Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts

April 2013

For too long, the country has focused on treating people after they become sick instead of preventing diseases before they occur. Investing in disease prevention is the most effective, common-sense way to improve health— helping to spare millions of Americans from developing preventable illnesses, reduce healthcare costs, and improve the productivity of the American workforce so we can be competitive with the rest of the world.

Tens of millions of Americans are currently suffering from preventable diseases such as cancer, heart disease and diabetes. And, today’s children are in danger of becoming the first generation in American history to live shorter, less healthy lives than their parents.

The nation’s public health system is responsible for improving the health of Americans. But, the public health system has been chronically underfunded for decades. Analyses from the Institute of Medicine (IOM), The New York Academy of Medicine (NYAM), the U.S. Centers for Disease Control and Prevention (CDC), and a range of other experts have found that federal, state and local public health departments have been hampered due to limited funds and have not been able to adequately carry out many core functions, including programs to prevent disease and prepare for health emergencies.

In Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts, the Trust for America’s Health (TFAH) and Robert Wood Johnson Foundation (RWJF) examine public health funding and key health facts in states around the country, finding: 

  • Inadequate Federal Funding: Federal funding for public health has remained at a relatively flat and insufficient level for years. The budget for CDC has decreased from a high of $7.31 billion in 2005 to $6.13 billion in 2012. Spending through CDC averaged to only $19.54 per person in FY 2012. And the amount of federal funding spent to prevent disease and improve health in communities ranged significantly from state to state, with a per capita low of $13.72 in Indiana to a high of $53.07 in Alaska.
  • Cuts in State and Local Funding: At the state and local levels, public health budgets have been cut at drastic rates in recent years. According to a TFAH analysis, 29 states decreased their public health budgets from FY 2010-11 to FY 2011-12. Budgets in 23 states decreased for two or more years in a row, and budgets in 14 states decreased for three or more years in a row. In FY 2011-12, the median state funding for public health was $27.40 per capita, ranging from a high of $154.99 in Hawaii to a low of $3.28 in Nevada. From FY 2008 to FY 2012, the median per capita state spending decreased from $33.71 to $27.40. This represents a cut of more than $1.15 billion, based on the total states’ budgets from those years, which would be $1.9 billion adjusted for inflation.

According to a survey by the Association of State and Territorial Health Officials (ASTHO), 48 state health agencies (SHAs) reported experiencing budget cuts since 2008. According to the Center on Budget and Policy Priorities (CBPP), states have experienced overall budgetary shortfalls of $540 billion combined from FY 2009 to FY 2012 and 31 states have projected or closed budget gaps totaling $55 billion in FY 2013. State and local health departments have cut more than 45,700 jobs across the country since 2008. During 2011, 57 percent of all local health departments reduced or eliminated at least one program.

The report also finds:

  • Wide Variation in Health Statistics by State: There are major differences in disease rates and other health factors in states around the country. For instance, only 6.7 percent of adults in Colorado and Utah have diabetes compared to 12.3 percent in Mississippi, and less than 12 percent of adults in Utah are current smokers while almost 30 percent report smoking in Kentucky.
  • Wide Variation in Health Statistics by County: There are also major differences in disease rates and health factors within each state. County Health Rankings, published by RWJF and University of Wisconsin Population Health Institute, provide county-level data on a number of key health factors for nearly every county in the country. The rankings assess health behaviors (tobacco use, diet, alcohol use, etc.), clinical care (access to and quality of care), social and economic factors (education, employment, income, etc.) and physical environment (environmental quality and the built environment). The Rankings highlight the healthiest and least healthy counties in every state and identify factors that influence health, outside of the doctor’s office. The rankings do not currently include budget data by county.

Overall, Investing in America's Health concludes that a sustained and sufficient level of investment in prevention is essential to improving health in the United States, and that differences in disease rates will not be changed unless an adequate level of funding is provided to support public health departments and disease prevention efforts.