Public Health Funding in United States

United States

Public health funding saves lives and money. The United States public health system aims to keep Americans safe and healthy through prevention, preparedness and surveillance programs, and serves as the first line of defense against epidemics. Increased spending on public health programs is associated with a decrease in mortality from preventable causes such as cardiovascular disease, diabetes, stroke and cancer.

Public health program spending accounts for less than 10% of all health care expenditures in most countries, yet its impact can be substantial. An investment of $10 per person per year in evidence-based community health programs could save the U.S. more than $16 billion annually. That is a potential savings of $5.60 for every $1 invested. The public health response to the recent COVID-19 pandemic exposed critical weaknesses caused by chronic underfunding of these systems at state and national levels, driving home the importance of prioritizing this area.

Populations that are most affected by public health funding include: 

• Children and infants: Financial coverage for childhood immunizations and developmental screenings are crucial for protecting infants and children from potentially life-threatening preventable diseases early in life when they are most vulnerable.
• Low-resource communities: People living in these communities experience the largest health and economic benefits from increased local public health spending. 
• Medicare enrollees: A 2017 study found that a 10% increase in local public health spending per capita was associated with decreases in Medicare expenditures, particularly among low-income and low-access populations.

The Affordable Care Act established the Prevention and Public Health Fund to expand and sustain national investments in evidence-based strategies to improve health outcomes and health care quality. The Prevention Fund supports $903 million in Centers for Disease Control and Prevention (CDC) grants for public health programs throughout the U.S., including efforts to reduce tobacco use, increase vaccine access and expand mental health and injury prevention programs.

The effectiveness of a public health intervention, in part, depends on the resources of the community receiving the intervention. Studies have found that public health interventions focusing on behavioral changes are more successful in populations with high socioeconomic status, while those with low socioeconomic status or other disadvantages benefit less from these interventions. Effective interventions must therefore adopt a social determinants of health lens, which recognizes the conditions in which people live, work and play as key influences on and indicators of health. 

State and local health departments are primarily responsible for funding and implementing public health activities, with supplemental financial support from federal agencies. Between the CDC’s steadily decreasing budget between 2010 and 2020 and disparities in state resources, this means that health departments are relying on inconsistent streams of public health dollars to provide necessary services. In order to reduce disparities and improve the state of public health for all Americans, it is critical that state and federal governments prioritize adequate and sustained funding for local health departments.

Baum, Fran, and Matthew Fisher. “Why Behavioural Health Promotion Endures despite Its Failure to Reduce Health Inequities.” Sociology of Health & Illness 36, no. 2 (2014): 213–25. https://doi.org/doi:10.1111/1467-9566.12112.

Johns, Marquisha, and Jill Rosenthal. “How Investing in Public Health Will Strengthen America’s Health.” Center for American Progress, May 17, 2022. https://www.americanprogress.org/article/how-investing-in-public-health-will-strengthen-americas-health/.

Levi, Jeffrey, Laura M. Segal, and Chrissie Juliano. “Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities.” Issue Report. Washington, D.C.: Trust for America’s Health, February 2009. https://www.tfah.org/wp-content/uploads/archive/reports/prevention08/Prevention08.pdf.

Mays, Glen P., and Cezar B. Mamaril. “Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities.” Health Services Research 52, no. S2 (2017): 2357–77. https://doi.org/doi:10.1111/1475-6773.12785.

Mays, Glen P., and Sharla A. Smith. “Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths.” Health Affairs 30, no. 8 (August 2011): 1585–93. https://doi.org/10.1377/hlthaff.2011.0196.

McKillop, Matt, and Dara Alpert Lieberman. “The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021.” Issue Report. Washington, D.C.: Trust for America’s Health, May 2021. https://www.tfah.org/wp-content/uploads/2021/05/2021_PHFunding_Fnl.pdf.

McKillop, Matt, and Dara Alpert Lieberman. “The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2022.” Issue Report. Washington, D.C.: Trust for America’s Health, July 2022. https://www.tfah.org/wp-content/uploads/2022/07/2022PublicHealthFundingFINAL.pdf.

Richardson, Ann K. “Investing in Public Health: Barriers and Possible Solutions.” Journal of Public Health 34, no. 3 (August 2012): 322–27. https://doi.org/10.1093/pubmed/fds039.

Sen-Crowe, Brendon, Mark McKenney, and Adel Elkbuli. “Public Health Prevention and Emergency Preparedness Funding in the United States: Are We Ready for the next Pandemic?” Annals of Medicine and Surgery 59 (November 2020): 242–44. https://doi.org/10.1016/j.amsu.2020.10.007.