Show Me the Money: A Discussion about Investments Needed to Change STD Rates in the United States Harrell Chesson Health Economist Centers for Disease Control and Prevention National Coalition of STD Directors Annual Meeting Alexandria, VA November 17, 2017 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention
“64 percent of all the world's statistics are made up right there on the spot.” -Todd Snider Statistician’s Blues
“64 percent of all the world's statistics are made up right there on the spot.” “84 percent of all statisticians truly hate their jobs.” -Todd Snider Statistician’s Blues
CDC Budget, Fiscal Year 2016 Budget Category * Budget Funding per capita ($ per person) Total $11.5 billion $35.49 HIV/AIDS $0.8 billion $2.47 STDs $0.16 billion $0.49 * CDC budget estimates (overall and HIV/STD components) adapted from CDC’s FY 2016 Justification of Estimates for Appropriation Committees . Assumes US population of 324 million (www.census.gov).
CDC Budget, Fiscal Year 2016 Budget Category * Budget Funding per capita ($ per person) Total $11.5 billion $35.49 HIV/AIDS $0.8 billion $2.47 STDs $0.16 billion $0.49 Consumption Category ** Annual spending Spending per capita (dollars per person) Taco Bell $6.0 billion $18.52 Bottled water $11.8 billion $36.42 Lotteries $69.0 billion $212.96 * * CDC budget estimates (overall and HIV/STD components) are approximated and were adapted from CDC’s FY 2016 Justification of Estimates for Appropriation Committees . ** Spending estimates Taco Bell and Lotteries (2012) were obtained from:http://www.washingtonexaminer.com/six- things-that-americans-spend-more-on-than-the-2014-midterm-elections/article/2555534; Taco Bell estimates are from 2013, and Lottery estimates are for 2012. Spending estimates for bottled water are for 2012 and were obtained from: http://www.businessinsider.com/bottled-water-costs- 2000x-more-than-tap-2013-7. Per capita calculations based on population of 324 million.
Outline What has been the impact of STD programs? Illustration of STD rates with and without prevention efforts User-friendly tool for programs to estimate the economic benefits of their teams with high chances of winning prevention activities What investment is needed to make an appreciable change in national STD rates? Illustration of future STD rates under different funding scenarios What is the effect of budget changes? User-friendly tool for programs to estimate the health and medical cost impact of budget cuts, budget increases 6
Outline What has been the impact of STD programs? Illustration of STD rates with and without prevention efforts User-friendly tool for programs to estimate the economic benefits of their prevention activities What investment is needed to make an appreciable change in national STD rates? Illustration of future STD rates under different funding scenarios What is the effect of budget changes? User-friendly tool for programs to estimate the health and medical cost impact of budget cuts, budget increases 7
Summary of studies examining impact of STD/HIV prevention funding on STD/HIV-related health outcomes Data examined Main findings State-level CDC funding allocations for STD and HIV prevention and state-level gonorrhea rates, 1981-1998 1 Greater amounts of prevention funding in a given State-level syphilis rates and state-level CDC year were associated with lower STD/HIV allocation for syphilis elimination activities, incidence rates in subsequent years 1997-2005 2 National-level HIV prevention allocations and national-level HIV incidence estimates, 1978- 2006 4 County-level public health spending and Greater amounts of public health spending in a county-level gonorrhea and syphilis rates in given year were associated with lower gonorrhea California, 2003-2012 5 and syphilis incidence rates in subsequent years State-level CDC HIV prevention funding (1996- The odds of having been tested for HIV were 2003) and HIV testing data from the Behavioral higher in states with greater amounts of HIV Risk Factor Surveillance System (2003) 3 prevention funding 1 Chesson HW et al., Eval Rev 2005.; 2 Chesson & Owusu-Edusei, Soc Sci Med 2008 ; 3 Linas BP et al., AJPH 2006; 4 Holtgrave & Kates,, Am J Prev Med 2007. 5 Gallet C. Int Adv Econ Res 2017.
