Closing the Loop: Why We Need to Invest—and Reinvest—in Prevention

Closing the Loop: Why We Need to Invest—and Reinvest—in Prevention ( 6 pages Discussion Paper)

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Published: September 9, 2014
Type: Discussion Paper
Topic(s): Public Health
Author(s)*: Larry Cohen, Anthony Iton

Discussion Paper

Larry CohenLarry Cohen

*The authors are participants in the activities of the IOM Roundtable on Population Health Improvement


Note: The views expressed in discussion papers are those of the authors and not necessarily of the authors’ organizations or of the IOM. Discussion papers are intended to help inform and stimulate discussion. They have not been subjected to the review procedures of the IOM and are not reports of the IOM or of the National Research Council.

In their discussion paper, Cohen and Iton propose a sustainable model for funding prevention strategies. The authors describe how the state of California used the $2.4 billion revenue generated from cigarette taxes from 1989 to 2008 to fund tobacco control programs to reduce smoking. A recent analysis suggests the state saved $134 billion – a 5,500 percent return on investment – from the reduction in medical expenditures that would have been required to treat smoking-related illnesses, yet little of that money has gone into prevention programs. Taking the $134 billion savings as an example, the authors discuss how their model of “closing the loop” to consistently fund prevention programs using taxes, fines, and fees on behaviors such as smoking and drinking combined with other sources would serve the goal of reducing national health care expenditures, currently nearly a trillion dollars. By pooling and managing prevention funds from federal, state, and local sources, philanthropies, and others based on population needs, and investing in evidence-informed strategies in communities, the prevention system continuously captures and reinvests savings through intermediary organizations that support the development of community strategies to improve health, reduce costs, and the need for additional health care, thereby creating a virtuous cycle of investment before people are sick or injured. The authors note that effectively “closing the loop” will depend on successful multi-sector partnerships and collaborations with the broad understanding that not all investments bring a greater return than the expense, but there is an urgent need to save lives and reduce misery now and into the future.     Read the Discussion Paper >>