You don't need to be a savvy consumer to know that spending more and getting less is a bad deal. But when it comes to health care, that's exactly the deal Americans are getting. The United States spends more money, both per person and as a percentage of GDP, than economically similar countries – and by a lot.  Our spending is nearly twice the average spent by other industrialized nations.

The logic should follow that we have the best health outcomes, right? Instead, the U.S. ranks 27th out of 36 economically similar nations in terms of life expectancy. We have one of the highest rates of mortality from heart disease. Babies born in the U.S. are less likely to see their first birthday than babies born in Slovakia.

What gives? Why do we have such poor outcomes if we spend so much? Part of that answer lies in how we're spending the money. Evidence suggests that the environments and conditions that affect how people live, work, and play have a greater impact than healthcare on their health outcomes. If you could detect and prevent a disease earlier, saving yourself from costly and sometimes painful treatment, wouldn't you do it? This is what public health does. Yet, the Institute of Medicine reports that only about 3% of U.S. health spending focuses on prevention and public health.

The Affordable Care Act tried to get a better deal for our health dollars by creating the Prevention and Public Health Fund (PPHF) to fund a multitude of prevention services from research into causes of Alzheimer's disease to efforts to prevent chronic diseases like diabetes and heart disease.

But Congress can't seem to focus on the goal of getting more bang for our buck. In 2012, it diverted $6.25 billion from the fund over nine years to cover Medicare physician payments. In 2016, sequestration cut $68 million.

Congress diverted even more funding this month with passage of the 21st Century Cures Act. While that law boosts funding for the National Institutes of Health, it balanced the cost with a 30% reduction in the PPHF.

Advancing medical science and investing in cures for debilitating conditions should always remain a priority, but it doesn't have to be an either-or situation. If we really want to spend less of our income on healthcare costs, our policymakers need to keep a sustained focus on public health. Congress should fully allocate funding for the PPHF now and for years to come.


Rosie Mae Henson, MPH, a 2016 graduate of the Dornsife School of Public Health at Drexel University, works for the School's Urban Health Collaborative.


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