Public health initiatives, by definition, are meant to improve public health.
[pullquote align=”right” color=””]We waste millions on public health campaigns that produce no discernible return on investment.[/pullquote]
They are usually based on solid scientific evidence, their implementation saves thousands if not millions of lives, and they pay for themselves many times over in lives saved, earnings preserved and medical expenditures averted.
Consider the classic public health campaigns to promote vaccination and to reduce tobacco smoking.
This graph from E&K Health Consulting shows the dramatic drop in incidence of vaccine preventable disease after the introduction of the vaccine for the specific disease:
Notice that the y-axis is logarithmic, which means that the actual changes were far more dramatic than a glance at the graph would indicate. For example, there were approximately a one hundred thousand cases of smallpox per year prior to the introduction of the vaccine. In 2012 there were no cases at all. For each and every vaccine, the number of cases decreased by several orders of magnitude after the introduction of the vaccine.
The public health campaign to reduce tobacco smoking has had similarly spectacular results.
This graph originally published in the National Cancer Institute Bulletin shows that in the wake of the Surgeon General’s report of 1964 warning about the link between smoking and lung cancer, per capita cigarette consumption dropped dramatically. After a lag period, lung cancer deaths began to drop dramatically, too.
We have spent millions of dollars promoting vaccination and reducing smoking and it has paid off in both lives and money saved.
How about breastfeeding?
In the past 20 years we have spent millions of dollars promoting breastfeeding despite scientific evidence that is weak, conflicting and riddled with confounders.
An entire industry, the lactation industry, has arisen to promote and profit from efforts to increase breastfeeding rates. For example, lactation consultants did not exist prior to the mid 1980’s. Now they are everywhere, in hospitals, in doctors’ offices and in private practice. There have been multimillion dollar health campaigns and there is now a certification costing hospitals more than $10,000 each to be designated as breastfeeding friendly.
Breastfeeding initiation rates have tripled since 1970 rising from 25% to 75%.
So where is the return on investment?
Where is the evidence that thousands of lives have been saved? Where is the evidence that millions of cases of disease have been prevented? Where is the evidence of millions of dollars in healthcare expenditures averted? Where is the evidence that the dramatic rise in breastfeeding has had any impact at all on infant or child health?
I haven’t been able to find any such evidence.
Sure there are papers making claims about theoretical health and spending benefits, but I haven’t found any evidence of actual health and spending benefits. If it exists, I invite anyone who has seen such information to share it with the rest of us.
That doesn’t mean that breastfeeding is a bad thing. It’s a good thing, but the benefits for children in first world countries are trivial. If those benefits were anything other than trivial, we should have seen a dramatic impact on infant health and pediatric care expenditure in the past 45 years when breastfeeding initiation rates rose by 200%, but we haven’t seen anything of the kind.
No doubt the lactation industry has benefited. The number of lactation consultants in the US has increased from 0 in 1980 to 3.5/1000 live births in the 2013 (14,000 lactation consultants). Tens of millions of dollars have been spent on public health campaigns, and tens of millions of dollars are spent by mothers themselves.
What do we have to show for it?
Nothing.
Unless, of course, you count the soul searing guilt and feelings of inadequacy among women who can’t or choose not to breastfeed.
Going forward we should dramatically scale back spending on breastfeeding promotion. In an era of scarce healthcare dollars, we can’t afford to waste millions on public health campaigns that produce no discernible return on investment.
Breastfeeding should be a private choice. There is no reason, scientific or economic, to spend millions promoting it.
