Reports

Investing in America's Health: A State-by-state Look at Public Health Funding & Key Health Facts

May 2014

Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) released Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts. This is the ninth time the report has been released.  

In Investing, TFAH and RWJF examine public health funding and key health facts for each state, finding:

  • Wide Variation in Health Statistics by State:  There are major differences in disease rates and other health factors in states around the country.  For instance, only 7.0 percent of adults in Alaska have diabetes compared to 13.0 percent in West Virginia, and 28.3 percent of adults in Kentucky are current smokers while only 10.6 percent report smoking in Utah.
  • Cuts in State and Local Funding:  At the state and local levels, public health budgets have been cut at drastic rates in recent years.  According to a TFAH analysis, 33 states and Washington, D.C. decreased their public health budgets from FY 2011-12 to FY 2012-13.  Budgets in 20 states decreased for two or more years in a row, and budgets in 16 states decreased for three or more years in a row. 
  • In FY 2012-13, the median state funding for public health was $27.49 per person, ranging from a high of $144.99 in Hawaii to a low of $5.86 in Missouri.  From FY 2008 to FY 2013, the median per capita state spending decreased from $33.71 to $27.49.  This represents a cut of more than $1.3 billion (adjusted for inflation).
  • Flat Federal Funding:  Federal funding for public health has remained at a relatively flat level for years.  The budget for CDC has decreased from a high of $7.07 billion in 2005 to $5.98 billion in FY 2013 (adjusted for inflation). Spending through CDC averaged to only $18.92 per person in FY 2013.  And the amount of federal funding spent to prevent disease and improve health in communities ranged significantly from state to state, with a per capita low of $13.67 in Indiana to a high of $46.48 in Alaska. 

Overall, the report concludes that the nation must shore up core ongoing funds for public health. In addition, the report recommends ensuring the Prevention and Public Health Fund is used to build upon and expand— not supplant – existing efforts.  Specifically, the report recommends that:

  • Core funding for public health — at the federal, state and local levels — be increased;
  • Funding be considered strategically — so funds are used efficiently to maximize effectiveness in lowering disease rates and improving health; 
  • In addition to reducing rates of chronic disease, the Prevention Fund be targeted to help modernize the nation’s approach to public health;
  • Accountability must be at the cornerstone of public health funding — the use of funds should be transparent and clearly communicated with the public; and
  • All Americans should be protected by a set of foundational public health capabilities and services no matter where they live. For this to be accomplished, these capabilities must be fully funded, and funding should be tied to achieving and maintaining these capabilities. The public deserves to know how effectively their tax dollars are being used, and accreditation, continuous quality improvement and transparency are important ways to help demonstrate that these capabilities are being met. The U.S. Department of Health and Human Services’ Advisory Group on Prevention has recommended that “federal funds be made available to help state and local health departments to build the foundational capabilities that are needed to support accreditation and a response to 21st century health challenges.” Federal resources such as those available through the Preventive Services Block Grant, which was doubled in the FY 2014 appropriations, could provide the Program an opportunity to address these needs.