TFAH Issues Report on Chronically Underfunded Public Health Infrastructure

This week, the Trust for America’s Health (TFAH) issued a report examining federal, state, and local public health funding trends, potential risks, and recommended investments and policy actions to prioritize prevention and effectively address ongoing and emerging threats. The report details significant nationwide public health challenges, including obesity, tobacco use, infectious diseases and foodborne illnesses, substance use disorders, suicide, and climate-related natural disasters. To adequately prepare for and address these challenges, TFAH indicates the need for a strong, well-resourced public health system focused on prevention, preparedness, wellness, and community recovery.

However, chronic underfunding and investments into the public health infrastructure remain a consistent and significant obstacle. In 2017, public health represented just 2.5 percent — $274 per person – of all health spending in the country. TFAH identifies evidence-based public health interventions, such as childhood vaccinations, school-based violence prevention programs, and indoor smoking bans, as effective strategies to improving health outcomes, preventing illness and death, and saving money over the long-term.

The TFAH report goes on to examine federal public health spending, finding that the budget for the U.S. Centers for Disease Control and Prevention (CDC) has not kept pace with the nation’s growing public health needs and emerging threats, particularly as it relates to substance misuse and weather-related emergencies. The CDC’s FY 2019 budget reflected a $143 million (two percent) increase over FY 2018 – after accounting for inflation, this increase for FY 2019 is essentially flat compared to the previous year. Looking further back, TFAH finds the CDC’s budget fell by 10 percent over the past decade (FY 2010-19) after accounting for inflation. California ranks 43rd in total CDC state funding per capita.

Critical CDC initiatives are examined by the report, finding that funding and support provided by the federal government over a broad range of topics – including community prevention, public health emergency preparedness and response, chronic disease prevention, substance misuse, and suicide prevention – are severely inadequately resourced and unable to provide sufficient support to states.

TFAH examines state public health funding and indicates that the ability of state health departments to fulfill critical and fundamental public health roles is heavily affected by federal funding. State public health funding was found to hold stable or increase in 33 states from FY 2017 to 2018; California’s state public health funding increased slightly by 2.8 percent during this period. Local public health funding is also examined by the report, finding a considerable number of local health departments throughout the U.S. experienced funding decreases over the past several fiscal years.

Citing the $4.5 billion gap between current funding and what is needed to build a strong nationwide public health infrastructure, TFAH details a series of policy actions and investments to achieve optimal health for all people in all communities. Recommendations include:

  • Substantially increase funding for the CDC, particularly in areas of community prevention, public health emergency preparedness and response, surveillance and data, healthy aging, and social determinants of health
  • Increase state and local investments in public health, prioritizing social determinants
  • Work across sectors to improve effectiveness and efficiency of public health investments

Given ongoing and emerging threats to the public’s health and safety, TFAH urges adequate investments into federal, state, and local public health systems and infrastructure. The full report, “Impact of Chronic Underfunding of America’s Public Health System: Trends, Risk, and Recommendations, 2019,” is available here.