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They say what doesn’t kill you makes you stronger. I say what does kill you likely could have been prevented.

The eight leading causes of death in the United States — heart disease, cancer, chronic lower respiratory diseases, accidents from unintentional injuries, stroke, Alzheimer’s disease, diabetes, and influenza — kill nearly 2 million Americans each year. Many of these conditions, and thus many of the deaths from them, could be prevented. Yet instead of putting money toward prevention, we spend most of our health investments on treating these conditions after they arise.

Nearly half of Americans have one or more chronic diseases like those that make up the leading causes of death. More than 80 percent of the annual $3 trillion we spend on health care — about $8,000 per person per year — goes for individuals with one or more chronic conditions.


Contrast that with our spending on prevention. According to a new report from my organization, Trust for America’s Health, the entire budget for all chronic disease prevention activities at the Centers for Disease Control and Prevention is just $1.2 billion — $4 per person per year.

To make matters worse, while spending on treatment continues to skyrocket, core funding for the CDC’s disease prevention and health promotion efforts has declined by around $580 million since 2010, after adjusting for inflation. States haven’t been able to make up for flatlining funds. State spending on public health has remained relatively level since 2010, at approximately $31 per person per year.


It’s a pretty simple equation: Continued budget cuts equal a decrease in the ability of public health organizations to protect and improve the nation’s health. Not surprisingly, the nation recently saw the first decreases in life expectancy in decades.

Our nation’s deficient funding of prevention doesn’t make sense because we know that prevention saves lives and dollars — evidenced-based programs provide a huge return on investment. Here are some examples highlighted in our report:

  • Deaths from the use of prescription painkillers have more than quadrupled in the past 15 years, and deaths from heroin have tripled since 2010. Five of the strongest school-based substance use prevention strategies have returns on investment ranging from $3.8:1 to $34:1. Some of these strategies could also help prevent suicide, binge drinking, unsafe sex, and other risky behaviors that have long-term effects on health.
  • 1 in 3 children in the US will develop type 2 diabetes in their lifetime, a rate that is increasing, and 1 in 4 young adults are not healthy enough to join the military. An investment of $10 per person in proven, evidence-based community prevention programs to increase physical activity, improve nutrition, and reduce tobacco use could save the country more than $16 billion annually — a $5.60:1 return.
  • Coordinating systems that address gaps between medical care and effective social service programs — by connecting patients in need with programs ranging from supportive housing to food assistance — could yield between $15 billion and $72 billion in annual health care savings within 10 years, according to an earlier analysis by TFAH and Healthsperien.
  • When health crises such as new infectious diseases arise, the country often lacks sufficient funding to effectively respond. At the same time, preventable infectious diseases — like the flu — cost the country more than $120 billion a year, a sum that is exponentially compounded when new diseases emerge.

It has been painfully clear for far too long that the decrease in federal public health spending has not been countered by higher state spending for public health. Instead, the nation has doubled down on cuts at federal and state levels, leaving us vulnerable to current public health crises like the obesity and opioid epidemics and to future public health crises — like the next Ebola or Zika.

Cutting public health funding has always been shortsighted. Eventually, the bill will be way past due and our children will pay the price.

John Auerbach is president and CEO of Trust for America’s Health and the former associate director for policy at the Centers for Disease Control and Prevention and commissioner of public health for the Commonwealth of Massachusetts.

  • Prevention is the key to improve health and decrease cost. Amazingly simple, yet, we as a country can’t figure out a way to do it effectively. WHY? My theory is that prevention of disease does not make money for any of the stakeholders. Public health needs to go mainstream…..

  • Prevention for these life-style related condition must take the form of the anti-tobacco campaign: tax the heck out of it, sue the makers, public education, and banning the activity in public spaces. Can you imagine this being done with added sugar, in its many forms? Or added fat? packaged “food” purveyors would rise up as one against any such effort. People would insist on their right to drink soda and eat junk food and fast food. All the while insisting we help them pay for treatment of diseases that we KNOW these substances cause. Good luck! Just taxing sugared soda is causing a row.

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