ELLEN ANDREWS

The COVID-19 pandemic has focused a bright light on the weakness of the U.S. public health system. Countries with strong public health systems fared much better in controlling the virus’ spread. America used to have a strong public health system. From 1900 to 2000, life expectancy rose by 30 years. Contrary to public opinion, it was public health, not medical advances, that saved us. Clean water, safer food, and control of infectious disease made the difference.

But we’ve neglected public health spending since the last century and we’re suffering the consequences. Even before COVID-19, life expectancy stopped rising and began falling for some populations. Preventable deaths, such as suicides, obesity-related, alcohol, and substance-use deaths, account for much of the drop in life expectancy. Opioid deaths in Connecticut were high before the pandemic, and are even higher now. Proven public health initiatives can prevent these deaths of despair.

According to a new study published in Health Affairs, by 2018, of every dollar spent on health care, the U.S. spent only 2.5 cents on public health. From 2008 to 2018, U.S. spending on health care grew 4.3% while public health funding was flat. The neglect of public health funding coincided with declines in life expectancy, health disparities, and the resurgence of diseases we’d beaten, like measles.

In the U.S., most public health spending happens at the state level and Connecticut is behind other states. The study found that Connecticut ranks 36th among states in per-person public health funding, spending 28% less than the national average, and Connecticut public health spending fell faster than other states. From 2008 to 2018, Connecticut per-person spending on public health declined almost twice as much as other states. Our public health spending on services that would have controlled the spread of COVID fell 11%. 

Connecticut spends only 1% of our state’s health budget on public health to improve the health of all 3.6 million state residents. We spend almost twice as much providing medical services for roughly 10,000 prison inmates.

Like the rest of the country, our state has thrown a lot of money into public health to combat COVID because we needed to. But we tend to forget about investing when times are good, paying the price next time for our usual neglect, panic, repeat cycle.

Investing in public health is smart, saving more lives for less money than any other intervention. California found that for every dollar devoted to public health spending, its Medicaid programs saved $3.12. But to make public health sustainable, we need to make sure that those considerable savings are reinvested in communities, not sacrificed to escalating payments for health care institutions and industries. Connecticut’s health care system needs to do its own hard work to find efficiency. 

Clearly, we can do better. Connecticut needs to learn from both the COVID and the deaths of despair pandemics and invest in public health.

Ellen Andrews, PhD, is the executive director of the CT Health Policy Project. Follow her on Twitter @CTHealthNotes.

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