“The US needs to ensure that the spending priorities and infrastructure of public health agencies are aligned with current health problems and emerging threats.”
—Y. Natalia Alfonso, Jonathon P. Leider, Beth Resnick, J. Mac McCullough, David Bishai
U.S. Public Health Neglected: Flat or Declining Spending Left States Ill Equipped to Respond to COVID-19
Journal Article Mar-25-2021 , , , , and 2-min read
Table of Contents
Table of Contents
Report Publish Date: March 25, 2021
This journal article describes a study of state spending on public health activities from 2008 to 2018.
Primary Takeaways
The authors found that public health spending was flat in most states and that the US saw rising rates of preventable deaths over the decade they studied. Overall, annual state public health spending per capita decreased from $80.40 in 2008 to $75.83 in 2018. States’ spending levels in each of the eight categories studied varied quite a bit. A poorly funded US public health system limits the ability of public health agencies to coordinate with each other and to mount the multisector responses necessary to stay ahead of complex public health threats, such as COVID-19.
Overview and Objectives
During the COVID-19 pandemic, observers were concerned about the U.S. public health system’s ability to protect Americans. Because states do most U.S. public health spending, the authors of this study wanted to see how state spending on public health had changed in the decade after the Great Recession.
Hypothesis or Approach
“We assessed total spending and spending for specific public health categories at the state level from 2008 to 2018, capturing state spending trends both during and after the Great Recession,” the authors write. They used data on state public health spending that is reported to the U.S. Census Bureau.
The researchers assessed eight categories of spending: maternal, child, and family health; capabilities; communicable disease control, environmental public health; chronic disease prevention; access and linkage to clinical care; injury prevention; and other public health.
How This Influences Change
“To achieve and maintain adequate public health protections and improve the nation’s health over the long term, sustainable funding and policy mechanisms to safeguard both state and federal investments in public health are needed,” the authors write.
Research: Go Deeper
The COVID-19 pandemic has prompted concern about the integrity of the US public health infrastructure. Federal, state, and local governments spend $93 billion annually on public health in the US, but most of this spending is at the state level. Thus, shoring up gaps in public health preparedness and response requires an understanding of state spending. We present state spending trends in eight categories of public health activity from 2008 through 2018. We obtained data from the Census Bureau for all states except California and coded the data by public health category. Although overall national health expenditures grew by 4.3 percent in this period, state governmental public health spending saw no statistically significant growth between 2008 and 2018 except in injury prevention. Moreover, state spending levels on public health were not restored after cuts experienced during the Great Recession, leaving states ill equipped to respond to COVID-19 and other emerging health needs.
Health Affairs, March 25, 2021.
https://doi.org/10.1377/hlthaff.2020.01084
Research Team
This study and report were conducted and created by the following people.
- Y. Natalia Alfonso
- Jonathon P. Leider
- Beth Resnick
- J. Mac McCullough
- David Bishai
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