The average life expectancy in the United States at the turn of the 20th century (1900) was 50 years. By the turn of the 21st century, Y2K, life expectancy had reached 80 years. Of course, we can point to amazing medical advancements in the 20th century that must account for that increase, right? Antibiotics, new drugs for just about everything imaginable, diagnostic testing like MRIs and CT scans, robotic surgery—the list of advancements goes on and on. The reality is that good public health accounts for about 80% of that 30-year lifespan increase. Vaccinations, more abundant and safer foods, safer water, motor vehicle safety, recognition of tobacco as a health hazard, and more are among public health improvements in the 20th century. Lately the news is that life expectancy is declining in the United States, now for the second year in a row. That puts the United States behind many other well-developed nations. Coincidentally, or maybe not, in the almost two decades of my public health career—beginning just after Y2K—cuts in public health spending have been the norm. Investment in public health has been on a constant decline for at least two decades. Investment at the federal and state level has a direct Impact on local public health because that is the source of 70% of our funding.
We know that public health accounted for serious advancements in health (measured by increasing life expectancy), and we also know that public health initiatives result in cost savings to our very expensive health care system, by far the most expensive system in the world. Not only that, but all or our organizations, agencies and businesses experience cost savings in things like employee health insurance, worker productivity, and disability prevention with good public health.
For every dollar invested in childhood immunizations, we save $22. For every dollar we invest in flu vaccinations, we save $11 in direct medical costs alone. For every dollar we invest in hearing screening, we gain $112 in worker productivity. Basically, investment in public health makes sense. People live longer, people are healthier, and there are incredible savings to be had in direct medical costs as well as employer costs such as lost productivity.
So back to our original question, what happened after Y2K? We systematically disinvested in public health and one could argue that as a result, we lost gains in life expectancy as health care costs continue to soar. An article from Citizens Research Council of Michigan, “An Ounce of Prevention: What Public Health Means for Michigan,” provides an excellent framework for us to continue to advocate for increased investment in public health. We are Ingham County Health Department; this is our mission. And, it just makes sense.