Public health expenditures on disease prevention and community health initiatives remained well below pre-recession levels in 2013, a report from the Trust for America's Health and the Robert Wood Johnson Foundation finds.
The tenth edition of the report, Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts 2015 (20 pages, PDF), found that combined federal, state, and local public health spending in 2013 totaled $75.4 billion, or $239 per person — some 10 percent below 2009 spending levels, adjusted for inflation. According to the study, public health budgets declined on a year-over-year basis in twenty-two states and the District of Columbia, fell for two or more years in a row in seventeen states, and declined for three or more years in a row in nine states. The report also found that over the last decade, the budget for the Centers for Disease Control and Prevention declined slightly from a high of $7.07 billion to $6.93 billion, while funding for the CDC's Public Health Emergency Preparedness Cooperative Agreement fell by nearly a third and the Hospital Preparedness Program budget was cut by more than half.
In addition, the report found persistently wide variations in state health budgets and key health indicators, including uninsurance rates, immunization rates, nutrition, physical activity, tobacco use, and rates of asthma, hypertension, and obesity. In FY2013-14, for example, investments in public health at the state level ranged from a per-capita high of $156.01 in Hawaii to $3.59 in Nevada, while Texas had the highest uninsurance rate (22.1 percent) and West Virginia had the highest rate of hypertension (41 percent).
"The public health system must be modernized," the report concludes, "and a sustained and sufficient level of investment in prevention is needed at all levels of government to improve health across the United States. Improvements and closing the gaps in differences in disease rates will not be accomplished unless an adequate level of funding is provided to support public health."