Win-Win project staff conducted a literature review of the current evidence for a diverse range of interventions that span across the life cycle and impact multiple sectors, including education, child wellbeing, and juvenile justice among others. The literature review informs the applicable outcomes to measure and the expected effect size of those outcomes. Additionally, we collect local demographic, health, education, crime and economic baseline data for the jurisdictions. Local baseline data allows us to tailor the program impact results to the specific jurisdiction. We then input the evidence and baseline data into the Win-Win Modeling tool to determine the long-term impact on health, education, crime and other outcomes. More details on the Win-Win Methodology can be read here.
The Win-Win Project continues to model interventions that fall across the life-cycle and Robert Wood Johnson Foundation Culture of Health Action Areas and impact multiple sectors. The results of these interventions will continually be added to the website, so check back often. We hope the findings will prove to be useful to inform program decision-making within and outside of public health and will be used to engage and collaborate with other sectors.
It’s one thing to say that crime doesn’t pay, or that prevention does. It’s a much more useful thing to know how much.