We regularly scan eleven journals for new studies of particular population health relevance (the list of journals is at the end of this post). Two recent papers caught our eye:
We have argued in this blog about the potential importance of local population health “policy packages” tailored to the specific health outcomes, factors, and policy resources and climate of individual jurisdictions. Macinko and Silver go beyond speculation with a compelling and important analysis of how states have varied over time with regard to public health policy. They approach this through the lens of two policy constructs: intradomain, which is the extent to which a state adopts the entire set of evidence based policies for a given policy set such as motor vehicle crashes, and interdomain referring to the extent a state adopts evidence based policies across multiple domains such as smoking, alcohol, and nutrition policies. Twenty-seven proven policies were examined, such as seatbelt laws, indoor smoking bans, and firearm restrictions, to uncover patterns within state policy environments between 1980 and 2000. One of the figures in their paper demonstrates some interesting patterns, including clustering of certain states into a few highly similar trajectory groupings which basically negates the typical red/blue state patterns in terms of health policy. The authors contend “these illustrations of state policy behavior, albeit crude, nevertheless suggest there may be patterns of state policymaking that bear further investigation.” This conceptualization and tracking of state policy patterns is a fresh and important perspective that should help us move forward with advancing a balanced investment portfolio of health in all policies.
“How can society prevent the most disease and deaths per dollar spent?” This is the opening line of this article, which evaluates 2815 cost-effectiveness analyses from the Tufts Medical Center Cost-Effectiveness Registry. These reports were categorized by person-directed (e.g., smoking cessation support) and environmental preventive strategies (e.g., indoor smoking ban); also noted was whether interventions were provided in clinical or nonclinical settings. Authors hypothesized that environmental measures would be generally more cost-effective, and further hypothesized that nonclinical person-directed initiatives would be more cost-effective than clinical ones, based on dollars per Quality Adjusted Life Year (QALY). Findings reveal that a greater proportion of environmental prevention strategies led to cost saving (46%) compared to either clinical (16%) or non-clinical person-directed interventions (13%). In addition, 25% of the environmental interventions were modestly priced (between $10,000 to $50,000 per QALY), while another 17% were very low-cost (at less than $10,000 per QALY). The authors conclude by noting that “even if the effect of an altered environment on each person is small, the cumulative population effect can be large; cost-effectiveness can be favorable because the cost per person reached is small.”
Journals we follow:
American Journal of Preventive Medicine
American Journal of Public Health
Annual Review of Public Health
Journal of the American Medical Association (JAMA)
Journal of Epidemiology and Community Health
Journal of Health and Social Behavior
New England Journal of Medicine
Preventing Chronic Disease
Social Science and Medicine
David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.