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Comment & Response
March 28, 2017

Priorities for Public Health Spending—Reply

Author Affiliations
  • 1Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
JAMA. 2017;317(12):1278. doi:10.1001/jama.2017.1851

In Reply There is always a scarcity of resources for public health initiatives. Inevitably, choices need to be made. Choosing to spend money on one option means the benefits that might have been accrued from the alternatives must be foregone. Those lost benefits are the opportunity cost of going with one option. Because the world will always have a scarcity of resources, including for public health measures, there are always opportunity costs.

Spending money for HIV/AIDS prevention and treatment necessarily comes at the cost of not funding other potential public health efforts. Dr Cahill and colleagues seem to be unwilling to grapple with the scarcity of public health resources and what benefits might be foregone by not funding other programs. They only tout the benefits of spending money on HIV/AIDS interventions, never mentioning the opportunity costs. Simply mentioning that HIV/AIDS interventions might be cost-effective does not address the opportunity costs of those interventions—only relative cost-effectiveness does that.