Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

This session includes papers with policy implications in the field of chronic disease prevention and health promotion. Public health and health economics tend to approach the question of health promotion differently. While morbidity and mortality due to certain risk factors provide sufficient rationale for new health promotion policies and health interventions from the public health perspective, the support for these policies in the economic approach comes from identifying market failures and from addressing equity issues to reduce and eliminate health disparities.

The first paper will serve as a background presentation. It will build on an economics workshop hosted by the Centers for Disease Control and Prevention, which served as an initial step to bring economics and public health closer together around the particular topic of heart disease and stroke prevention, but also had broader application. The public health community believes that by preventing or by detecting and treating certain risk factors, society may experience less illness and death than if the same amount of investment were made for the treatment of conditions. For example, heart disease and stroke have been the nation's leading causes of death and major causes of disability; yet these conditions are mostly preventable. This presentation will address the critical issues and the research needs in the area of economics of chronic disease prevention and health promotion.

Two of the papers in this session are econometric analyses related to the most important risk factors for chronic diseases – smoking and obesity. One of them uses data from 17 waves of the Simmons National Consumer Survey (NCS). The findings suggest that TV advertising of smoking cessation products may help prevent chronic diseases, especially for smokers in lower SES. In addition, private sectors' response of heavier advertising may magnify the impact of public tobacco control policies.

The third paper uses data from 15 waves of the Children of the National Longitudinal Survey of Youth 1979 (Children of NSLY79) to explore if the increase in family income of the lower SES group has an effect on child overweight. The findings suggest that policies aimed at reducing the overweight prevalence among children through increases in family income and food budgets may have the unintended consequence of potentially exacerbating the overweight problem.

The last presentation addresses the distribution of funds between prevention and treatment. Because the National Health Expenditure Accounts (NHEA) do not identify expenditures for prevention, this study uses information from supplementary national data sources, literature, and expert judgment to estimate the portion of each NHEA category associated with primary and secondary prevention. Important issues are whether the share of national health expenditures going to prevention is appropriate and whether the allocation across different preventive activities could be improved. In the second phase of this study the authors will compare their estimates of what is being spent on various categories of prevention to what the literature suggests is most valuable. They will analyze these findings, incorporating the opinions of experts who remain skeptical of much of the literature.