A Funding Crisis for Public Health and Safety: State-by-State Public Health Funding and Key Health Facts, 2017 found that core funding for disease prevention and health promotion programs has declined by around $580 million federally and has remained flat in states since 2010 (adjusting for inflation).
The annual review demonstrates that cuts to federal funds have not been offset by increases to state and local funding. Adjusting for inflation:
- The Centers for Disease Control and Prevention's (CDC) core budget has decreased by more than $580 million since 2010. In fiscal year 2016, the agency's budget was $7.17 billion ($22.26 per person).
- State public health spending has remained relatively level since 2010 ($11.5 billion total in 2015-2016, median spending $31.62 per capita).
The President's proposed FY 2018 budget blueprint would include a nearly 18 percent cut to the U.S. Department of Health and Human Services (HHS). The full budget detail is expected to be released later this Spring. Budget sequestration – which requires reductions in the rate of increase in federal spending – is scheduled to go back into effect in FY 2018 and would lead non-defense spending, including at CDC, to fall 16 percent below 2010 spending rates (adjusting for inflation).
"Major budgetary cuts have hampered the ability of public health agencies to protect and improve the nation's health – impeding the response to pressing health concerns and the rising costs of treating preventable illnesses and injuries," said John Auerbach, president and CEO, of TFAH. "It is painfully clear that the decrease in federal spending has not led to higher state spending for public health. Rather, the nation has doubled down on cuts at both levels, leaving us vulnerable to the next public health crisis. Cutting public health programs is shortsighted – and we will all pay the price over time."
The Funding Crisis brief also found that:
- Around 75 percent of CDC's funds go to support state and local programs – but this support ranges from a low of $15.39 per person in Virginia to a high of $49.67 per person in Alaska – with differences due to competitive grant awards and some targeted-need programs;
- Public Health Emergency Preparedness (PHEP) core funding for states and local communities – with the exception of the one-time, short-term funding for Ebola and Zika response needs – has been cut by more than one-third (from $940 million to $651 million) per year since the program was established in the wake of the 9/11 and anthrax attacks. CDC has responded to more than 750 emergencies in the past two years; and
- Only $4 per person per year is spent on chronic disease prevention activities at CDC ($1.2 billion total). Nearly half of all Americans have one or more chronic disease – a majority of which are preventable – and more than 80 percent of healthcare spending is for chronic conditions.
TFAH also highlights how investing in proven public health strategies can improve health and yield positive returns. For instance:
- Investing $1 in substance use prevention to realize as much as $34 in return. Deaths from prescription painkiller use have more than quadrupled in the past 15 years and deaths from heroin have tripled since 2010, contributing to higher death rates among middle-aged Whites. Five of the strongest school-based substance use prevention strategies have returns on investment ranging from $3.8:1 to $34:1.
- Saving more than $16 billion through a more active and healthy population. One in three children will develop type 2 diabetes in their lifetime and one in four young adults are not healthy enough to join the military. An investment of $10 per person in proven, evidence-based community prevention programs to increase physical activity, improve nutrition and reduce tobacco use could save the country more than $16 billion annually – a $5.60:1 return.
- Connecting health and social services to cut billions in costs. Health and social service coordinating systems that address gaps between medical care and effective social service programs – by connecting patients in need with programs ranging from supportive housing to food assistance – could yield between $15 billion and $72 billion in annual healthcare savings within 10 years, according to an analysis by TFAH and Healthsperien.
- Reducing the $120 billion spent annually on preventable infectious diseases. Fifteen years after 9/11 and 11 years after Hurricane Katrina, when health crises such as new infectious diseases arise, the country often lacks sufficient funding and capabilities in place to effectively respond. Preventable infectious diseases cost the country more than $120 billion annually – and that cost is exponentially compounded when new diseases emerge.
Key recommendations for achieving a modern public health system highlighted in the paper include:
- Increasing funding for public health – at the federal, state and local levels – to support basic capabilities to turn the tide on health epidemics and prevent disease;
- Modernizing the public health system to address gaps in critical infrastructure and update outdated systems and technologies;
- Creating a standing Public Health Emergency Fund for immediate use when new threats emerge – while still making sure to maintain ongoing preparedness and response funding. To be effective, this fund must provide a complimentary surge of resources for response to new crises and cannot replace the need to provide ongoing support for standing health security capabilities that must always be in place to deal with the regular cycle of emergencies and threats the country faces;
- Supporting better health – and top local priorities – by providing communities with the flexibility to focus on their highest concerns, develop private-public partnerships to leverage resources and ensure accountability; and
- Expanding the use of evidence-based, high-impact strategies to improve health in every community.