Changing Political Realities & Opportunities for Prevention: Cost-Effective Social Investments
In the wake of the 2008 economic downturn, pressure on policymakers to justify spending, especially for public health and prevention, has continued to rise. No longer can decision makers rely on good intentions of social programs and policies alone. There is a growing burden now to demonstrate that programs constitute a wise societal investment. In particular, many decision makers are facing increased scrutiny to provide evidence that their choices benefit not only select groups, but produce positive economic benefits for society (e.g., increased jobs/productivity, reduced service use/budget deficits).
Prevention efforts capable of averting expensive treatment and social service use are of particular interest within this evolving political context. Consequently, the growing demand for robust estimates that consider not only the effectiveness of programs, but whether such efforts are an efficient use of public monies, provides researchers an unprecedented opportunity to inform social policy.
Refining Our Understanding of Prevention's Value
Preventive approaches to health and well-being have long been thought to be more efficient than waiting for a physical, mental, emotional or behavioral problem to fully exhibit itself, but only recently have such assumptions been rigorously tested. Over the last 5 to 10 years researchers have begun to recognize the value of evaluating the costs and benefits of prevention programs for mental, emotional and behavioral (MEB) problems.
In 2009, the Institute of Medicine and National Academies of Science released a report estimating the annual cost of mental, emotional, and behavioral disorders among youth to be as high as $247 billion annually. The report outlined the growing importance of understanding the economic costs and benefits of prevention. The report's chapter on the costs and benefits of prevention reflected the sentiments of increasingly vocal prevention scientists, economists and health service researchers tired of witnessing the failure of evidence-based programs to be successfully translated into practice largely because local efforts were unable to justify sustaining relatively costly and time-intensive programs. The report went further:
Recommendation 9-3: Researchers should include analysis of the costs and cost-effectiveness (and whenever possible cost-benefit) of interventions in evaluations of effectiveness studies (in contrast to efficacy trials).
Unfortunately, there is currently little capacity to conduct such analyses within mental, emotional, and behavioral prevention. Many prevention researchers are not trained in these evaluation techniques and many researchers who conduct economic analyses know little about mental, emotional, and behavioral prevention efforts and the developmental theory on which they are based. Consequently, there is a clear need for transdisciplinary collaboration around the study of prevention economics.
The Founding of PEPR
In response, the Prevention Economics Planning & Research Group (PEPR) was founded. To initiate PEPR activities, organized a series of events at the 2011 Society for Prevention Research's annual conference in Washington, DC.
The first was a day-long preconference workshop on the economics analysis of prevention that was held the day before the meeting began. Around 30 prevention scientists attended the preconference. Many of the attendees were early career scholars. Their attendance was made possible through the generous support of the the National Institute on Drug Abuse's Division of Epidemiology, Services and Prevention Research (DESPR), who funded multiple Early Career Investigator Travel Awards.
The second event was a panel discussion on research priorities in economic analyses of prevention. The panel comprised of prevention researchers, economists, and policy analysts to provide perspectives on major research priorities for strengthening economic analyses in prevention science. Panelists included Steve Aos, Director of the Washington State Institute for Public Policy; Beverlie Fallik, Senior Public Health Analyst at the Center for Substance Abuse Prevention, Substance Abuse & Mental Health Administration; Jon Baron, Director of the Coalition for Evidence Based Policy; and Lynn Karoly, Director of the Office of Research Quality Assurance, Senior Economist, RAND.