Often, you hear that an investment in our nation’s children and education system is really an investment in our economy. Not as often do you hear the same thing about our children’s health and the nation’s public health system.
Yet the logic is quite clear and similar. A healthier child misses less school and learns more while their caregiver misses less work. A healthier adult requires less expensive medical care and is happier and at work more.
For a decade, Trust for America’s Health has released a report called Investing in America’s Health, which examines public health funding and key health facts for each state.
Unfortunately, funding for the nation’s health is incredibly low this year compared to just a handful of years ago. In fact, combined federal, state, and local public health spending is below pre-recession levels at $75.4 billion total in 2013. Adjusting for inflation, public health spending was 10% lower in 2013 than in 2009.
In addition, the federal government has not kept up with inflation, as funding for public health has remained relatively flat for years. For instance, the budget for the U.S. Centers for Disease Control and Prevention (CDC) has decreased from a high of $7.07 billion in fiscal year (FY) 2005 to $6.93 billion in FY 2015. Spending through CDC averaged to only $20.01 per person in FY 2015. One of the main government entities charged with safeguarding the nation’s health throws down just $20 per person.
Sadly, it gets worse at the local level. Beginning with the recession and continuing to 2014, public health budgets have been cut at drastic rates. In total, 22 states and Washington, DC, decreased their public health budgets from FY 2012–2013 to FY 2013–2014. Perhaps more importantly, 17 of those states decreased for 2 or more years in a row, and 9 decreased their budget for 3 or more years in a row.
This lack of investment leads to real problems: Tens of millions of Americans are currently suffering from preventable diseases such as cancer, heart disease, and diabetes. Today’s children are in danger of becoming the first generation in American history to live shorter, less healthy lives than their parents.
The ideal of our country is that every American, no matter where he or she lives, deserves basic health protections. Yet fundamental public health services and the funding of these programs often vary dramatically from state to state and among communities and cities within the states. Frankly, there is no system in this country that ensures a minimum level of health services for all Americans or guarantees that the little money that we do spend is being used in the most effective ways to reduce and prevent disease and injury.
Our report reached the following conclusions:
- The public health system must be modernized.
- A sustained and sufficient level of investment in prevention is needed at all levels of government to improve health.
- Stable, sufficient, dedicated funding is needed to support public health emergencies and major disease outbreaks to reduce ongoing threats such as the flu, foodborne illness, and the measles. Currently, inadequate and fluctuating resources have left gaps in the ability to quickly detect, diagnose, treat, and contain the spread of illnesses.
In addition, the first dollars of core funding should be used to ensure that all Americans are protected by a set of foundational public health capabilities and services, no matter where they live. For this to be accomplished, these capabilities must be fully funded, and funding should be tied to achieving and maintaining these capabilities. The Prevention and Public Health Fund—the nation’s largest single investment in prevention, using evidence-based and innovative partnership approaches to improve the health of Americans—should be fully allocated to improve the public health system and reduce disease rates.
Lastly, to be successful, all funding must be considered strategically so that funds are used efficiently to maximize effectiveness in lowering disease rates and improving health. Accountability must be the cornerstone of all public health funding. Americans deserve to know how effectively their tax dollars are used, and the government’s use of funds should be transparent and clearly communicated to the public.
A targeted, sustained, accountable investment in the nation’s health is an investment in the nation’s future wealth. Our health and wealth are inexorably tied. We know that this is true. It is time to start acting like it by modernizing and accurately and adequately funding our nation’s public health.