THE TENSION BETWEEN COST-UTILITY ANALYSIS AND PREVENTIVE PUBLIC HEALTH

Public health programs must often work under severe budgetary constraints. It would appear then that cost-utility analysis could offer decision-makers a practical approach to prioritizing public health interventions. Unfortunately, cost-utility analysis is a poor tool for programmatic decision-making in public health because it systematically downgrades interventions aimed at prevention, and because it is not designed to help guide multi-dimensional, multi-input community public health programs. Thus, a different kind of prioritization framework is needed, one that is better aligned with community action and the preventive aims of public health.