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Is an ounce of prevention worth a pound of cure? Estimates of the impact of English public health grant on mortality and morbidity


  • Stephen Martin

    (Department of Economics and Related Studies, University of York, York, UK)

  • James Lomas

    (Centre for Health Economics, University of York, York, UK)

  • Karl Claxton

    (Centre for Health Economics and Department of Economics and Related Studies, University of York, York, UK)


Most previous attempts to estimate the marginal productivity of English health care expenditure have employed instruments that rely on statistical tests alone for their justification. A new approach to instrumentation has proposed the use of ‘funding rule’ variables as instruments, which can be justified on theoretical grounds. We exploit the availability of a funding formula for local authority (LA) public health expenditure in England to investigate the relationship between such expenditure and mortality. Although there have been many studies of the impact of specific health promotion activities on outcomes, we are not aware of any successful attempts to relate English public health expenditure to mortality. Moreover, by converting healthcare (treatment) expenditure to a local authority geography, we are also able to estimate an outcome specification that includes both treatment (healthcare) and prevention (public health) expenditure. This enables us to identify the relative contribution of both types of expenditure to reductions in mortality. Previously published work has linked effects on disease specific mortality to changes in quality-adjusted life years. We use these estimates to report the cost per quality-adjusted life year (QALY) for both treatment and public health (prevention) expenditure.

Suggested Citation

  • Stephen Martin & James Lomas & Karl Claxton, 2019. "Is an ounce of prevention worth a pound of cure? Estimates of the impact of English public health grant on mortality and morbidity," Working Papers 166cherp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:166cherp

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    References listed on IDEAS

    1. Karl Claxton & James Lomas & Stephen Martin, 2018. "The impact of NHS expenditure on health outcomes in England: Alternative approaches to identification in all‐cause and disease specific models of mortality," Health Economics, John Wiley & Sons, Ltd., vol. 27(6), pages 1017-1023, June.
    2. Brown, T.T., 2016. "Returns on investment in California county departments of public health," American Journal of Public Health, American Public Health Association, vol. 106(8), pages 1477-1482.
    3. James Lomas & Stephen Martin & Karl Claxton, 2018. "Estimating the marginal productivity of the English National Health Service from 2003/04 to 2012/13," Working Papers 158cherp, Centre for Health Economics, University of York.
    4. Brown, Timothy Tyler, 2014. "How effective are public health departments at preventing mortality?," Economics & Human Biology, Elsevier, vol. 13(C), pages 34-45.
    5. Small, Dylan S., 2007. "Sensitivity Analysis for Instrumental Variables Regression With Overidentifying Restrictions," Journal of the American Statistical Association, American Statistical Association, vol. 102, pages 1049-1058, September.
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    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Brendan Collins’s journal round-up for 22nd July 2019
      by Bren Collins in The Academic Health Economists' Blog on 2019-07-22 11:00:41


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    2. Candio, Paolo & Meads, David & Hill, Andrew J. & Bojke, Laura, 2021. "Taking a local government perspective for economic evaluation of a population-level programme to promote exercise," Health Policy, Elsevier, vol. 125(5), pages 651-657.

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