Healthier, the case for public health

http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf
US Health in International Perspective. Shorter lives, poorer health. S Woolf, L Aron, eds. NRC and IOM. 2012.
US Health in International Perspective. Shorter lives, poorer health. S Woolf, L Aron, eds. NRC and IOM. 2012.
Our World in Data. The link between health spending and life expectancy: The US is an outlier.
<https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus> Accessed September 7, 2016
 Percent of adults with diabetes by T stop, 2010

If you get off If you get off

at Arlington: at Maverick:
3% 11%

If you get off

at Fenway:
2%
If you get off
at Dudley
Square: 11%

If you get off at

Mattapan: 10%
Health of Boston 2012-2013: A neighborhood focus. Boston Public Health Commission.
<http://www.bphc.org/healthdata/health-of-boston-report/Pages/Health-of-Boston-Report.aspx> Accessed February 9, 2015.
 Despite geographic proximity to health services

MGH
East Boston
Neighborhood Health
Center

Brigham and
Womens;
Children's; Beth
Israel
BMC; Tufts
Medical
Center

Mattapan Community
Health Center; The Spark
Center

Google Maps. <https://www.google.com/maps/> Accessed March 17, 2015.

 Very little difference in course of
disease with precision medicine
approches vs. traditional
treatments

Salas-Vega S et al. Assessment of Overall Survival, Quality of Life, and Safety Benefits Associated With NewCancer Medicines. JAMA Oncol. JAMA Oncol.
doi:10.1001/jamaoncol.2016.4166
Stephenson AL. Survival Comparison of Patients With Cystic Fibrosis in Canada and the United States. Annals of Internal Medicine.
doi:10.7326/M16-0858
https://www.elsewhere.co.nz/blues/7145/blind-willie-johnson-considered-2015-from-deep-in-the-soul-to-deep-space/
What causes health; what we spend our money on

National health expenditures:

Determinants $2.6 trillion

Access to care: 6%

Genetics: 20%

Socioeconomic and
physical
environments:
22% Medical services:
90%

Healthy
behaviors:
37%

Socioeconomic and
physical
environments: 22%

Other:
15%
Healthy behaviors: 9%
Other: 1%

Healthy People/Healthy Economy: An Initiative to Make Massachusetts the National Leader in Health and Wellness. 2015. Data from NEHI 2013.
<http://www.tbf.org/tbf/56/hphe/Health-Crisis>
Tarlov A. Social determinants of health: the sociobiological translation. In: Blane D, Brunner E, Wilkinson R, editors. Health and social organization: towards a
health policy for the 21st century. London: Routledge; 1996 pp. 71-93.
 Changes in spending, 2000-2015

1.0

81%
0.8
% Growth (decline)

0.6

0.4

0.2
1% -2% -12% -22% -25% -27% -35%
0.0

-0.2

-0.4

-0.6

* Health care expenditure is Group Insurance Commission spending plus MassHealth (Medicaid)

Healthy People/Healthy Economy: An Initiative to Make Massachusetts the National Leader in Health and Wellness. 2015. Data from Massachusetts Budget
and Policy Center Budget Browser. <http://www.tbf.org/tbf/56/hphe/Health-Crisis>
 Prevention, keeping
us from getting sick

Treatment,
curing us once
we get sick

Healthy People/Healthy Economy: An Initiative to Make Massachusetts the National Leader in Health and Wellness. 2015. Data from NEHI 2013.
<http://www.tbf.org/tbf/56/hphe/Health-Crisis>
Tarlov A. Social determinants of health: the sociobiological translation. In: Blane D, Brunner E, Wilkinson R, editors. Health and social organization: towards a
US Health in International Perspective. Shorter lives, poorer health. S Woolf, L Aron, eds. NRC and IOM. 2012.
Motor vehicle safety: A 20th century public health achievement. MMWR. 1999;48(18):369-374.
In a city of a million residents, 40 percent expansion
of transit developments has annual health benefit of
$216 million
https://www.cdc.gov/policy/hst/hi5/publictransportation/index.html; Litman, T., Evaluating Public Transportation Health Benefits. 2010, Victoria Transport Policy
Institute http://www.apta.com/resources/reportsandpublications/documents/apta_health_benefits_litman.pdf
Financial support for habitable
homes: After rehabilitating
housing 62% of adults have
excellent health vs 33% before

https://www.cdc.gov/policy/hst/hi5/homeimprovement/index.html ; Breysse J et al. Health Outcomes and Green Renovation of Affordable Housing. Public Health
Rep. 2011; 126(Suppl 1): 6475. doi: 10.1177/00333549111260S110
https://www.flickr.com/photos/nodding_pig/15588502903/sizes/l
 Multi-component worksite
obesity prevention: Costs of
obesity ~ $73B among full-
time employees; 5% weight
loss results in $90 average
per person saving

https://www.cdc.gov/policy/hst/hi5/worksite/index.html Finkelstein, E.A., et al., The costs of obesity in the workplace. Journal of Occupational and
Environmental Medicine, 2010. 52(10): p. 971-976.
Trogdon, J., et al., A return-on-investment simulation model of workplace obesity interventions. Journal of Occupational and Environmental Medicine,
2009. 51(7): p. 751-758.
 Early childhood
education associated
with benefit:cost ratio
of $5:$1 with reduction
in crime rate, child
maltreatment, teen
pregnancy, academic
achievement

https://www.cdc.gov/policy/hst/hi5/earlychildhoodeducation/index.html
The Guide to Community Preventive Services, Promoting Health Equity Through Education Programs and Policies: Center-Based Early Childhood Education. The
Community Guide: What Works to Promote Health 2015 October 27, 2015 [cited 2015 November 30]; Available from: Promoting Health Equity Through Education
Programs and Policies: Center-Based Early Childhood Education.
Halfon, N. and M. Hochstein, Life course health development: an integrated framework for developing health, policy, and research. Milbank Quarterly, 2002. 80(3): p.
433-479.
Isaacs, J.B., Cost-Effective Investments in Children Isaacs. 2007, The Brookings Institute: Washington D.C.
Each time the Earned Income Tax Credit increases
by 10 percent, infant mortality drops by 23.2 per
100,000
https://www.cdc.gov/policy/hst/hi5/taxcredits/index.html
Arno, P.S., et al., Bringing health and social policy together: The case of the earned income tax credit. Journal of public health policy, 2009. 30(2): p. 198-207.
Homer J, et al. Combined Regional Investments Could Substantially Enhance Health System Performance And Be Financially Affordable.
Health Affairs. <http://content.healthaffairs.org/content/35/8/1435.abstract /> Accessed September 18, 2016
Adams J, Mytton O, White M, Monsivais P. Why Are Some Population Interventions for Diet and Obesity More Equitable and Effective Than Others? The Role of Individual
Agency. PLOS Medicine. 2016; 13(4): e1001990
Belluz J, Frostenson S. These maps show how Americans are dying younger. Its not just the opioid epidemic. Vox. May 9, 2017.
https://www.vox.com/2016/12/13/13926618/mortality-trends-america-causes-death-by-county Accessed May 14, 2017.
 Blacks in 2014

Blacks in 1986

Blacks in 1934

1910 1950 1988

National Academy of Medicine. The growing gap in life expectancy by income: Implications for federal programs and policy responses. 2015.
http://www.nap.edu/download.php?record_id=19015#
 The world, by preventable deaths

Worldmapper.<http://www.worldmapper.org/display.php?selected=1>
twitter/@sandrogalea

sgalea@bu.edu