Dr. Ed Ehlinger likes to point out that it wasn’t doctors, or medicine, that halted the scourge of cholera in 19th-century London. It was sewers.

After a deadly outbreak in 1854, Dr. John Snow traced the source of illness to a contaminated water pump. By building a sewer system, city officials helped put an end to cholera epidemics — and accomplished one of the earliest achievements in the field of public health.

Ehlinger, Minnesota’s health commissioner, notes that today we have a different set of health scourges. And a desperate need for public health measures to tame them.

Last week, Ehlinger made an impassioned case that spending a little more on prevention could save more lives than the best medical system in the world, and at far less cost. In a speech to a roomful of public health professionals in West St. Paul, he argued that there’s a mismatch in how we spend our health dollars: the lion’s share goes to doctors and hospitals to treat the sick; but only 3 to 4 percent goes for efforts to prevent the ailments that kill people prematurely, such as diabetes and heart disease.

“We spend more money by far than any other country,” he said. “The only way we’re going to control costs is to do [more] prevention.”

Ehlinger admits that, by many measures, Minnesota is relatively healthy, with the lowest rate of childhood obesity (23 percent) and some of the highest life expectancies (78 years for men, 83 for women) in the country.

But the health rankings are starting to slide, while spending on prevention — to battle infant mortality, control outbreaks, promote healthy behaviors — has been on a nose-dive. Since 2007, Minnesota has dropped from 19th to 48th nationally in its public health funding, according to the United Health Foundation.

Now, Ehlinger argues, is the time to invest in keeping people healthy, especially with the coming “silver tsunami” of aging baby boomers. “This is going to overwhelm [us] unless we change our model and really start to focus on prevention.”