The Choosing Wisely Campaign aims at decreasing unnecessary spending in healthcare. As Dr. Anderson discussed in previous columns, the campaign identified several medical interventions that warrant a thorough discussion between patients and physicians prior to their implementation. Problems like high healthcare spending often require a multi-factorial approach. Another way to lower healthcare spending is to decrease the need and demand for these services. Public Health programs address upstream causes of disease and injuries thereby preventing the need for medical interventions. For example, since the 1970s seatbelt use has increased through public health programs which included educational and legislative intervention. As a result, traffic deaths have decreased by approximately 50%.
A systemic review of public health interventions in high-income countries reported an average Return of Investment (ROI) of 4.1 to 1 meaning that for every dollar spent on the public health program 4.1 dollars are saved in healthcare spending. Nationwide public health interventions had an even higher ROI at 27.2 to 1. Many of these programs are available in our community and include home blood pressure monitoring for hypertension, community-based fall prevention, early education programs for preschool and school-aged children, family planning services, infant car seats, booster seats, and lead-based paint control. Not only do these programs save money, but they also are tied to better health outcomes.