TFAH Report Examines Chronic Underfunding of Public Health and Emergency Preparedness Systems

The Trust for America’s Health (TFAH) recently released its report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2020. The report examines federal, state, and local public health funding trends, finding a continuing pattern of underfunding vital public health and emergency preparedness programs. As such, TFAH determines that the lack of funding has made the nation vulnerable to health security risks, including the novel coronavirus pandemic.

While the United States spends an estimated $3.6 trillion annually on health, less than three percent of that funding is directed toward public health and prevention. Public health spending as a proportion of total health spending has been decreasing since 2000 and fall in inflation-adjusted terms since the Great Recession. TFAH finds that health departments across the country are battling 21st century health threats with 20th century resources.

TFAH details funding levels of the U.S. Centers for Disease Control and Prevention (CDC) for Fiscal Year 2020 which increased in certain areas including one-time investments in capital facilities, public health data modernization, and global health security. Modest investments were also made in suicide prevention and gun violence research; however, despite these modest increases, the CDC’s program level budget remains just above its level in FY 2008 when adjusting for inflation. Furthermore, the Prevention and Public Health Fund (PPHF), which was originally designed to expand and sustain the nation’s investment in public health and prevention, remains at half of where it should have been funded in 2020 due to the reappropriation of funds to other spending programs.

The report goes on to examine other federal public health-related investments, emergency preparedness programs and activities, and core capabilities of a robust public health system. Notably, the report discusses the public health workforce, finding that the workforce has shrunk by approximately 56,000 positions over the past decade primarily due to funding issues. In assessing the overall investment pattern into public health, TFAH notes, “An unfortunate pattern has emerged: as a nation, we pay attention to public health investment when there’s a crisis, often borrowing from existing public health budgets (money typically meant to address chronic illness) to pay for the emergency response before falling back into a pattern of underinvesting in public health.” The continued trend of using resources from other public health programs to pay for public health emergencies has left the overall public health infrastructure on weak footing.

TFAH outlines a series of 28 recommendations for policy action within four priority areas. Those four areas are:

  • Increased funding to strengthen the public health infrastructure and workforce, including modernizing the system’s data and surveillance capacities.
  • Safeguarding and improving Americans’ health by investing in chronic disease prevention and the prevention of substance misuse and suicide.
  • Improving emergency preparedness, including preparation for weather-related events and infectious disease outbreaks.
  • Addressing the social determinants of health and advancing health equity.

The full TFAH report is available here.