Reports

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

April 2015

Trust for America's Health (TFAH) released Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts. This is the 10th time the report has been released. 

In Investing, TFAH examines public health funding and key health facts for each state, finding:

  • Combined federal, state and local public health spending is below pre-recession levels at $75.4 billion total in 2013 – or $239 per person ($218 adjusted for inflation) compared to $241 per person in 2009.  Adjusting for inflation, public health spending was 10 percent lower in 2013 than in 2009.
  • Federal funding for public health has remained at a relatively flat level for years.  The budget for CDC has decreased from a high of $7.07 billion in FY 2005 to $6.93 billion in FY 2015. Spending through CDC averaged to only $20.01 per person in FY 2015.  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 $15.14 in Indiana to a high of $50.09 in Alaska.
  • At the state and local levels, public health budgets have been cut at drastic rates.  According to a TFAH analysis, 22 states and Washington, D.C. decreased their public health budgets from FY 2012-13 to FY 2013-14.  Budgets in 17 states decreased for two or more years in a row, and budgets in nine states decreased for three or more years in a row.  In FY 2013-14, the median state funding for public health was $31.06 per person, ranging from a high of $156.01 in Hawaii to a low of $3.59 in Nevada.  From FY 2008 to FY 2014, the median per capita state spending decreased from $33.71 to $31.06.  This represents a cut of more than $1.3 billion adjusted for inflation.

Public Health Emergency Preparedness Cuts:

  • Public Health Emergency Preparedness (PHEP) Cooperative Agreement Funding – which provides support for states and localities to prepare for and respond to all types of disasters – has dropped from a high of $919 million in FY 2005 to $643 million in FY 2015.
  • The Hospital Preparedness Program (HPP)—which seeks to improve medical surge capacity and enhance community and hospital preparedness for health emergencies— has been cut from a high of $515 million in fiscal year 2004 to just $255 million in FY 2015 a cut of more than 50 percent, including a more than $100 million cut in FY 2014.

Investing recommends that:

  • Core funding for public health – at the federal, state and local levels – be increased.
  • The first dollars of core funding should be used to assure that all Americans are protected by a set of foundational public health capabilities and services no matter where they live. 
  • Funding be considered strategically – so funds are used efficiently to maximize effectiveness in lowering disease rates and improving health.
  • The Prevention Fund should be fully allocated to support evidence-based and innovative approaches to improve the public health system and reduce disease rates.
  • Stable, sufficient, dedicated funding is needed to support public health emergencies and major disease outbreaks – so the country is not caught unprepared for threats ranging from Ebola to an act of bioterror and is better equipped to reduce ongoing threats such as the flu, foodborne illnesses and measles. 
  • Accountability must be at the cornerstone of public health funding.  Americans deserve to know how effectively their tax dollars are used, and the government’s use of funds should be transparent and clearly communicated with the public.