Shortchanging America's Health

Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) today released a new report, Shortchanging America’s Health: A State-By-State Look at How Public Health Dollars Are Spent, which finds federal spending for public health has been flat for nearly five years, while states around the country cut nearly $392 million for public health programs in the past year, which leaves communities around the country struggling to deliver basic disease prevention and emergency health preparedness services.

States in the Midwest received the least federal funding support for disease prevention in public health, at only $16.50 per person in fiscal year (FY) 2009, according to the analysis. This is $3.30 less per person than the Northeastern states, which receive the highest amount, at $19.80 per person. Western states receive $19.22 per person, while Southern states receive $19.75 per person.

“Chronic under funding for public health means that millions of Americans are needlessly suffering from preventable diseases, health care costs have skyrocketed, and our workforce is not as healthy as it needs to be to compete with the rest of the world,” said Jeffrey Levi, PhD, Executive Director of TFAH. “If we are going to improve the health of Americans, we need to fundamentally rethink our approach to funding and managing public health and disease prevention in the United States.”

States are expected to cut budgets even more in the coming year, which will further limit the ability of public health departments to carry out services for:

  • Cancer, diabetes, obesity, and other chronic disease prevention;
  • HIV/AIDS, MRSA, TB, and other infectious disease prevention;
  • Food and water safety;
  • Environmental health improvement; and
  • Bioterrorism and health emergency preparedness.

Other key findings in the Shortchanging America’s Health report include that:

  • Federal funding to states from public health from the U.S. Centers for Disease Control and Prevention (CDC) averaged out to only $19.23 per person in FY2009. The amount spent to prevent disease and improve health in communities ranged significantly from state to state, with a per capita low of $13.33 in Virginia to a high of $58.65 in Alaska. Approximately 75 percent of CDC's budget is distributed through grants or cooperative agreements to states and communities to support programs to prevent diseases and prepare for health disasters.
  • State funding for public health ranged dramatically across the country, from a low of $3.55 per person in Nevada to a high of $169.92 per person in Hawaii. The national median is $28.92 per person. The structure of state and local health departments varies from state to state, with some states relying more on local funds.

“Public health departments are responsible for finding ways to address the systemic reasons why some communities are healthier than others and for developing policies and programs to remove obstacles that get in the way of making health choices possible,” Levi said. “But right now, public health departments do not have the resources they need to improve health in communities. Our ability to address the geographic and racial/ethnic disparities in health is limited by our failure to invest adequately in creating a modernized public health system.”

The full report includes state-by-state pages of key health statistics and funding information and is available on TFAH's Web site at and RWJF’s Web site at The report was supported by a grant from RWJF.

Rankings of State Budgets (Based on FY 2009)

1=Most funds; 50=Least funds. Funds are listed on a per person basis. The national median is $28.92 per person. The public health budget decreased from FY2008 to FY2009 when adjusted for inflation in states marked with an *.

1. Hawaii* ($169.92); 2. District of Columbia ($134.17); 3. West Virginia ($89.10); 4. Idaho ($80.19); 5. Vermont ($76.60); 6. Oklahoma ($74.41); 7. California* ($71.46); 8. New York ($68.83); 9. Massachusetts* ($66.13); 10. Alabama ($64.45); 11. New Mexico ($62.12); 12. Wyoming* ($60.42); 13. Delaware ($52.77); 14. Alaska* ($50.83); 15. Colorado ($49.53); 16. Rhode Island* ($48.88); 17. Kentucky ($46.37); 18. Tennessee* ($45.74); 19. Louisiana* ($42.80); 20. Virginia* ($38.73); 21. Nebraska ($38.03); 22. Maryland* ($37.05); 23. Washington* ($36.48); 24. New Jersey* ($32.38); 25. Utah* ($30.38); 26. South Dakota ($28.92); 27. Arkansas ($28.07); 28. Connecticut ($27.19); 29. Maine* ($25.78); 30. Florida* ($25.61); 31. South Carolina* ($24.52); 32. Illinois ($24.32); 33. Montana* ($23.69); 34. Iowa ($22.47); 35. New Hampshire* ($22.03); 36. Michigan ($21.99); 37. North Dakota ($21.05); 38. Georgia ($19.66); 39. Pennsylvania* ($19.64); 40. Kansas* ($16.66); 41. Oregon ($16.06); 42. Texas ($15.83); 43. Minnesota* ($14.66); 44. North Carolina* ($14.13); 45. Ohio* ($13.84); 46. Arizona* ($12.78); 47. Indiana* ($12.64); 48. Mississippi* ($10.53); 49. Wisconsin* ($10.23); 50. Missouri ($9.26); 51. Nevada ($3.55).

Rankings of CDC Funds for States (Based on FY 2009)

1=Most funds; 50=Least funds. Funds are listed on a per person basis. The national average CDC funding is $19.23 per person.

1. Alaska ($58.65); 2. Vermont ($36.98); 3. Wyoming ($35.35); 4. Rhode Island ($32.79); 5. New Mexico ($30.51); 6. North Dakota ($30.37); 7. South Dakota ($30.16); 8. Delaware ($27.26); 9. Hawaii ($26.78); 10. Montana ($26.60); 11. Louisiana ($25.62); 12. Maryland ($24.65); 13. Idaho ($24.00); 14. West Virginia ($23.66); 15. Maine ($23.43); 16. New Hampshire ($23.37); 17. (tie) Arkansas ($23.30); 17. (tie) Mississippi ($23.30); 19. New York ($22.21); 20. Washington ($21.79); 21. Nebraska ($21.38); 22. Texas ($21.28); 23. Massachusetts ($20.97); 24. South Carolina ($20.91); 25. Oklahoma ($20.86); 26. North Carolina ($20.48); 27. Connecticut ($19.98); 28. Colorado ($19.59); 29. Georgia ($19.32); 30. Alabama ($19.01); 31. Nevada ($18.73); 32. Arizona ($18.59); 33. Illinois ($18.29); 34. Utah ($18.19); 35. Oregon ($17.92); 36. Iowa ($17.78); 37. Kansas ($17.38); 38. Florida ($17.27); 39. California ($16.81); 40. New Jersey ($16.67); 41. Minnesota ($16.50); 42. Tennessee ($16.41); 43. Missouri ($16.25); 44. Wisconsin ($15.98); 45. Michigan ($15.97); 46. Kentucky ($15.57); 47. Pennsylvania ($14.86); 48. Indiana ($14.25); 49. Ohio ($13.52); 50. Virginia ($13.33). D.C. was not included in the per capita rankings because total funding for D.C. include funds for a number of national organizations.

* Regions are based on the U.S. Census Bureau definitions. Midwestern states include: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. Northeastern states include: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. Western states include: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. Southern states include: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.

Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

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 quality of 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 35 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.