Author ORCID Identifier

Date of Award

Fall 9-13-2021

Degree Type


Degree Name

Doctor of Public Health (DrPH)


Public Health

First Advisor

Sarah Ann McCool

Second Advisor

Karen Nielsen

Third Advisor

Susan Snyder


Background: Averting the onset of disease or detecting disease early through preventive care can improve overall population health. It is well recognized in the literature that preventive care has been historically undervalued and underinvested, despite a growing body of evidence on the impact of total health funding on economic growth and health outcomes. The relationship between health outcomes and public funds spent on prevention has not been thoroughly investigated. The purpose of this dissertation is to examine the relationship between government funds spent on preventive care and health outcomes. To do this, an examination of preventive care expenditures was conducted using data from countries in the Organization of Economic Cooperation and Development (OECD).

Methods: A three-phased methodological approach was used to gather evidence on preventive care expenditures. The first phase was a descriptive analysis of preventive care spending. The second phase investigated four paired relationships between preventive care expenditures and health outcomes among OECD countries. A cross-correlation function was used to examine the temporal association of these relationships from 2000 to 2019. Lastly, economic and demographic factors were applied to delineate between country differences.

Results: On average, OECD countries spent approximately 3% of total health funds on preventive care. Ten countries had positive cross-correlations, five countries had negative cross-correlations, and the remaining 15 had inconclusive results. This dissertation could not determine a relationship between health outcomes and public funds spent on preventive care.

Conclusion: These results indicate the importance of high-quality data and consistent reporting to build evidence on government expenditures on public health on health outcomes. Without credible and reliable health spending data, it is challenging to study the possible relationship between preventive care spending and health outcomes. Establishing a global minimum standard of public health programs can serve as a key input to developing benchmarks to meet a basic public health standard. This may offer a pathway for more consistent, reliable and regular reporting of expenditure data. Lastly, there is a need for available, accessible, and actionable expenditure data from economically and geographically diverse countries to strengthen fiscal capacity.


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