Harnessing the Power of Evaluation to Maximize the Impact of State Chronic Disease Prevention and Tobacco Control Public Health Programs

Health department leaders across the United States face a familiar challenge: How can we maximize the impact of finite public health resources? Evaluation provides the answer. Embedding evaluation into the design and delivery of public health programs helps health department leaders identify effective interventions, refine programs in real time, and demonstrate the value of their work to the communities they serve, funders, and other key partners. 

Over the years, RTI has collaborated with health departments to provide a wide range of evaluation services targeting costly public health problems like tobacco use and diabetes. We leverage existing data, technology, and rigorous mixed methods to provide timely and budget-friendly evaluation support. From analyzing the financial impact of statewide programs to examining local policy implementation trends, our work has helped guide decision-making and optimize chronic disease health outcomes in the states we support. 

Demonstrating the Positive Economic Benefits of Public Health

Increasingly, there is a need to document the return on public health investments. RTI has conducted economic impact evaluations to quantify the health and economic benefits of statewide tobacco control programs in Kansas, Florida, New York, North Dakota, and Vermont. 

From 1999 to 2015, our return on investment (ROI) analysis for Florida estimated that for every US$1 spent on the tobacco control program, smoking attributable healthcare expenditures decreased by almost US$11. Accounting for economic costs associated with years of life lost due to smoking-attributable mortality, ROI totaled approximately US$113. Similarly, from 2001 to 2019, our ROI analysis for the New York Tobacco Control Program estimated that the return for every US$1 spent on the program totaled US$160, accounting for healthcare expenditure savings and economic costs associated with years of life lost due to smoking-attributable mortality.

Fighting Chronic Disease in Rural Florida

In partnership with the Bureau of Tobacco Free Florida (BTFF), we uncovered a critical gap: life expectancy was significantly lower in the rural panhandle region. Acting on these findings, we delivered clear, actionable recommendations to strengthen collaboration between BTFF and the Bureau of Chronic Disease Prevention, targeting the factors contributing to these health disparities. Our work led to the launch of a new taskforce charged with breaking down siloes, accelerating health referrals, and unifying communication strategies — driving faster, more coordinated action to improve health outcomes across the region.

Reaching Diabetes Patients Through Primary Care Providers

We worked with the New York State Department of Health to conduct a formative evaluation for Diabetes Self-Management Education and Support (DSMES) services for Medicaid recipients. Findings showed that the primary reason Medicaid members reported participating in DSMES was that their doctor told them to. Based on these results, NYSDOH ramped up provider educations, including disseminating an infographic flyer developed by RTI for primary care providers and endocrinologists that described the benefits of the DSMES services and offered tips on sharing information about DSMES with patients. 

Tailored Local Solutions that Improve Programs

To achieve health improvement goals, health departments often rely on local grantees to implement community-level interventions. RTI supports these efforts by monitoring and evaluating grantee activities to ensure they align with strategic objectives and drive measurable impact. We worked with BTFF to assess how specific grantee activities contributed to local policy changes that promote healthy behaviors. 

Our analysis revealed that municipal policy adoption was associated with partner meetings and direct engagement with local decision-makers, while community outreach activities had little effect on health policy outcomes. Based on these findings, we recommended that BTFF tailor community outreach activities to the unique context of each county, align annual Work Plan goals with broader program objectives, and refine the focus of certain health policy activities to improve effectiveness.

RTI harnesses the power of evaluation to help state and local health departments prioritize and implement high-impact interventions. Our evaluation work yields credible, actionable insights that health departments use to strengthen their programs and improve health outcomes in the communities they serve.