The nation’s chronic lack of investment in public health is putting American lives and livelihoods at risk

COVID-19 emergency funding was critical to the initial response but did not address the nation’s longstanding underinvestment in public health; $4.5 billion in annual funding is required

WASHINGTON, July 28, 2022 /PRNewswire/ — Chronic underfunding has left a public health system incapable of addressing the nation’s health security needs, its persistent health inequalities, as well as emerging threats, and has been a contributing factor to the inadequate response to the COVID-19 Pandemic contributed, according to a report The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2022published today by Trust for America’s Health.

“Emergency funding is important, but not sufficient to fill long-standing public health investment gaps. The boom-and-bust cycle of public health funding has left the system without the tools or manpower to modernize and respond to the breadth of threats affecting our communities,” said J. Nadine GraceMD, MSCE, President and CEO of Trust for America’s Health.

This annual report examines trends in public health funding at the federal, state, and local levels and recommends investments and policies to build a stronger public health system, prioritize prevention, and address the ways in which social and economic inequalities in present barriers to good health in many communities.

The lack of funding in core public health programs has slowed the response to the COVID-19 pandemic and exacerbated its impact, particularly in low-income communities, communities of color and for older Americans — populations who are more likely to suffer from chronic illnesses and have fewer resources to take care of themselves emergency to recover. TFAH is one of many organizations within the public health community calling for an annual campaign $4.5 billion Investing in public health infrastructure at the state, local, tribal and territorial levels.

“As we navigate the next phases of the pandemic and beyond, it is critical that we modernize public health data infrastructure, expand and diversify the public health workforce, invest in health promotion and prevention programs, and reduce health inequalities. Public health investment is needed in every community, but should be particularly targeted at those communities most at risk from the impact of structural racism, poverty, systemic discrimination and disinvestment during a health emergency,” said Dr. Gracia.

Emergency funding is insufficient to address systemic weaknesses created by chronic underfunding

State and local health officials were coping with two different realities in 2021. Short-term funding increased significantly as the federal government provided funds to states and localities to fight the pandemic. But that funding was one-time money and often tied specifically to COVID-19. Most of this could not be used to address long-standing public health system deficiencies, including ensuring the delivery of basic public health services, replacing outdated data systems, and increasing public health workforces. A October 2021 An analysis conducted by the de Beaumont Foundation and the Public Health National Center for Innovations found that state and local health departments need an 80 percent increase in their workforce to provide comprehensive public health services to their communities.

Another challenge for state and local health officials is that emergency response funding, while vital during the emergency, is too late to build prevention and preparedness programs, programs that must be in place before an emergency if they want to save lives. To be adequately prepared for the next public health emergency, the country must keep public health funding at higher levels and provide more flexible funding.

Funding for two key emergency preparedness and response programs has declined sharply over the past two decades:

  • The US Centers for Disease Control and Prevention (CDC) is the nation’s leading public health agency and the primary source of funding for state, local, tribal and territorial health departments. CDC annual funding for public health emergency preparedness (PHEP) programs increased slightly between fiscal 2021 and fiscal 2022 $840 million to $862 millionbut has been reduced by just over a fifth since fiscal 2002, or about half when adjusted for inflation.
  • The Hospital Preparedness Program, administered by the US Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response, is the primary source of federal funding to help healthcare systems prepare for emergencies. Adjusted for inflation, it has declined by nearly two-thirds over the past two decades.

The financing of health promotion, prevention and justice also requires sustainable growth

As a nation we spent $4.1 trillion for health in 2020, but only 5.4 percent of that spending was for public health and prevention. Remarkably, this share has almost doubled over the past year compared to 2019 – due to the short-term funding of the COVID-19 response – but is still grossly inadequate and is likely to return to pre-pandemic levels if the historical pattern of the increasing public health funding during an emergency, but neglect resumed at other times. Insufficient funding means that effective public health programs, such as those to prevent suicide, obesity and environmental health hazards, reach only a fraction of states. This longstanding neglect contributes to high rates of chronic disease and persistent health inequalities.

“We need to break the pattern of only investing in the public health system during an emergency, which undermines preparedness and prevention performance. Continued investment in public health and health equity, including non-emergency times, will save lives and help reduce the economic cost to our country during and between emergencies,” said Dr. Gracia.

The impacts of structural racism, poverty, discrimination and divestment must also be addressed by investing in programs that ensure every community has access to healthy food, safe housing, health care, transportation, education and employment – all factors that affect the affect people’s health.

Policy recommendations

The report calls for policy action by the administration, Congress, and state and local officials in four areas:

Significantly increase core funding strengthen public health infrastructure and expand the public health workforce, including increasing CDC baseline allocations and modernizing national health records and disease tracking systems.

Invest in the nation’s health security B. by increasing resources for health emergency preparedness, including within the health system, improving immunization infrastructure and combating the effects of climate change.

Address health inequalities and their impact on the causes of disease by addressing the social determinants of health that have an outsized impact on health outcomes.

Protect and improve health throughout life. Many programs that promote health and prevent the major causes of disease, disability and death have long been neglected and do not reach all states or the most vulnerable populations. Revitalizing programs that control chronic disease, support children and families, and prevent substance abuse and suicide should be a top priority.

Read the full report at:

Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health through policy action for every individual and community and works to make disease and injury prevention a national priority.

SOURCE Trust for America’s Health

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