Health Sciences Centre, University of Canterbury, Christchurch 8140, New Zealand.
J Public Health (Oxf). 2012 Aug;34(3):322-7. doi: 10.1093/pubmed/fds039. Epub 2012 Jun 13.
Health care is a less important determinant of health than behaviour and the environment but paradoxically, spending on health in most countries suggests the opposite. What determines these health policy and funding decisions, and might there be ways to increase investment in public health?
Published papers, reviews and reports on the cost-effectiveness of public health interventions and barriers to investment in public health were reviewed.
There is evidence to support investment in public health. Many public health interventions have been shown to save money, and some have cost-effectiveness ratios better than or equivalent to health care interventions. Despite this, there are recognized barriers to investing in public health. These barriers include the greater requirements for cost-effectiveness sometimes placed on public health interventions, the belief that in the long run prevention may cost more than treatment, the timeframes required for some public health interventions, the 'identifiable victim effect', the influence of interest groups, and the reality that evidence alone does not drive health policy.
Investment in public health has the potential to deliver improved health outcomes. Strategies to address the barriers and increase investment in public health are suggested.
医疗保健对健康的决定作用不如行为和环境重要，但具有讽刺意味的是，大多数国家在医疗保健上的支出却表明情况恰恰相反。那么，究竟是什么决定了这些卫生政策和资金决策？是否有办法增加对公共卫生的投资？
对公共卫生干预措施的成本效益以及投资公共卫生的障碍的已发表论文、综述和报告进行了回顾。
有证据支持对公共卫生的投资。许多公共卫生干预措施已被证明可以节省资金，并且其中一些具有比医疗保健干预措施更好或等效的成本效益比。尽管如此，投资公共卫生仍存在公认的障碍。这些障碍包括对公共卫生干预措施有时提出更高的成本效益要求、人们认为从长远来看预防可能比治疗花费更多、一些公共卫生干预措施所需的时间框架、“可识别受害者效应”、利益集团的影响，以及证据本身并不能推动卫生政策这一现实。
投资公共卫生有可能改善健康结果。提出了一些应对障碍和增加公共卫生投资的策略。
