Special Issue on the Financial Impact of Health Promotion Programs

This issue of the American Journal of Health Promotion is to devoted to one topic, the Financial Impact of Health Promotion Programs.  Most of our readers are program managers or clinicians who have devoted their lives to improving people's health. Nevertheless, we receive more questions about the financial impact of health promotion than the health impact.  The reason should be obvious. If people can persuasively demonstrate that their programs save money, they can secure program funding.

Why is This So Important?

Despite our readers' strong interest in this topic, we developed this special issue for a very different purpose.  As should be clear to anyone reading our journal in the past year, we are leading a growing collaborative effort to "Build Health Promotion into the National Agenda."  Through this effort, our goal is to develop significant federal and state policy supporting health promotion and ultimately to integrate health promotion concepts into all elements of society.  The first question members of Congress posed to us when we started these efforts was economic.  "Do health promotion programs save money?"  This question is not asked by the government about most medical procedures. For most medical procedures it is necessary only that they improve health. This question is not asked for most new areas of scientific inquiry.  For most new areas of scientific inquiry, it is necessary only that they have strong backing from an established scientific discipline, show potential to enhance our understanding of some element of science, and perhaps show some eventual practical application.  To be supported by federal policy, medical procedures and scientific endeavors also need a vocal, well financed advocacy structure to make Congress aware of their potential and needs.

Health promotion remains on the fringe of science and the fringe of health care, and has no organized political advocacy effort advancing its needs .  As such, the level of proof required of health promotion is higher than that required of other fields.  Our hope is that readers will share these results with their elected officials.  We are also planning to send a copy of this special issue to each US Senator and Representative. 

Findings

Enough about our motives, what does this special issue report? Literature reviews by Steve Aldana, Wendy Max and Thomas Golaszewski provide persuasive evidence from 83 studies showing that people with unhealthy habits usually do have higher medical care costs, and sometimes have higher rates of absenteeism, but the relationships between risks and costs are complex.  An additional 50 studies show that many health promotion programs do reduce medical care costs and absenteeism.  Thirteen studies showed that the savings are often much greater than the cost of the programs.  The methodology discussions by those authors plus David Anderson, Seth Serxner, Daniel Gold and Ron Ozminkowski show that these research findings must be viewed with caution because of the relatively small number of studies, and limitations in the methodology including small sample sizes, short study duration, measurement problems, and analysis challenges.  Some of these problems are inherent in research conducted in real world settings, but many can be controlled through well designed, better funded studies.  Reflective articles by authors in two research settings, two government settings, two policy settings and 10 corporate settings show that the current evidence is sufficient for many employers and some government agencies to implement programs.  Although we did not make a direct comparison in this series of articles, the evidence supporting the financial returns from health promotion programs is better than the evidence supporting investments of similar order of magnitude made by employers and the federal government on a regular basis. 

In summary, health promotion is a promising option available to the federal government to improve the health of the nation's people and control medical costs.  The returns to employers are already clear. However, the quality of health promotion science does need to be improved, and federal funding will be required to make that happen.

Advocacy Effort, Future Special Issues, Future Conference

More details on our efforts to build advocacy support for health promotion can be found at our website (HealthPromotionAdvocacy.org).  To further support this advocacy effort, we are planning future special issues on "The Most Effective Health Promotion Strategies" and "The Health Impact of Health Promotion."    Also, our February/March 2002 Art and Science of Health Promotion Conference will be devoted to "Creating a New Vision for Health Promotion."  The vision which emerges from that conference will provide a blueprint for legislation we advocate during the next decade.  For details on how to participate in that conference as  presenter, see our Call for Proposals at the end of this issue and on our website (HealthPromotionConference.org).

Michael P. O'Donnell, PhD, MBA, MPH
Editor in Chief, American Journal of Health Promotion