New Report: Decades of Underfunding Have Limited the Public Health System’s Capacity to Protect Americans’ Health and Respond to Emergencies

Core federal public health funding remained flat for the past decade as the nation’s population and health risks grew

(Washington, DC – August 21, 2024) – Insufficient funding has left the nation’s public health system without the necessary resources to meet the public health challenges of the 21^st century, according to a new report, The Impact of Chronic Underfunding on America’s Public Health System 2024: Trends, Risks, and Recommendations, released today by Trust for America’s Health.

According to the report, the country’s rising rates of chronic disease and its insufficient response to the COVID-19 public health emergency were due in part to decades of underinvestment in public heath infrastructure and its workforce. A further concern is that the health security advancements made when policymakers increased public health funding due to the COVID-19 public health emergency are now at risk as this funding ends.

Most public health funding is allocated by the federal government, primarily through the Centers for Disease Control and Prevention (CDC), to states, tribes, territories, and local health departments. These entities in turn support a wide range of critical public health activities including disease detection and surveillance; food, water, and environmental safety; health promotion; and emergency preparedness. Federal funding, however, has not kept pace with the nation’s growing public health challenges. CDC’s current fiscal year budget (FY 2024) is 3 percent less than it was for FY 2023 when accounting for inflation and has increased by just 4 percent over the past decade after inflation.

Specific to emergency preparedness, CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement, which provides funding and technical assistance to state, local and territorial health departments to support their emergency preparedness, has seen its funding decrease over the past two decades. The program’s current annual funding of $735 million is far short of the $1 billion recommended by the public health community.

A second emergency preparedness program, the Health Care Readiness and Recovery program, which is administered by the Administration for Strategic Preparedness and Response, has seen its funding reduced by nearly two-thirds after adjusting for inflation.

Another area of persistent underfunding concerns programs addressing the number of Americans living with a chronic disease. Six in 10 U.S. adults have a chronic disease, and chronic diseases and mental health conditions account for the vast majority of the nation’s healthcare spending. Funding for health promotion and disease prevention programs such as obesity, cancer, and substance misuse prevention is so low that proven, evidence-based programs are not in place in many states and communities due to lack of funding. CDC is expected to spend only $1.4 billion on chronic disease prevention and health promotion this fiscal year, an amount below what it spent on such programs in FY 2015 after adjusting for inflation and a small fraction of the $4.5 trillion the nation spends on healthcare annually.

Progress Made in Response to the COVID-19 Pandemic is at Risk Due to Funding Cliffs

The response to the COVID-19 public health emergency included significant investments in public health infrastructure and workforce and policy actions to support American’s economic and nutrition security. These actions were critical to the national response, and they helped protect the country’s health and bolster its resilience. But these investments were one-time, temporary allocations, and due to funding ending or being rescinded, the progress created is at risk of being lost. Successful programs at risk for major cuts or elimination include support for the public health workforce, wastewater surveillance, and disease forecasting

“While the nation has emerged from the acute phase of the COVID-19 pandemic, another crisis looms: a major drop in funding threatens to undo the progress that was made toward strengthening the public health infrastructure and addressing health disparities in response to the emergency,” said J. Nadine Gracia, M.D., MSCE, President and CEO, Trust for America’s Health. “We need increased and sustained investment in order to prepare the nation for future public health emergencies and to address the root causes of poor health and health disparities in every community.”

Action is Needed to Safeguard the Nation’s Health

The report includes recommended actions for the Administration and Congress to protect health, address health disparities, reduce healthcare spending, and enhance the nation’s health and economic security, including:

• Strengthen the nation’s public health infrastructure: Increase and sustain funding to modernize public health data systems, support local and state public health laboratories and epidemiology, and grow and diversify the public health workforce.
• Enhance health security: Boost funding for programs that fortify defenses against a wide range of threats, from infectious diseases to weather-related events. Support vaccine infrastructure and ensure healthcare system readiness.
• Address health inequities and the social determinants of health: Invest in programs and policies that target the root causes of health disparities, including the social and structural drivers of health.
• Promote health and prevent chronic disease across the lifespan: Allocate resources for evidence-based interventions that promote healthy behaviors and prevent chronic diseases at every stage of life.
• Prioritize primary prevention of behavioral health concerns and deaths of despair: Invest in comprehensive suicide and substance use disorder prevention programs, emphasizing early interventions and timely identification of individuals at risk.
• Prepare for and mitigate the health impacts of climate change and environmental threats: Increase funding to address the health consequences of climate change, extreme weather events, and other environmental health hazards.

Read the report

 Trust for America’s Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and works to make the prevention of illness and injury a national priority.