Social and economic multipliers: what they are and why they are important for health policy in Europe

Public health has, at its heart, the imperative of preventing disease. Acting early, in those circumstances where it is possible to prevent ill health, will always be better than trying to treat an established disease, both in terms of the human suffering avoided but also, in many cases, the lower ultimate cost. Yet not everyone agrees. Consider financial decisions being made across Europe. In the pursuit of austerity’, a programme to reduce deficits and debts, governments in many parts of Europe are making deep budget cuts that are reducing public health measures that are known to be effective. These fiduciary decisions are often made with little regard to their health consequences or even their longer-term social and economic ramifications. In a time of budget pressure, it is more important than ever that those working in public health are able to engage with finance ministers, not only using health arguments but also economic ones. Here, we review some of the conventional methods used to make the economic case for investing in health and then go beyond them to argue for a ‘multiplier approach’ to health investment, which is more in line with macroeconomic perspectives.