"A healthy United States is a strong United States. A prepared nation is a safe nation. But persistent underfunding of the country's public health system has left the nation vulnerable," said John Auerbach, president and CEO, of TFAH. "The country needs a long-term commitment to rebuild the nation's public health capabilities – not just to plug some of the more dangerous gaps but to make sure each community will be prepared, responsive and resilient when the unexpected occurs."
Flat Federal Funding
In Fiscal Year (FY) 2017, the U.S. Centers for Disease Control and Prevention's (CDC) budget was $7.1504 billion ($21.95 per person). Adjusting for inflation, CDC's core budget—not including the Prevention and Public Health Fund—has been essentially flat for the last decade.
Because much of CDC's budget is distributed to states and localities, the impact of budget cuts is experienced directly at the state and local level. Of the roughly 75 percent of CDC funds that go to states and local communities, support ranges from a low of $5.74 per person in Missouri to a high of $114.38 per person in Alaska.
In addition, 12 percent of CDC's budget consists of the Prevention and Public Health Fund, with about $625 million a year of that directed to state and local efforts. From FY 2013 through FY 2027, the Prevention Fund will receive nearly $12 billion less than the law intended.
Within CDC, the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Program is the only federal program that supports the work of state and local health departments to prepare for and respond to emergencies. Except for one- time, short-term funding to contain the Ebola and Zika viruses, core emergency preparedness funding has been cut by more than one-third (from $940 million in FY 2002 to $667 million in FY 2017) since the program was established.
State Public Health Funding Declining
Spending for public health by states has been declining. Based on a TFAH analysis (adjusted for inflation), 31 states made cuts to their public health budgets from FY 2015-2016 to FY 2016-2017. Only 19 states and Washington, D.C. maintained or increased their budgets, making it hard for states to compensate for reduced federal funding.
According to the report, state public health spending is actually lower in 2016-2017 than it was in 2008-2009, as some of the funding cuts that occurred during the Great Recession have not been fully restored—and federal funding has been essentially flat (almost half of state public health spending comes from federal funds).
Local Public Health Funding Decreasing
Since 2008, local health departments (LHDs) have lost 55,590 staff due to layoffs or attrition. In addition, about 25 percent of LHDs reported a lower FY 2016 budget than the previous year, with fewer LHDs reporting an increase in their budget for the current year as compared to the previous.
"Each year, we issue this report to examine the amount of public health funding each state receives and provide an independent analysis of how communities protect the public's health. With life expectancy declining in the U.S. for the second year in a row—something unheard of in recent memory—policymakers must take the public's health seriously and allocate the funds needed to improve well-being and prevent illness and injury," said Auerbach.
The report includes eight key recommendations:
Increase Funding for Public Health – at the Federal, State and Local Levels
Preserve the Prevention and Public Health Fund
Prepare for Public Health Emergencies and Pandemics
Establish a Standing Public Health Emergency Response Fund
Build a National Resilience Strategy to Combat Deaths of Despair
Prevent and Reduce Chronic Disease
Support Better Health and Top Local Priorities in Every Community
Expand the Use of Evidence-Based, High-Impact Strategies to Improve Health in Every Community
The full analysis is available at www.healthyamericans.org. The brief was supported by a grant from the Robert Wood Johnson Foundation (RWJF).
Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org