Summary of studies examining impact of STD/HIV prevention funding on STD/HIV-related health outcomes Data examined Main findings State-level CDC funding allocations for STD and HIV prevention and state-level gonorrhea rates, 1981-1998 1 Greater amounts of prevention funding in a given State-level syphilis rates and state-level CDC year were associated with lower STD/HIV allocation for syphilis elimination activities, incidence rates in subsequent years 1997-2005 2 National-level HIV prevention allocations and national-level HIV incidence estimates, 1978- 2006 4 County-level public health spending and Greater amounts of public health spending in a county-level gonorrhea and syphilis rates in given year were associated with lower gonorrhea California, 2003-2012 5 and syphilis incidence rates in subsequent years State-level CDC HIV prevention funding (1996- The odds of having been tested for HIV were 2003) and HIV testing data from the Behavioral higher in states with greater amounts of HIV Risk Factor Surveillance System (2003) 3 prevention funding 1 Chesson HW et al., Eval Rev 2005.; 2 Chesson & Owusu-Edusei, Soc Sci Med 2008 ; 3 Linas BP et al., AJPH 2006; 4 Holtgrave & Kates,, Am J Prev Med 2007. 5 Gallet C. Int Adv Econ Res 2017.
Summary of studies examining impact of STD/HIV prevention funding on STD/HIV-related health outcomes Data examined Main findings State-level CDC funding allocations for STD and HIV prevention and state-level gonorrhea rates, 1981-1998 1 Greater amounts of prevention funding in a given State-level syphilis rates and state-level CDC year were associated with lower STD/HIV allocation for syphilis elimination activities, incidence rates in subsequent years 1997-2005 2 National-level HIV prevention allocations and national-level HIV incidence estimates, 1978- 2006 4 County-level public health spending and Greater amounts of public health spending in a county-level gonorrhea and syphilis rates in given year were associated with lower gonorrhea California, 2003-2012 5 and syphilis incidence rates in subsequent years State-level CDC HIV prevention funding (1996- The odds of having been tested for HIV were 2003) and HIV testing data from the Behavioral higher in states with greater amounts of HIV Risk Factor Surveillance System (2003) 3 prevention funding 1 Chesson HW et al., Eval Rev 2005.; 2 Chesson & Owusu-Edusei, Soc Sci Med 2008 ; 3 Linas BP et al., AJPH 2006; 4 Holtgrave & Kates,, Am J Prev Med 2007. 5 Gallet C. Int Adv Econ Res 2017.
Summary of studies examining impact of STD/HIV prevention funding on STD/HIV-related health outcomes Data examined Main findings State-level CDC funding allocations for STD and HIV prevention and state-level gonorrhea rates, 1981-1998 1 Greater amounts of prevention funding in a given State-level syphilis rates and state-level CDC year were associated with lower STD/HIV allocation for syphilis elimination activities, incidence rates in subsequent years 1997-2005 2 National-level HIV prevention allocations and national-level HIV incidence estimates, 1978- 2006 4 County-level public health spending and Greater amounts of public health spending in a county-level gonorrhea and syphilis rates in given year were associated with lower gonorrhea California, 2003-2012 5 and syphilis incidence rates in subsequent years State-level CDC HIV prevention funding (1996- The odds of having been tested for HIV were 2003) and HIV testing data from the Behavioral higher in states with greater amounts of HIV Risk Factor Surveillance System (2003) 3 prevention funding 1 Chesson HW et al., Eval Rev 2005.; 2 Chesson & Owusu-Edusei, Soc Sci Med 2008 ; 3 Linas BP et al., AJPH 2006; 4 Holtgrave & Kates,, Am J Prev Med 2007. 5 Gallet C. Int Adv Econ Res 2017.
Summary of studies examining impact of STD/HIV prevention funding on STD/HIV-related health outcomes Data examined Main findings State-level CDC funding allocations for STD and HIV prevention and state-level gonorrhea rates, 1981-1998 1 Greater amounts of prevention funding in a given State-level syphilis rates and state-level CDC year were associated with lower STD/HIV allocation for syphilis elimination activities, incidence rates in subsequent years 1997-2005 2 National-level HIV prevention allocations and national-level HIV incidence estimates, 1978- 2006 4 County-level public health spending and Greater amounts of public health spending in a county-level gonorrhea and syphilis rates in given year were associated with lower gonorrhea California, 2003-2012 5 and syphilis incidence rates in subsequent years State-level CDC HIV prevention funding (1996- The odds of having been tested for HIV were 2003) and HIV testing data from the Behavioral higher in states with greater amounts of HIV Risk Factor Surveillance System (2003) 3 prevention funding 1 Chesson HW et al., Eval Rev 2005.; 2 Chesson & Owusu-Edusei, Soc Sci Med 2008 ; 3 Linas BP et al., AJPH 2006; 4 Holtgrave & Kates,, Am J Prev Med 2007. 5 Gallet C. Int Adv Econ Res 2017.
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