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John Fieno:
Welcome to our presentation. My name is John Fieno, and I serve as the Health Economist for the Missouri Department of Health and Senior Services. I’m presenting on behalf of our co-authors at DHSS. We are examining the effect of state public health spending on population health outcomes, mainly premature death. While several past studies showed a positive effect of public health spending on health outcomes, these studies are dated. Nothing has been published on the subject of the last 10 years, and there’s been no discussion of health equity in that literature. Premature death is defined as years of life lost prior to age 75. This has become a solid epidemic in the United States. For as the United States has a rate of premature death more than double that of our OECD countries, like Korea, Japan, Italy, Spain, Holland, to name a few.

This data set is a panel time series; the units are the 50 states in the District of Columbia, and the time elements are the years from 2013 to 2022. The key covariate is state public health spending, which we defined as state effort in public health per capita, average across the current year plus the eight previous years. Our dependent variable is premature death among three groups: everybody in the United States, white people, and African American people.

The primary result was that the coefficient for state public health spending was negative and reached above the 95% plateau for all three populations, but the breakdown by racial group might be the most interesting finding. The coefficient for African American people is negative 60. For every dollar spent, there is a reduction of 60 life years to premature death. As compared to one, five negative 25 for White. So major implication for public health is that state public health spending can make a sizeable dent into premature death, can improve equity, and can even support or assist the most vulnerable in society.