Beyond the Boom-and-Bust Cycle: The Need for a Long-Term Funding Strategy for Public Health
By Dara Alpert Lieberman, MPP, Director of Government Relations, Trust for America’s Health, Member of CHF Board of Directors
As public health advocates, we are often asked: “We have spent an exorbitant amount of money on the health response to the COVID-19 pandemic, so why does public health need more money?” In short, if we had spent billions on strengthening and sustaining public health and prevention before the COVID outbreak, we could have avoided spending trillions responding to the pandemic and averted needless suffering.
According to a new report from Trust for America’s Health (TFAH), The Impact of Chronic Underfunding on America’s Public Health System, decades of neglecting public health made the country more vulnerable to the pandemic, and short-term emergency response funding alone will not fill these longstanding gaps. Although health departments need to be nimble, modern, and capable of responding to emerging threats to health, federal public health funding is often siloed, disease-specific, and inadequate. These challenges highlight the need for sustained and increased funding that can build a foundation for health departments to modernize and expand effective programs to communities that need and want them most.
In June, TFAH and the Coalition for Health Funding cohosted a webinar that explored these issues, Beyond Emergency Funding: Sustaining Public Health Funding in the Post-COVID Landscape. The panel of experts at the webinar expanded on TFAH’s report and further discussed the challenges of public health funding. Some of the key points made were:
Public health is massively underfunded. State and local health departments need about 80,000 additional full-time equivalent positions to provide a minimum set of public health services, according to the Staffing Up Project.
Short-term, siloed, and disease-specific funding often restricts health departments from hiring cross-cutting staff, such as experts in health equity, disease surveillance, risk communications, and community outreach. Important exceptions include the recent announcement of public health infrastructure and workforce funding through the American Rescue Plan Act, as well as a new Public Health Infrastructure program in CDC’s budget.
Health departments continue to operate with 20th century data systems, such as phone and fax. Recent investments in public health data modernization are a start to building 21st century, interoperable surveillance systems, but these challenges require expanded and sustained investment.
Together, these funding limitations mean that only half of the country is served by a public health system capable of performing essential public health services and capabilities.
Due to underfunding, critical prevention programs to address leading health crises—obesity, suicide, health inequities, and environmental health threats, for example—only reach a fraction of the states, Tribal Nations, territories, and communities with the greatest need. These grant programs have long lists of approved-but-unfunded recipients.
Public health emergency response efforts are more expensive than regular funding for core public health infrastructure. Billions of dollars in investments before the COVID-19 pandemic could have resulted in trillions of dollars in savings—and more importantly, fewer lives lost—during the crisis. Prevention investments could also have reduced the underlying health inequities and high rates of chronic disease that made the nation more vulnerable to COVID-19, resulting in less disease, fewer deaths and lower costs.
Emergency funding, while critical, is often specifically targeted at emergency-specific activities, rather than long-term or cross-cutting needs. Health departments will face a funding cliff as COVID response funds expire, meaning they cannot retain or transition staff to full-time positions.
To address these concerns, TFAH’s report calls on Congress and state lawmakers to transition away from emergency-based funding for public health and prioritize annual, sustained investments:
Congress should approve at least $11 billion for CDC in FY2023 to begin to rebuild and modernize public health and grow successful prevention programs.
Congress should provide at least $4.5 billion per year for public health infrastructure and workforce investments at the State, Tribal, Local, and Territorial level. This could be done through mandatory or regular appropriations but must be sustained year-to-year.
Congress should build on and sustain recent investments in public health data modernization to provide real-time data for decision-making.
Congress should invest in the nation’s health security by strengthening public health emergency preparedness, improving the immunization infrastructure, grow efforts to address antimicrobial-resistant infections, and address the impacts of environmental threats heightened by climate change.
Congress should address health inequities and root causes of disease by investing in CDC’s Chronic Disease Center, including the new Social Determinants of Health program, age-friendly public health systems, and the Racial and Ethnic Approaches to Community Health and Healthy Tribes programs.
Congress should invest in primary prevention of behavioral health concerns through support for federal programs that prevent suicide and Adverse Childhood Experiences (ACEs), including CDC and SAMHSA programs that promote youth resiliency.
For the full report and recommendations, visit www.tfah.org.