Chronic underfunding of America's public health system significantly undermines the nation's ability to meet routine health needs and respond to emerging public health threats, according to commentary by Sen. Ted Kennedy in a special March/April issue of the Journal of Public Health Management and Practice (JPHMP). The failure of the federal government to provide adequate support for public health infrastructure forces local and state public health agencies to take on new responsibilities, such as combating bioterrorism and pandemics, while continuing to provide essential public health services, all with fewer resources.
Sen. Kennedy's commentary is one of many articles in the JPHMP special issue that opens a groundbreaking dialogue on how public health finance affects public health practice and preparedness. Responding to the desire of policymakers and key stakeholders for more information about how America's public health system is financed and how funds are managed, this issue of the JPHMP takes a major step toward building a field of study in public health finance and advancing public health systems research. The insights and analyses of prominent public health officials, researchers, and practitioners provide strong evidence for pursuing innovative funding mechanisms to strengthen the country's public health system.
According to Peggy Honoré, chief science officer at the Mississippi Department of Health, and guest editor of this special issue, "There is a pressing need for public health financing to emerge as a distinct discipline. We need to understand how financing and resource allocation shape the ability of the public health system to protect us from emerging health threats and address the persistent disparities that affect millions of Americans."
This view is echoed by Garth Graham, assistant deputy secretary of minority health at the U.S. Department of Health and Human Services, who writes, "If we are going to make real progress in eliminating health disparities, understanding this multidimensional problem will require a multidisciplinary approach. Public health systems research provides strong evidence for understanding the structural and financial components of an effective strategy."
This special issue of the JPHMP, dedicated to public health financing topics, was released at a first-of-its-kind meeting of local, state, and national public health leaders; distinguished health services researchers; representatives from foundations and nonprofits; and members of the media in Washington, D.C., on February 13 and 14.
The special journal issue was made possible by a grant from the Robert Wood Johnson Foundation (RWJF), one of several RWJF-funded initiatives the Foundation has undertaken to help build the field of Public Health Systems Research.
"We need to better understand the demands placed on public health agencies, the services they provide, and the funding needed to support these activities, so that we can identify gaps and facilitate better allocation of public health resources," said RWJF senior program officer, Debra Perez. "We are pleased to support this special journal issue and the important work of the researchers. We look forward to their continued contributions to the field of public health."
Among the topics addressed by contributors to this issue of the JPHMP:
- Peggy Honoré and Dr. Brian Amy of the Mississippi Department of Public Health outline how theories and concepts from related fields are applied to the practice of public health and used to advance the public health finance agenda;
- Sen. Edward Kennedy identifies the benefits of a strong public health system and how inadequate support continues to undermine the ability to meet needs, reduce disparities, and respond to emergencies;
- Dr. Garth Graham, deputy director of the Office of Minority Health, U.S. Department of Health and Human Services, makes a compelling case for public health systems research as an approach to understanding structural and financial components of disparity reduction and system strengthening strategies;
- Dr. Kevin Stephens, director, City of New Orleans Health Department, provides an overview of the financial impact of Hurricane Katrina on the City of New Orleans Health Department and implications for future funding mechanisms;
- Jeffery Levi, executive director, Trust for America's Health, and his fellow investigators examine state and local budgeting patterns in order to document financing trends at the federal and state levels;
- Dr. James Buehler of Emory University, and David Holtgrave of Johns Hopkins University propose a framework for identifying funding opportunities based on current federal allocation strategies; and
- Carolyn Bourdeaux of Georgia State University and Jason Fernandes of the Georgia State Senate Budget and Evaluation Office use the State of Georgia health budget as a case study to show how the breakdown of appropriation dollars may conflict with established public health frameworks such as the 10 Essential Services.
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.