False Economies: Myths about Public Health Spending

Abstract

Coronavirus has raised questions about the use of public health resources in Britain. It has been argued that the government’s response was weakened by public health budget cuts and that public health expenditure saves money in the long run by reducing future healthcare costs. In reality, there has been no cut in Public Health England’s budget for infectious disease prevention. Between 2014 and 2019, its budget for protection from infectious diseases rose from £52 million to £86.9 million. Cutting the public health budget has been described as a false economy, but this is a misrepresentation. Most public health interventions are cost-effective if a quality-adjusted year of life is valued at £20,000, but only 20% of interventions save money or produce a cash return. More than a third of public health interventions would not be approved if they were NHS treatments because they are not cost-effective. It is not possible to tell from the available data whether England’s public health budget is too small, too large or about right, but many of the arguments made for increased spending on public health are based on a misunderstanding of economics and human behaviour.