The chronic lack of investment in the nation’s public health puts American lives and livelihoods at risk

PR Newswire

WASHINGTON, July 28, 2022

Emergency funding for COVID-19 was critical to the initial response, but did not address the nation’s longstanding underinvestment in public health; 4.5 billion dollars annual funding is required

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

Trust for America’s Health logo. (PRNewsFoto/America’s Health Trust)

“Emergency funding is important, but not enough to fill long-standing gaps in public health investment.” The boom and bust cycle of public health funding means the system does not have the tools or the 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 financing and recommends investments and policy actions to build a stronger public health system, prioritize prevention, and address the ways in which social and economic inequities create barriers to wellness health in many communities.

A lack of funding in essential public health programs has slowed the response to the COVID-19 pandemic and exacerbated its impact, particularly in low-income communities, communities of color, and for older Americans—populations experiencing higher rates of chronic disease and have fewer resources to recover from an emergency. TFAH is one of many organizations in the public health community calling for an annual 4.5 billion dollars investments in public health infrastructure at the state, local, tribal, and territorial levels.

“As we move through 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 health promotion and prevention programs, and reduce disparities in healthcare. Investments in public health are needed in every community, but should be targeted specifically at those communities that, due to the impact of structural racism, poverty, systemic discrimination and disinvestment, are most at risk during a health emergency. healthcare,” said Dr. Gracia.

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

State and local public health agencies navigated two different 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 one-off and often specifically related to COVID-19. Most of these cannot be used to address long-standing deficits in the public health system, including ensuring the delivery of essential public health services, replacing outdated data systems, and increasing the public health workforce. Ann October 2021 an analysis conducted by the de Beaumont Foundation and the National Center for Public Health Innovation found that state and local health departments need an 80 percent increase in the size of their workforce to be able to provide comprehensive public health services to their communities.

Another challenge for state and local health departments is that emergency response funding, while critical during an emergency, is too late to build prevention and preparedness programs, programs that need to be put in place before emergency if they want to protect life. To be adequately prepared for the next public health emergency, the nation 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 US Centers for Disease Control and Prevention (CDC) is the nation’s lead public health agency and the primary source of funding for state, local, tribal, and territorial health departments. CDC’s annual funding for Public Health Emergency Preparedness (PHEP) programs increased slightly between FY 2021 and FY 2022 from 840 million dollars to 862 million dollarsbut it is down by just over a fifth from FY 2002, or roughly halved when adjusted for inflation.

  • The Hospital Preparedness Program, administered by the Department of Health and Human Services under the Office of the Assistant Secretary for Preparedness and Response, is the primary source of federal funding to help health systems prepare for emergencies. Over the past two decades, it has fallen by nearly two-thirds, adjusted for inflation.

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

As a nation we spend $4.1 trillion for health care in 2020, but only 5.4 percent of that spending is directed toward 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 woefully short and likely to return to pre-pandemic levels if the historical pattern of increasing funding for public health during an emergency, but neglecting it at other times resumes. Underfunding means that effective public health programs, such as those to prevent suicide, obesity and environmental health threats, reach only a small fraction of states. This long-standing neglect contributes to high rates of chronic disease and persistent health inequalities.

“We must break the pattern of investing in the public health system only during an emergency, which undermines the power of preparedness and prevention. Investing in public health and health equity on an ongoing basis, including in non-emergencies, will save lives and help reduce the economic costs to our nation 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 that every community has access to healthy food, safe housing, health care, transportation, education, and employment—all factors that impact impact on people’s health.

Recommendations for policy action

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

Significant increase in core funding to strengthen public health infrastructure and increase the public health workforce, including increasing CDC base funds and modernizing the nation’s public health data and disease surveillance systems.

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

Focus on health disparities and their impact on the root causes of disease by targeting the social determinants of health that have an outsized impact on health outcomes.

Protecting and improving health throughout life. Many programs that promote health and prevent the leading causes of disease, disability and death have long been neglected and do not reach all countries or the populations most at risk. Restoring programs that halt chronic disease, support children and families, and prevent substance abuse and suicide must be a top priority.

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

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

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SOURCE America’s Health Trust

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