title: Return on investment of public health interventions: a systematic review.
abstract: Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions.
  
  
  
  We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries.
  
  
  
  We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5.
  
  
  
  This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.
authors.affiliation: North Wales Local Public Health Team, Public Health Wales, Mold, Flintshire, UK.|Department of Public Health and Policy, University of Liverpool, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Masters
authors.affiliation: Department of Public Health and Policy, University of Liverpool, UK.|Department of Public Health, Halton Borough Council, Cheshire, UK.|Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK.
authors.forename: Elspeth
authors.initials: E
authors.lastname: Anwar
authors.affiliation: Department of Public Health and Policy, University of Liverpool, UK.|Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK.
authors.forename: Brendan
authors.initials: B
authors.lastname: Collins
authors.affiliation: Centre for Health Economics, University of York, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Cookson
authors.affiliation: Department of Public Health and Policy, University of Liverpool, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
mesh_terms: D006293:Health Promotion / Q000191:economics*; D011634:Public Health / Q000191:economics*
keywords: ECONOMICS; Economic evaluation; Health inequalities; PUBLIC HEALTH; PUBLIC HEALTH POLICY