$10 a person equals $16 billion annually

Payoff seen within five years

Little changes can make a big difference. Although that message still is seen as counterintuitive by some health care experts, Trust for America's Health (TFAH) has concluded that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save the country more than $16 billion a year within five years, or a return of $5.60 for every $1 invested.

TFAH executive director Jeffrey Levi says that prevention often is not seen as a viable cost-saving option by those who work on health care budgets in Washington, DC, but research has been proving the value of prevention activities. That research has been advanced by the TFAH work, which Levi says is the first community-level study to estimate the difference prevention can make.

Of the estimated annual savings of $16 billion, the report says, Medicare could save more than $5 billion, Medicaid more than $1.9 billion, and private payers more than $9 billion. The report's focus is on disease prevention programs that don't require medical care and target communities or at-risk community segments. Examples include providing access to affordable nutritious foods, increasing sidewalks and parks in communities, and raising tobacco tax rates.

The estimated returns on investment are from a model developed by researchers at the Urban Institute and a review of evidence-based studies conducted by the New York Academy of Medicine. The researchers found that many effective prevention programs cost less than $10 per person and that they have succeeded in lowering rates of diseases that are related to physical activity, nutrition, and smoking. "The evidence shows that implementing these programs in communities reduces rates of Type 2 diabetes and high blood pressure by 5% within two years; reduces heart disease, kidney disease, and stroke by 5% within five years; and reduces some forms of cancer, arthritis, and chronic obstructive pulmonary disease by 2.5% within 10-20 years," the report asserts.

The researchers note that their savings estimates cover only medical cost savings and don't include the likely significant gains that could be achieved in worker productivity and enhanced quality of life. They say they built the model to yield conservative savings estimates, using low-end assumptions for the impact of programs on disease rates and high-end assumptions for costs.

The model also shows estimated state-specific savings ranging from a return-on-investment of 3.7:1 in Utah (saving $89 million) to 9.9:1 in Washington, DC ($57 million). Projected five-year savings range from $29 million in Wyoming to $1.7 billion in California. Levi says the variations from state to state relate to differing underlying health care processes in the states.

The researchers say they evaluated 84 studies to develop the assumptions for the drops in disease rates and the programs' costs. Examples of the types of studies include programs that:

  • keep schools open after hours where children can play with adult supervision;
  • provide access to fresh produce through farmers markets;
  • make nutritious food more affordable and accessible in low-income areas;
  • require clear calorie and nutrition labeling of foods;
  • provide young mothers with information about how to make good nutrition choices;
  • offer information and support for people trying to quit smoking and other tobacco use;
  • raise cigarette and other tobacco tax rates.

To build the model, the researchers evaluated which diseases can be affected by improving physical activity and nutrition and preventing smoking and other tobacco use; how effective programs are at reducing disease rates; the current rates of these diseases and current annual costs for treating them; and the amount that could be saved if disease rates were reduced based on the estimates. (Download the report at healthyamericans.org/reports/prevention08/Prevention08.pdf. Contact Levi at (202) 223-9870.)