What are the benefits and risks of using return on investment to defend public health programs?

• APHA and CPHA estimates of ROI on major public health range from 125% to 3900%.
• Assessing the economic value of public health programs using ROIs could provide robust arguments in their defense.
• Even if there are known benefits to using ROIs, there are also several risks.
• We offer recommendations for using ROI while acknowledging programs full range of impacts.

Return on investment (ROI) is an economic measure used to indicate how much economic benefit is derived from a program in relation to its costs. Interest in the use of ROI in public health has grown substantially over recent years. Given its potential influence on resource allocation, it is crucial to understand the benefits and the risks of using ROI to defend public health programs. In this paper, we explore those benefits and risks. We present two recent examples of ROI use in public health in the United States and Canada and conclude with a series of proposals to minimize the risks associated with using ROI to defend public health interventions.