Vilma G Carande-Kulis’s research while affiliated with Centers for Disease Control and Prevention and other places

The Centers for Disease Control and Prevention's Environmental Public Health Tracking (EPHT) Program has funded multiple partners to develop a nationwide surveillance system that focuses on the environment and its impact on human health. To show that investing in a nationwide EPHT Network is a sound practice, the program must demonstrate that monetized improvements to the public's health due to tracking outweigh the costs. In the process of developing capacity for the EPHT Network, programs have had a positive impact on the public health. Results from successful programs can be used to estimate financial measures of the EPHT performance, such as net present value, return on investment, and payback period. The estimation of such measures for the EPHT requires an understanding of the economic elements for analysis in the context of surveillance systems. A quantitative assessment must take into account elements that are difficult to measure and value. By performing a return on investment, a financial measure of program performance, the expected costs and potential benefits of individual projects need to be assessed and compared with the current cost burden of the health condition.

Among the many roles a government plays in our daily lives, protecting the public's health is one of the most conspicuous. The government provides goods and services such as registration of births and deaths, public health surveillance of disease and injury, outbreak investigations, research and education, health insurance for the poor and elderly, enforcement of laws and regulations, evaluation of health promotion programs, and assurance of a competent healthy workforce. In the past, economics in public health has almost exclusively focused on efficiency of programs through the use of cost-effectiveness or net present value measures clustered under the rubric of "economic evaluation." Efficiency measures are useful at the programmatic level. However, lack of full employment and market failures including public goods and the impact of consumers and producers actions not reflected in the markets (externalities) not only compromise efficiency but also generate health inequities. We propose an expansion of the scope of existing health economics research in an area characterized as public health economics--the study of the economic role of government in public health, particularly, but not exclusively, in supplying public goods and addressing externalities.

Among the many roles a government plays in our daily lives, protecting the public's health is one of the most conspicuous. The government provides goods and services such as registration of births and deaths, public health surveillance of disease and injury, outbreak investigations, research and education, health insurance for the poor and elderly, enforcement of laws and regulations, evaluation of health promotion programs, and assurance of a competent healthy workforce. In the past, economics in public health has almost exclusively focused on efficiency of programs through the use of cost-effectiveness or net present value measures clustered under the rubric of “economic evaluation.” Efficiency measures are useful at the programmatic level. However, lack of full employment and market failures including public goods and the impact of consumers and producers actions not reflected in the markets (externalities) not only compromise efficiency but also generate health inequities. We propose an expansion of the scope of existing health economics research in an area characterized as public health economics—the study of the economic role of government in public health, particularly, but not exclusively, in supplying public goods and addressing externalities.

Allocation of public health resources should be based, where feasible, on objective assessments of health status, burden of disease, injury, and disability, their preventability, and related costs. In this article, we first analyze traditional measures of the public's health that address the burden of disease and disability and associated costs. Second, we discuss activities that are essential to protecting the public's health but whose impact is difficult to measure. Third, we propose general characteristics of useful measures of the public's health. We contend that expanding the repertoire of measures of the public's health is a critical step in targeting attention and resources to improve health, stemming mounting health care costs, and slowing declining quality of life that threatens the nation's future.

Public health policy makers often focus their attention on the economic evaluation methods (eg, cost-benefit and cost-effectiveness analyses) because of their interest in the economic returns from investment in prevention programs. This article presents a case for the broader applicability of economic theories and methods in development of public health prevention research issues. Public financing, delivery, and regulatory policies are often advocated and used to correct the imperfections in the market for preventive health services. A proper understanding of the incentives and constraints faced by individual agents in the market, however, can improve the effectiveness of these policies in achieving the prevention targets. In developing a research agenda, economics can play a more substantial role beyond the traditional economic evaluation research.

Public health policy makers often focus their attention on the economic evaluation methods (eg, cost-benefit and cost-effectiveness analyses) because of their interest in the economic returns from investment in prevention programs. This article presents a case for the broader applicability of economic theories and methods in development of public health prevention research issues. Public financing, delivery, and regulatory policies are often advocated and used to correct the imperfections in the market for preventive health services. A proper understanding of the incentives and constraints faced by individual agents in the market, however, can improve the effectiveness of these policies in achieving the prevention targets. In developing a research agenda, economics can play a more substantial role beyond the traditional economic evaluation research.

Early childhood development is influenced by characteristics of the child, the family, and the broader social environment. Physical health, cognition, language, and social and emotional development underpin school readiness. Publicly funded, center-based, comprehensive early childhood development programs are a community resource that promotes the well-being of young children. Programs such as Head Start are designed to close the gap in readiness to learn between poor children and their more economically advantaged peers. Systematic reviews of the scientific literature demonstrate effectiveness of these programs in preventing developmental delay, as assessed by reductions in retention in grade and placement in special education.

The social and physical surroundings in which people live affect their health. Knowing what basic conditions and opportunities in communities advance or impede improvement of community health can inform public health practice and policy. This article describes the methods for conducting systematic literature reviews of three community interventions to promote healthy social environments: early childhood development programs, programs to promote affordable family housing in safe neighborhoods, and interventions to increase the cultural and linguistic competence of healthcare systems. Existing methods, established for conducting systematic reviews for the Guide to Community Preventive Services, were applied to these interventions to promote healthy social environments.

This report presents the results of systematic reviews of effectiveness, applicability, other positive and negative effects, economic evaluations, and barriers to use of selected population-based interventions intended to prevent or control dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (the Task Force) about the use of these selected interventions. The Task Force recommendations are presented in this supplement.

Overview: This report presents the results of systematic reviews of effectiveness, applicability, other positive and negative effects, economic evaluations, and barriers to use of selected population-based interventions intended to prevent or control dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (the Task Force) about the use of these selected interventions. The Task Force recommendations are presented in this supplement.1