by Jordan Mueller, MPH ’16, Department of Sociomedical Sciences
At the Dean’s Grand Rounds on November 12, Dr. Glen Mays, a public health economist from the University of Kentucky and a leading figure in the field of public health policy and financing, didn’t mince words about inefficiencies riddling the American health care delivery system. “75% of US health care spending is attributable to conditions that are largely preventable, ‘downstream’ causes,” he said. It’s a harsh reality.
As one of the most influential voices in public health systems infrastructure, Mays’s presentation, “Optimizing Public Health Systems for Population Health Improvement: Institutions, Economics, and Metrics,” translated the incredibly dense material of cost-effectiveness, returns on investment, and the economic burdens of preventable disease into easily understandable diagrams showing the areas where the nation has the most to gain.
As students of public health, time and again, we have been made aware that America spends more than any other industrialized country on healthcare, yet we have poorer health than peer nations. We die sooner.
The need to remedy this grim state of affairs is the reason many of us enrolled at Mailman. Fortunately, we had Dr. Mays on hand to present us with evidence-based practices to improve public health’s rank and status among the many fields vying for funding.
A political hot button, health care reform has the power to sway elections, bolster political allegiances, and even shut down the federal government. The presentation on the next generation of public health provided an alternative to the political frenzy that surrounds the broken American healthcare system. According to Mays, streamlining the preventative power of public health will create a healthier population. This will take an overhaul of infrastructure, institutions, and incentives.
“Less than 5% of U.S. health spending is allocated to prevention and public health,” says Mays. In inspiring fashion, Dr. Mays went on to outline the ways in which public health can work with these dismal numbers in the short-term while also improving the financial outlook for public health research. The key is to make public health evidence accessible to the population and appealing to the payers.
Identifying a key leverage point, Dr. Mays’s words resonated with the audience of public health professionals when he asked, “How do we reduce missed connections between science and society?” He then answered his question with a calculated solution: public health must address large inequities in society, clarify an incoherence in missions of public health organizations, and mobilize the collective actions of multiple stakeholders in government and private sector. Dr. Mays acknowledged the difficulty of these endeavors, but expressed his full confidence in the future generation of public health leaders.
The presentation had two main themes: improving health delivery systems, and using the measured effectiveness of these systems to create a steady stream of public and private financing. Dr. Mays emphasized that “Delivery system structure matters.” But what is a public health delivery system, exactly? There are three types: comprehensive, conventional, and limited. Comprehensive delivery systems institute a majority of the NIH’s recommended public health activities like screening, prevention, and epidemiological analysis. Limited delivery systems are less effective in implementing these measures.
In the language of economics, comprehensive health systems generate a return on investment of almost $3.00 for every $1.00 spent. These systems do more with less, and save society money in the form of foregone medical costs resulting from good health. Not only do comprehensive public health delivery systems improve population health, they attract funding through their ability to cut medical costs. Dr. Mays’ research has created a public health “win-win” that society desperately needs.
I had the opportunity to talk with Mays the next day. At lunch, he claimed that schools of public health like Mailman “have a huge role… if they can rise to the occasion.”
During the informal gathering set up for interested students, I asked how public health research, often requiring decades of analysis and multifactorial leverage points, can compete for federal funding with exciting and profitable medical research. He acknowledged that “there is no magic bullet,” and offered another one of his solutions: if we can present the evidence of public health’s returns on investment to key private funders with political clout, our field can have a voice in the market that is American politics.
Public health delivery systems require ingenuity and innovation. They improve health with minimal resources. Although minimal funding for public health would seem to stand in the way of improving our delivery systems, Dr. Mays assured me that “to move from a conventional to a comprehensive health system doesn’t take more money, it takes better leadership.” If leadership is the necessary capital for population health, then the Mailman School of Public Health is poised to be a principal financier. And we students hope to tender our currency soon.