TFAH Issues Report on Chronic Underfunding of U.S. Public Health System

This past week, the Trust for America’s Health (TFAH) released a new report entitled, “The Impacts of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021,” examining federal, state, and local public health funding trends and recommending investments and policy actions to build a stronger public health system, prioritize prevention, and address social and economic inequities that create barriers to good health.

According to the report’s authors, missteps of the COVID-19 pandemic response were rooted in a public health system weakened by years of underfunding, the federal government’s failure to communicate and follow the best available science, and health inequities that put communities of color at elevated risk.

The report finds that between FY 2012 and FY 2021, the U.S. Centers for Disease Control and Prevention’s (CDC) budget has realized a decrease with continued insufficiency to meet the country’s public health needs. When adjusting for inflation, the CDC’s core budget over the past decade decreased by two percent. The decrease in federal funds has occurred in a time when the U.S. population has grown, the number and severity of weather-related emergencies increased, and the number of Americans grappling with substance use disorders, suicide, and chronic disease grew.

At the state level, 43 states and the District of Columbia maintained or increased their public health funding in FY 2020. In some instances, however, state-supported COVID-19 response funding increased the state’s public health funding for the year, but emergency funds are unlikely to translate into sustained funding growth. Notably, California ranks 48 out of 51 in total CDC program funding to states per capita, just ahead of Wisconsin, Indiana, and New Jersey.  

Further, TFAH determines that between 2008 and 2019, the estimated number of full-time local public health agency staff decreased by 16 percent while state health agencies lost almost 10 percent of their collective workforce between 2012 and 2019. These personnel cuts translated into fewer trained professions available to do critical work as the COVID-19 pandemic was experienced throughout the country. While Congress passed numerous COVID-19 relief measures providing critical funding to support the emergency response, TFAH notes this one-time funding is not a solution to years of underfunding which hallowed out the system, making it less able to spend emergency funds quickly and efficiently.

To address these significant systemic issues, TFAH advances a call for a $4.5 billion annual investment in the nation’s core public health capabilities. Other TFAH recommendations include:

• Substantially increase core funding to strengthen the public health system, including by building and supporting the workforce, modernizing the system’s data tools, and increasing surveillance capacities.
• Strengthen public health emergency preparedness, including within the health care delivery system.
• Safeguard and improve Americans’ health by investing in chronic disease prevention and the prevention of substance misuse and suicide.
• Take steps to advance health equity by combatting the impacts of racism and addressing social determinants that lead to poor health.

The full TFAH report is available here.