Return on investment analysis: A tool for policy advocacy

This paper presents the results of two public health advocacy efforts that used “Return on Investment” (ROI) analysis. The efforts of the observed advocacy initiatives were to persuade policy-makers about the benefits of public health programs, in the context of public sector cutbacks. In the past, ROI was typically reserved for the business world. However, today ROI which already is being increasingly used in public health evaluation also has an increased value in policy advocacy. ROI provides evidence on the financial logic of public health programs and initiatives. The paper is based on the data collected throughout the process of using of ROI research in two different situations, one to promote the establishment of a local public health department, and a second in an advocacy effort to restore funding to diabetes prevention programs. The paper shows the specific ROI research methodology employed, the strategy used to determine the best way to present the data, the strategies for disseminating the data to different policy networks, and finally the overall impact of the effort. The results show that in both scenarios the ROI has a) been successful in capturing the immediate attention of the policymakers, b) been able to attract attention to the negative impact of the cutbacks, and c) been successful in attracting nontraditional public health actors and advocates because of its economic logic. The paper concludes with a discussion on the most appropriate conditions for the use of ROI analysis as an advocacy tool, and the key steps in determining its application.