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What is Public Health Return on Investment (ROI)?

The amount of health impact when compared to resources invested.



Bilingual ROI Flyer:

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    Chronic Disease

  • Reducing the prevalence of diabetes and hypertension by just 5% would save $124 million in Arizona alone ($9 billion nationally). After five years, the savings would soar to $351 million annually in Arizona ($24.7 billion nationally).1
  • Heart disease, stroke, and diabetes account for 36.6 percent of deaths in the United States, but this could be significantly reduced by changing just three risk factors - decreasing smoking, increasing exercise, and improving healthy eating.2
  • An investment of $10 per person per year in proven community-based disease prevention programs could yield net savings of more than $2.8 billion annually in the US in health care costs in one to two years, and more than $16 billion annually within five years (in 2004 dollars). In Arizona, an investment of $10 per person per year could yield net savings of more than $89 million annually in one to two years and nearly $300 million in five years.3
  • For more information on chronic disease in Maricopa County, see our Community Health Assessment Go to website page.


  • The US has saved $300 million per year in direct medical costs since the eradication of small pox in 1977.4
  • For more information on immunizations in Maricopa County, see our ImmunizationsGo to website page.

    Injury Prevention

  • Motor vehicle-related injuries are the leading cause of death among U.S. children.5 However, child safety seats reduce the risk of death by 71% for infants and by 54% for children ages 1 to 4 years old.6
  • For more information on injury prevention in Maricopa County, see our Safe Kids CoalitionGo to website program page.


  • Obesity prevalence among children and teens has nearly tripled since 1980. Today, about 17 percent, or 12.5 million, of children and teens ages 2 to 19 are obese.7
  • Health costs for sedentary patients cost $1,500 per year than physically active patients.8
  • For more information on obesity in Maricopa County, see our Nutrition and Physical ActivityGo to website program page.

    Oral Health

  • Every dollar spent on prevention saves $4 in dental treatment.9
  • For less than $1 per year per person to fluoridate the water, you save $38 per year for the cost of dental treatment.9
  • For more information on oral health in Maricopa County, see our Oral HealthGo to website program pages.

    Prenatal Care

  • Care coordination and services provided to women before pregnancy (pre-conception and interconception) provides a net savings of $1,720 in healthcare costs. From July 1, 2012 to February 28, 2013, Healthy Start provided pre- and interconception services to 104 women saving $179,000 in future healthcare costs.10
  • For more information on Healthy Start in Maricopa County, see our South Phoenix Healthy StartGo to website program page.

    Sexually Transmitted Diseases

  • The cost of treating each contact named to the Department of Public Health-STD Program and brought in for medication averaged $24,463 between 2008 and 2012. If those patients had not been treated by the Department of Public Health-STD Program, the cost of those infections would have averaged $160,509 over the same 5 year period. Thus by performing case interviews, solicitation of contacts, and treatment of the partners named the Department of Public Health-STD Program saved an average of $136,046 for each case of chlamydia and gonorrhea.11
  • For more information on STDs in Maricopa County, see our STDGo to website program page.


  • Each insured individual who quits smoking reduces their annual medical and life insurance costs by $210 per year.12
  • In 2010, a pack of cigarettes in Arizona cost about $6.38, however the combined medical costs and productivity losses attributed to each pack of cigarettes is about $26.57.13
  • For more information on Tobacco cessation in Maricopa County, see the Tobacco Free AZGo to website website.

    Women, Infants & Children

  • For every $1 spent on a woman in WIC, $4.21 is saved in Medicaid14
  • If 90% of infants were exclusively breastfed for 6 months, the US would save $13 billion per year.15
  • For more information on WIC in Maricopa County, see our WICGo to website program page.


  • Average annual healthcare costs were $285 less for employees who were at least moderately active than for those who were sedentary.16
  • Obese employees (BMI > 35) have 4.2% higher health-related productivity loss, equal to $506 per employee per year.21 Medical costs paid for obese individuals $1,429 higher annually than for normal weight. 17
  • Job related stress contributes 10–30% of heart disease risk in working people.18
  • A 1% reduction in excess weight, elevated blood pressure, glucose and cholesterol has been shown to save $83 to $103 annually in medical costs per person.19
  • Research studies suggest that, for every dollar invested in health promotion, a company saves $3 to $5 in health and safety costs.20
  • For more information on Worksite Health in Maricopa County, see our Worksite WellnessGo to website page.




