Tyrone Burke, September 13, 2021

Finding the Right Measurement to Quantify Impact of Public Health

An ounce of prevention is worth a pound of cure, or at least that’s how the saying goes.

When it comes to preventive health care, there is no precise measure of the return on investment. Public health makes up a relatively small percentage of overall health-care spending, but how much money is spent on and saved through programs that encourage people to quit smoking, screen themselves for cancer, or wear a mask to prevent COVID-19 is unknown.

This is partly because it is inherently challenging to quantify the cost of care that isn’t delivered because illness is successfully prevented, but also because public health programs are delivered by a variety of different organizations, thus blurring the definition of public health.

“We can find public health in immigration policy, school vaccinations, and labour policy—think about legislation that protects workers,” says Prof. Mehdi Ammi, a health economist at Carleton’s School of Public Policy and Administration.

“But we don’t know the total that is spent on these interventions from all sources.”

The Canadian Institutes of Health Research (CIHR) recently awarded Ammi a three-year, $467,000 grant to develop health data to better understand the impact of public health spending, and inform future policy-making.

“The end goal is to identify how much is spent, such that we can measure how much return on investment we get from public health—the value for money,” says Ammi, who will lead the research with co-Principal Investigator Prof. Sara Allin, of the Institute of Health Policy, Management and Evaluation at the University of Toronto’s Dalla Lana School of Public Health, and a group of Canadian public health decision-makers and international collaborators.

“I’m an economist, and one key question for us is really about if there is one extra dollar to spend in the health system, where should it be spent? Is it better spent on paying physicians, building a hospital, or public health measures?”

Because preventive health measures typically yield no measurable immediate result, their impact must be observed through the statistical analysis of health outcomes over time. Ammi and Allin will conduct a comparative case study using 20 years of health data from Canada’s provinces and territories, and compare it with data from Australian states and regions in England. Because each jurisdiction has different public health measures and different health outcomes, they will be able to better quantify the economic impact of dollars spent.

“Public health is only about five per cent of overall health spending in Canada, but it is something that has huge potential in terms of return on investment. When we spend on public health, we expect that people are going to be healthier down the road. They are going to use the health-care system less, and that will save money that could be reinvested in other programs,” says Ammi.

The researchers knew there would be challenges in measuring the outcomes of public health spending, but were a little surprised by exactly how difficult it is to accurately measure what is spent.

“There is no clear guideline on how to classify public health. The international guidelines are relatively vague. In Canada, it is even more challenging to measure because it is a federation, and every jurisdiction does it somewhat differently.”

To deal with this, Ammi will develop classifications and subclassifications of spending types to produce estimates that can be compared across jurisdictions. He hopes that a clearer picture of the return on investment will lead to greater investments in public health over the long-term—and capitalize on a moment of heightened awareness of the importance of public health and renewal of public health systems. The COVID-19 pandemic thrust public health into the spotlight to a degree that may be greater than any time in recent memory—even previous public health crises like the 2003 outbreak of SARS.

“With COVID, there has been a lot of interest,” says Ammi.

“There has been a lot of activity and engagement from governments, as people think about what we need to do to build a better public health system. I am particularly proud of this project’s integrated knowledge-translation plan, which will ensure real-world impact.”

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