The Nation’s Chronic Underinvestment in Public Health Puts American Lives and Livelihoods at Risk

Emergency COVID-19 funding was critical to the initial response, but has not resolved the country’s longstanding underinvestment in public health; $4.5 billion annual funding is needed

WASHINGTON, July 28, 2022 /PRNewswire/ — Chronic underfunding has created a public health system that cannot meet the country’s health security needs, its persistent health inequities, and emerging threats, and has contributed to the inadequate response to the COVID-19 pandemic, according to a report, The Impact of Chronic Underfunding on the US Public Health System: Trends, Risks, and Recommendations, 2022released today by Trust for America’s Health.

“Emergency funding is important but not enough to fill long-standing gaps in public health investment. The ‘boom and bust’ cycle in public health funding has meant the system has not the tools or manpower to modernize and respond to the range of threats affecting our communities,” said J. Nadine GraceMD, MSCE, President and CEO of Trust for America’s Health.

This annual report examines federal, state, and local trends in public health funding and recommends investments and policy actions to build a stronger public health system, prioritize prevention, and address the ways in which social and Economics create barriers to good health in many communities.

Lack of funding in core public health programs has slowed the response to the COVID-19 pandemic and exacerbated its impact, especially in low-income communities, communities of color, and for older Americans – populations that experience higher rates of chronic disease and have fewer resources to recover from an emergency. TFAH is one of many organizations within the public health community calling for an annual report $4.5 billion investment in public health infrastructure at state, local, tribal and territorial levels.

“As we navigate the next stages of the pandemic and beyond, it is critical that we modernize public health data infrastructure, grow and diversify the public health workforce, invest in advocacy and prevent health and reduce health inequalities. Investments in public health are needed in every community, but should be particularly directed to communities that, due to the impacts of structural racism, poverty, systemic discrimination and disinvestment, are at greatest risk during a health emergency,” Dr. Gracia said.

Emergency funding is not sufficient to address system weaknesses created by chronic underfunding

State and local public health agencies managed two diverging realities in 2021. Short-term funding increased significantly as the federal government provided response funding to states and localities in an effort to control the pandemic. But this funding was ad hoc and often specifically related to COVID-19. Most of this money could not be used to address long-standing deficits in the public health system, including ensuring the provision of basic public health services, replacing outdated data systems and increasing the public health personnel. 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% increase in the size of their workforce to be able to provide comprehensive public health services to their communities.

Another challenge for national and local health departments is that emergency response funding, while critical during the emergency, comes too late to put in place prevention and preparedness programs, programs that need to be in place. square before an emergency if they want to protect lives. To be adequately prepared for the next public health emergency, the country must maintain higher levels of public health funding and provide more flexible funding.

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

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

Funding for health promotion, prevention and equity also needs sustained growth

As a nation we have spent $4.1 trillion on health in 2020, but only 5.4% of this spending targeted public health and prevention. Notably, this share almost doubled last year compared to 2019 – due to short-term funding for the COVID-19 response – but is still grossly insufficient and likely to return to pre-pandemic levels if the historical pattern of increasing public health funding during an emergency but neglecting it at other times resumes. Inadequate funding means that effective public health programs, such as those aimed at preventing suicide, obesity and environmental threats to health, reach only a fraction of states. This longstanding neglect contributes to high rates of chronic disease and persistent health inequities.

“We need to break with the pattern of only investing in the public health system in emergencies, which undermines the power of preparedness and prevention. Investing in public health and health equity of manner, including outside of times of emergency, will save lives and help reduce economic costs to our country during and between emergencies,” said Dr. Gracia.

The impacts of structural racism, poverty, discrimination and disinvestment must also be addressed through investments in programs that ensure every community has access to healthy food, safe housing, healthcare, transportation , education and employment – all factors that have an impact on people’s health.

Recommendations for policy actions

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

Significantly increase core funding to strengthen public health infrastructure and develop the public health workforce, including increasing grassroots ownership of the CDC and modernizing the country’s public health data and disease tracking systems.

Investing in the country’s health security increasing funding for public health emergency preparedness, including within the health system, improving immunization infrastructure, and addressing the impacts of climate change.

Addressing health inequalities and their impact on the root causes of disease by addressing the social determinants of health that have a disproportionate impact on health outcomes.

Preserving and improving health throughout life. Many programs that promote health and prevent major causes of disease, disability, and death have long been neglected and do not reach all states or most-at-risk populations. Revitalizing programs that stem chronic disease, support children and families, and prevent substance abuse and suicide should be a top priority.

Read the full report at: https://www.tfah.org/report-details/funding-report-2022/

Trust for America’s Health is a nonpartisan, nonprofit organization that promotes optimal health for every person and community through political action and strives to make disease and injury prevention a national priority. www.tfah.org.

SOURCE America’s Health Trust