National Academy of Medicine

Closing the Loop: Why We Need to Invest—and Reinvest—in Prevention

By Larry Cohen and Anthony Iton
September 09, 2014 | Discussion Paper

In their discussion paper, Cohen and Iton propose a sustainable model for funding prevention strategies. The authors describe how the state of California used the $2.4 billion revenue generated from cigarette taxes from 1989 to 2008 to fund tobacco control programs to reduce smoking. A recent analysis suggests the state saved $134 billion – a 5,500 percent return on investment – from the reduction in medical expenditures that would have been required to treat smoking-related illnesses, yet little of that money has gone into prevention programs. Taking the $134 billion savings as an example, the authors discuss how their model of “closing the loop” to consistently fund prevention programs using taxes, fines, and fees on behaviors such as smoking and drinking combined with other sources would serve the goal of reducing national health care expenditures, currently nearly a trillion dollars. By pooling and managing prevention funds from federal, state, and local sources, philanthropies, and others based on population needs, and investing in evidence-informed strategies in communities, the prevention system continuously captures and reinvests savings through intermediary organizations that support the development of community strategies to improve health, reduce costs, and the need for additional health care, thereby creating a virtuous cycle of investment before people are sick or injured. The authors note that effectively “closing the loop” will depend on successful multi-sector partnerships and collaborations with the broad understanding that not all investments bring a greater return than the expense, but there is an urgent need to save lives and reduce misery now and into the future.



Suggested Citation

Cohen, L. and A. Iton. 2014. Closing the Loop: Why We Need to Invest – and Reinvest – in Prevention. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. doi: 10.31478/201409c


Disclaimer: The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.