“Sadly, it takes a cluster of casualties to alert the world that humans are once more under attack and that we need to marshal our scientific forces,” writes Julio Frenk, Mexico’s minister of health from 2000 to 2006, and dean of the Harvard School of Public Health.

Let’s put aside the told-you-so politics bemoaning the pandemic preparedness dollars ripped from the stimulus bill. The fact is, we’ve known that the U.S. public health system has been malnourished for years. There’s also compelling evidence that revitalizing this system might be our most cost-effective route to health.

As noted in an earlier blog posting, a 2008 study by Trust for America’s Health found that a $10 per person annual investment in community-based prevention over five years could produce 5 percent reductions in type 2 diabetes, high blood pressure, heart and kidney disease, and stroke — with an estimated ROI of $5.60 for every dollar invested.

Another study showed that for each 10 percent increase in public health spending, mortality rates fall as much as 6.9 percent. In one example, health policy experts calculate that it would cost eight times as much to achieve the same outcome through medical care than it would through public health investment.

Somehow we’ve lost sight of what Hippocrates advised 2,400 years ago. We’ve got the whole “ounce of prevention is worth a pound of cure” thing backwards; almost 95 cents of every health care dollar is spent treating those who are already sick, while only about 2 cents goes to prevent illness. And it costs a lot more to restore health one sick patient, one pill at a time than it does to invest in healthy environments and popultations.

Will we make different choices post (near) pandemic? Breakdowns can lead to breakthroughs, only when we see through the devastation to some new future possibility and make a different choice. Yet, even in the years following Hurricane Katrina, public health funding at every level has been reduced radically, with shortfalls estimated at $20 billion a year.

So, what is the best way to invest in our nation’s health? There are plenty of creative ideas – from bike paths and indoor farmer’s markets to smoker quit lines and housing coops for ex-offenders. There’s even a new $10-million X Prize that will have communities compete for health improvement.

The choice is ours: We either pay now, or pay much, much more later.