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A dollar of prevention is worth $7 of cure [Commentary]

Recently we've seen a number of proposed federal budgets, all of which have partisan approaches. The following proposal is bipartisan, stressing two major themes echoed by our major political parties: serving human needs and saving federal dollars. A budget based on preventing rather than treating problems is more humane and reduces the need for untested or ineffective government programs — again, a bipartisan approach.

Several areas ripe for prevention where we should be spending our money are outlined below:

Preventive medicine. Health care expenses are drastically heightened by chronic diseases and disorders, which also contribute to lost productivity and lost tax revenue. Besides the human toll, the total economic impact of chronic disease and disorder is $1.3 trillion annually. Although some argue that prevention in health care is not cost-saving, evidence suggests prevention can save significant dollars if it promotes healthy behavior, ameliorates environmental risks and targets populations at high risk for disease and disorder.

Early childhood education. Educational success can be bolstered with rigorously tested, effective programs that promote early cognitive and language development. The most cost-saving programs target children who are most at-risk for academic failure. Cutting dropout rates in half — with evidence-based programs — would increase federal government revenues by $30 billion per year by improving productivity and tax revenues, and it would reduce expenditures for criminal justice, public health and welfare. A more productive and tax-paying workforce — with better labor skills via education and fewer social problems — means a lowered federal deficit, a healthier economy and a more vibrant citizenry.

Criminal intervention programs. Crime costs over $1 trillion annually and contributes to human suffering. Though states primarily manage judicial systems, significant savings can accrue for federal-based justice agencies, corrections, public health and drug enforcement through early intervention programs that provide a large cost benefit. Every dollar spent on intervention can typically return $7 to $10 in savings while some programs that reduce recidivism in adults can generate savings of about $20,000 per offender per year.

Diplomatic strategies. International conflict has cost the U.S. more than $1.5 trillion in Iraq and Afghanistan. Conflict can be prevented with targeted military, diplomatic and cultural strategies that could save billions or trillions of dollars. Estimated returns of expenditures for conflict prevention average $59 per dollar invested. Prevention activities include targeted development policy, aid for high-risk regions and the creation of a standing international peacekeeping force for immediate response to crisis.

Infrastructure improvements. Infrastructure in the U.S. has suffered due to a significant backlog of needed investments, amounting to over $2 trillion. On average, each dollar put toward infrastructure and disaster prevention saves $7 when calamity strikes. For example, levee investments return $6 for every dollar spent by preventing floods in susceptible communities.

Unfortunately, many government programs were established in the absence of sufficient or rigorous research evidence — perhaps a major reason for policy failures. For example, in 2004-2005 only 7.8 percent of the many prevention programs in public schools were well tested; of those, only 44 percent met minimum standards for quality implementation. Fortunately, there are scores of well tested, effective interventions that bring desired outcomes for education and behavioral and physical health care.

A budget that focuses on proactive ways in which we can reduce the incidence of disease, disorder and calamity holds more promise from a humanity and cost efficiency perspective than might be imagined. In all domains, problems can be avoided rather than addressed retroactively. The challenge, however, is that prevention requires up-front spending for a later pay-off, often in three to 10 years. But given that there is no overnight remedy for U.S. budget concerns, the promise of prevention justifies the investment. Moreover, costs can be offset to some degree by shifting money away from ineffective programs and soliciting additional private financing of prevention — such as "pay-for-success" bonds, a funding mechanism with bipartisan state-level support.

Research has shown that prevention works best when approaches are locally-based and span across agencies and service systems. But there is still need for balance between local control and federal funding and oversight. Bipartisan and cooperative support between the federal, state and local levels will result in improvements in both social outcomes and the public bottom line. A budget that builds in prevention and these governance components can contribute to a more thriving nation.

Neil Wollman, is a Baltimore native and Senior Fellow in the Bentley Alliance for Ethics and Social Responsibility at Bentley University, Waltham, Mass.; and Taylor Bishop Scott is a doctoral student in psychology at UNC-Charlotte; they are the co-director and public policy coordinator, respectively, of the National Prevention Coalition. Mr. Wollman's email is

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