As for my opinion:  I participated in a forum on this topic recently in
California, where another speaker had combed the literature on cost/benefits
in HP and DP.  The only place where there seem to be measured benefits
outstripping costs:

1.      Prenatal programs for low-income women.
2.      Diabetes screening and support for low-income persons.

Period.  This is similar to the conclusions drawn by a Wales-based health
economist who did a related study focussing more on European experiences.
His conclusion:  You can argue cost-efficiency some of the time (meaning a
given program demonstrates efficiency in costs relative to achieving its
objectives), but even there much of the "social work" in HP and DP doesn't
lend itself to monetization.  The problems with cost/benefit studies are
numerous, ranging from difficulty of attribution (did the program cause the
change, either in individual behaviour or even public policy?), causality
(was the behaviour or the policy really the most important cause?) and
monetization (how can one attach a $ to "empowerment" or "justice"?).
Alongside those are others:  Health systems run up costs independent of
population health status (internal economies and supply-side drivers), and
older people cost more (so smokers who die young, despite the treatment
costs in their final year or so, may cost the health care system less).

At 01:50 PM 1/13/98 -0500, you wrote:
>Apologies for the whimsical subject but a little levity never hurts...
>
>Thanks to everyone who is contributing to this discussion.  I think we are
>uncovering some very important issues.
>
>I would like to pose a question in response to Ron Labonte's message.
>
>Ron wrote:
>
>>Avoid using the language of the conservative or neoliberal right
>>wing.  It's all about economics (value for money, etc.) which reduces people
>>to calculating entrepreneurs and hides the moral nature of "social work"
>>(broadly defined, which includes health promotion) and social relationships
>>generally.  Its underpinning economic theory is also historically wrong.
>>Use a language of care, need, value and morals.  Always.
>
>Is there any value to cost-benefit analyses in health promotion?  I would
>argue that there is.  Effective health promotion conducted on a wide scale
>will lead to improved health status AND reduced health care costs.
>Measuring the impact of health promotion programs on the health care
>system's bottom line will enable us to use economic arguments in favour of
>health promotion.
>
>Ron, your message seems to indicate that you would not agree.  I am
>interested in your opinion, as well as anyone else who is interested.
>
>
>Braz King
>Managing Director
>Smaller World Communications
>116 Westwood Lane
>Richmond Hill, ON
>L4C 6Y3
>(905)771-6965
>(905)771-7974 fax
>
>
______________________________________

Ronald Labonte, PhD
Communitas Consulting
29 Jorene Drive
Kingston, Ontario, Canada  K7M 3X5
(voice):  613-634-7396
(fax):    613-634-2384
e-mail:  [log in to unmask]
______________________________________