Investing in public health: barriers and possible solutions.

BACKGROUND: Health care is a less important determinant of health than behaviour and the environment but paradoxically, spending on health in most countries suggests the opposite. What determines these health policy and funding decisions, and might there be ways to increase investment in public health?
METHODS: Published papers, reviews and reports on the cost-effectiveness of public health interventions and barriers to investment in public health were reviewed.
RESULTS: There is evidence to support investment in public health. Many public health interventions have been shown to save money, and some have cost-effectiveness ratios better than or equivalent to health care interventions. Despite this, there are recognized barriers to investing in public health. These barriers include the greater requirements for cost-effectiveness sometimes placed on public health interventions, the belief that in the long run prevention may cost more than treatment, the timeframes required for some public health interventions, the 'identifiable victim effect', the influence of interest groups, and the reality that evidence alone does not drive health policy.
CONCLUSIONS: Investment in public health has the potential to deliver improved health outcomes. Strategies to address the barriers and increase investment in public health are suggested.