At the University of Arkansas, Glenn Mays and Sharla Smith have compared how much money communities across the U.S. spend on public health with those communities' rates for infant mortality and for deaths from cardiovascular disease, cancer, and diabetes. Their data was derived from 2900 local public health agencies. They found that for each 10% increase in public health spending, the mortality rates declined by between 1.1% and 6.9%. They compared this result with medical spending as follows: On average, an increase of 10% in public health spending in these communities amounts to $300,000, and it achieves a 3.2% reduction in cardiovascular mortality. To achieve the same result medically would require the hiring of 14 primary care physicians (for 10,000 residents), and that would cost at least $2.5 million, over eight times as much.

This research, when published, will furnish the best evidence yet for promotion of population health over personal health approaches.

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What infrastructure is necessary at the community level to capture savings in the medical care system that can be used to address social determinants of health?

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