Using population health factors to create policy is becoming more popular, but the challenges are numerous.
Chief among them are quantifying and monetizing health information that may not lend itself to such analysis and getting groups with different priorities to work together toward a shared outcome.
Speakers at the National Health Policy Conference in Washington this week noted several distinct ways to evaluate programs that aim to improve population health. An underlying theme: more coordination, transparency and evidence is needed.
Cost-benefit analyses and ROI consider financial gains by the government or a business from a program relative to what it invests. Cost-effectiveness, in contrast, looks beyond monetary gain to aspects like improved health factors that aren't explicitly linked to specific dollar amounts in savings.
Eva Westley, research associate at the Washington State Institute for Public Policy, which evaluates programs for the state government, said program advocates are often wary of the institute's analyses, "especially when it comes to those squishier outcomes we can't handle in our models as well as we'd like."
But making those calculations starts with understanding and communicating the specific outcomes of policies, said John Auerbach, CEO of Trust for America’s Health.
“There’s a surprising lack of very specific, concrete evidence of, say, if you work for a certain sector and that sector develops a certain policy that we believe is likely to have an impact on health, then how do we measure that? How do we capture that information?” he said.
When research is available, it is not always shared or made public, so work is unnecessarily doubled up, Auerbach said.
“It may be worth an expensive startup and an expensive investment if the research demonstrates the value of the investment anywhere,” he said. “Because [if] . . . there is a direct connection between this investment and that outcome in a well-designed study somewhere, that should be enough.”
Fred Zimmerman, professor at the UCLA Fielding School of Public Health, agreed that seed funding is often a significant challenge, and many programs don’t pay for themselves, at least not at first. But without continued funding, promising projects can flounder. “It takes sustained effort to have a sustained impact,” he said. “It’s just that simple.”
One way to address accountability is through social impact bonds, which tie government funding to successful outcomes, Zimmerman said.
Another important aspect for population health programs is time. Some policies can take years to make a difference, but grants are funded for limited amounts of time, and many businesses are not willing to invest in a policy that won’t impress investors relatively quickly.
Von Nguyen, acting associate director for policy at the CDC, said policymakers want to see improvements early on as well. Often they face elections or term limits and want concrete results to point to when campaigning or debating. “When you’re trying to convince policymakers to make a change in policy you only have a few years . . . so it’s imperative to look for short-term incomes,” he said.
Another key is to create distinct proposals and talking points that consider the audience.
A pitch to a private company is likely to be different from a pitch to a community group or a pitch to academics, and all will be different from a pitch to a government agency. “Knowing your audience is critical to understanding when to use cost-effectiveness or cost-benefit or return on investment,” Nguyen said.
For example, Auerbach said, some researchers are working with an eye toward publishing in a journal, but that type of information and presentation won’t entice businesses. Governments want to see the data, but also have to consider more practicalities and fewer hypotheticals. “The entity that’s trying to make the case is making the case in a way that speaks to its culture, but not to other cultures,” he said.