REPORT The Impact of Chronic Underfunding on America's Public Health System

The Impact of Chronic Underfunding on America's Public Health System

Persistent underfunding leaves the nation vulnerable and puts lives at risk.

The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2019 examines federal, state, and local public health funding, and recommends needed investments and policy actions to prioritize prevention, effectively address 21st century threats, and ultimately achieve optimal health for all Americans.

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Key Findings: Over the past decade, the Centers for Disease Control and Prevention’s program funding—more than half of which goes to states, localities, and other nonfederal partners—decreased by 10 percent, after adjusting for inflation. At the same time, substance misuse has skyrocketed, the incidence of obesity and related health problems are up sharply, and the threat of weather-related emergencies is on the rise. Federal funding cuts negatively impact state health departments as these funds are a primary source of state public health money. Similarly, these spending cuts trickle down and have serious consequences for local health departments and the communities they serve, given that such allocations also constitute a substantial portion of local health departments’ budgets. Multiple years of funding cuts contributed to more than 55,000 lost jobs at local health departments from 2008-17. These cuts undermine efforts to hire, train, and retain a strong public health workforce, which in turn limits governments’ ability to effectively protect and promote the health of their communities.

Topline Recommendations:

Increase federal investments in public health. Provide sufficient full-year funding for federal agencies to avoid interruptions in funding for critical health security programs. Increase state and local investment in public health, prioritizing prevention and the social determinants of health. Work across sectors to improve the effectiveness and efficiency of public health investments. Ease coordination of funding from multiple streams.

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