How effective are public health departments at preventing mortality?

Econ Hum Biol. 2014 Mar;13:34-45. doi: 10.1016/j.ehb.2013.10.001. Epub 2013 Oct 24.


This study estimates the causal impact of variation in the expenditures of California county departments of public health on all-cause mortality rates and the associated value of lives saved. Since the activities of county departments of public health are likely to affect mortality rates with a lag, Koyck distributed lag models are estimated using the Lewbel instrumental variables estimator. The findings show that an additional $10 per capita of public health expenditures reduces all-cause mortality by 9.1 deaths per 100,000. At current funding levels, the long-run annual number of lives saved by the presence of county departments of public health in California is estimated to be approximately 27,000 (26,937 lives, 95% confidence interval: [11,963, 41,911]). The annual value of these lives is estimated to be worth $212.8 billion using inflation-adjusted standard U.S. government estimates of the value of a statistical life ($7.9 million).

Keywords: All-cause mortality; California; Dynamic panel models; Lewbel instrumental variables; Public health expenditures.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • California
  • Delivery of Health Care / economics
  • Delivery of Health Care / statistics & numerical data
  • Female
  • Humans
  • Male
  • Mental Health / economics
  • Mental Health / statistics & numerical data
  • Middle Aged
  • Models, Economic
  • Mortality / trends*
  • Public Health / economics*
  • Public Health Practice / statistics & numerical data
  • Residence Characteristics
  • Sex Factors
  • Socioeconomic Factors
  • Substance-Related Disorders / economics
  • Substance-Related Disorders / epidemiology
  • Young Adult