  1. Barbara A. Ormond, Brenda C. Spillman, Timothy A. Waidmann, Kyle J. Caswell, and Bogdan Tereshchenko. Potential National and State Medical Care Savings From Primary Disease Prevention. American Journal of Public Health: January 2011, Vol. 101, No. 1, pp. 157-164. doi: 10.2105/AJPH.2009.182287
  2. Boufford, Jo Ivey. "New Report Highlights Proven Disease Prevention Programs in Communities - Trust for America's Health." Trust for America's Health - Preventing Epidemics. Protecting People. Trust for America's Health (TFAH) and The New York Academy of Medicine (NYAM), 24 Sept. 2009. Web. 25 Mar. 2013. <>.
  3. "Investments in Disease Prevention Yield Significant Savings, Stronger Communities." Prevention for a Healthier America 1 (2009): 3. Trust for America's Health. Web. 25 Mar. 2013. <>
  4. Taken from Economic Benefits and Costs Associated With Target Vaccinations, Edward P. Armstrong, PharmD, FASHP, J Manag Care Pharm. 2007;13(7)(suppl S-b):S12-S15,
  5. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System. Aug. 2, 2010.
  6. U.S. Department of Transportation, National Highway Traffic Safety Administration. Traffic Safety Facts 2008: Children. 2009.
  7. Centers for Disease Control and Prevention. Available at
  8. Levi, J., Vinter, S., Richardson, L., Laurent, R., & Segal, L.M. (2009). F as in fat: How obesity policies are failing in America 2009. Washington, D.C.: Trust for America’s Health, Robert Wood Johnson Foundation. Retrieved on March 25, 2013 from; Ogden, C.L., Carroll, M.D., Curtin, L.R., Lamb, M.M., & Flegal, K.M. (2010). Prevalence of high body mass index in US children and adolescents, 2007-2008. Journal of the American Medical Association, 303(3).
  9. Delta Dental, "Rational Health Care Reform: The Role of Dental Benefits," (2009)
  10. Data provided by Maricopa County Department of Public Health's South Phoenix Healthy Start program
  11. Data provided by Maricopa County Department of Public Health's STD program
  12. "Helping Smokers Quit Saves Money." American Lung Association 1 (2011): n. pag. <>. Web. 26 Mar. 2013.
  13. Rumberger, Jill, Christopher Hollenbeak, and David Kline. "Potential Costs and Benefits of Smoking Cessation for Arizona." Penn State 1 (2010): n. pag. Web. 26 Mar. 2013.
  14. "WIC: Solid Returns on Investment While Reducing the Deficit." National WIC Association 1 (2011): n. pag. Web. 26 Mar. 2013.
  15. Feifei Wang, Tim McDonald, Laura Champagne, Dee W. Edington. Relationship of Body Mass Index and Physical Activity to Health Care Costs Among Employees. J. Occup Environ Med. 2004; 46(5): 428-436.
  16. Gates DM, Succop P, Brehm BJ, Gillespie GL, Sommers BD. Obesity and presenteeism: the impact of body mass index on workplace productivity. J Occup Environ Med. 2008;50(1):39-45.
  17. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Affairs. 2009;28(5):w822-831.
  18. Belkic K, Landsbergis PA, Schnall PL, Baker D. Is job strain a major source of cardiovascular disease risk? Scand J Work Environ Health. 2004;30(2)85-128
  19. Henke, R.M., Carls, G.S., Short, M.E., Pei, X., Wang, S., Moley, S., et al. The Relationship between Health Risks and Health and Productivity Costs Among Employees at Pepsi Bottling Group. J Occup Environ Med. 2010;52(5)519–527.
  20. Goetzel RZ. An introduction to the employer perspective section of the special issue of the American Journal of Health Promotion. A corporate perspective: reflections from the economic buyer of health promotion programs. Am J Health Promot. 2001;15:5.
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