INVEST NOW … or pay later “ The payoff for public health investments is extraordinary in terms of lifetime health status and averting the need for costly interventions at the later stages of life. But it is difficult to persuade governments or individuals to pay for something when the payoff is not immmediate.” DEBORAH ALLEN, SM ’80, SM ’86, SD ’98 Director, Child, Adolescent and Family Health Boston Public Health Commission
In our economic system, payback comes when you sell something expensive to a captive market. You have that in health care, when you sell high-cost drugs, medical services, and equipment. But public health promotes the opposite: Let’s invest now for a benefit that may not emerge for many years. Let’s create the conditions for healthy birth, healthy infancy, and healthy childhood. The payoff is extraordinary in terms of lifetime health status and averting the need for extraordinarily costly, often ineffective intervention at the later stages of life. It also creates a population that has a much higher quality of life. But it is more difficult to persuade governments or individuals to pay for something for which the payoff is not immediate. Adverse health exposures for fetuses in utero or children in the early years of life can cause lifelong problems. It could be a mother inhaling toxic chemicals where she works. It could be maternal stress associated with poverty and racism, which causes her fetus to be exposed to toxic levels of the stress hormone cortisol. Exposures like these lead to disproportionate levels of preterm birth and low birth weight. And even if there is no visible impairment, We have to ensure that families have the internal
the child is invisibly vulnerable and will have an elevated Aubrey LaMedica/HSPH
lifetime risk of asthma, cardiovascular disease, diabetes,
resources to raise kids, but also that families live in
and hypertension.
communities where there’s access to exercise and good
When you invest early in prevention, and a healthy
food. These are not what people traditionally think of as
full-term baby grows into a healthy child, then you prevent
health interventions—but they are the things that shape
not only chronic medical problems, but also cognitive and
lifetime health.
behavioral impacts. 23 Fall 2012
continued