It is generally believed that, in addition to its obvious health benefits, prevention costs less than cure and that because the potential savings are so great, more attention should be given to prevention simply on the grounds that it saves money. For example, President Jimmy Carter of the USA wrote that prevention ‘can substantially reduce both the suffering on our people and the burden on our expensive system of medical care’. Likewise, in outlining a four point programme to control Medicare costs in the USA, Somers commented how distressing it was to see continued lack of attention on prevention which was ‘potentially the most effective of all cost-control strategies’. The situation is much more complex, however, and careful economic analysis suggests a different picture. In reviewing a variety of health promotional strategies for all age groups, Russell concludes that ‘even when financial cost of the preventive measure looks small, careful evaluation often shows that the full costs are rather large, larger than any savings’.

In this chapter, therefore, I look at the nature of the costs of health promotion, summarise current information on the magnitude of these costs to individuals and to society, describe some of the ways in which costing techniques may be biased against elderly people, emphasise the lack of current funding on health promotion and suggest ways in which potential purchasers might get the best value for their money.