Public health saves lives, saves money: An evaluation of public health ROI in Los Angeles County

Background. In Los Angeles County, the concept of public health return on investment (ROI) is emerging as an important part of how the impact of public health programs, policies, and services are measured. Limited availability of cost-benefit savings data for public health investments in Los Angeles County reflect how recently ROI has been embraced: Data for projected monetary returns, savings, and intangible benefits are sparse, while routinely collected data for health indicators and economic cost of disease and injury are readily accessible. Together, these groups of complementary data are fundamental to developing ROI-minded, community-level, evidence-based integrated practices, and to demonstrating the necessity for local prevention and early intervention strategies that target both individual and societal system components.

Objectives. (1) To define community-level indicators of public health ROI; (2) to identify and apply criteria for recognizing ROI language, frameworks, methodologies, and formulas in the literature; and (3) to evaluate the availability of public health ROI and cost-benefit data for Los Angeles County.

Methods. Public health indicators of ROI were categorized by the health priorities outlined in the Community Transformation Grant (CTG) awarded to Los Angeles County in 2011. For each of the categories, applicable data on local key health indicators from 2011 were constructed in terms of opportunity statements that fit the prescribed measurability requirements defined in the Planning ROI Process Model for Public Health. Literature on existing frameworks and models for measuring the value of public health investments served as an overall primer for public health ROI identification criteria. Publically released reports published between 2010 and 2013 by the Los Angeles County Department of Public Health (LACDPH) and its partners were evaluated using the criteria to identify the extent to which ROI and cost-benefit analysis measures are applied and discussed in the County.

Results. Existing data on the key indicators of health can be used to develop internal and external benefit and cost descriptions that effectively capture public health ROI in Los Angeles County. There is some information regarding the current ROI framework and model(s) in use, such as those published in a study on the economic impact of sodium reduction in Los Angeles County.

Discussion. ROI methods can assist local health departments with developing interventions that aim to maximize successful health outcomes at lower costs, to measure the effectiveness of long-range strategies by programs or by interventions, and to identify intangible benefits. Data on indicators of health provide a good baseline for future comparison, and there are some examples in the publically available literature that this data is being used in conjunction with cost data to forecast projected returns in Los Angeles County.