Reports

Shortchanging America's Health 2006

A State-by-State Look at How Federal Public Health Dollars are Spent

June 2006

Trust for America's Health (TFAH) released a study in June 2006 that finds the amount of federal funds states receive for disease prevention and bioterrorism preparedness ranges by more than $40 per person. Alaska receives more than any other state in federal funds on a per person basis from the Centers for Disease Control and Prevention (CDC) at $53.36. Florida receives the least at $11.38 per person. The national average is $20.99 per capita. The report also examines state spending for public health programs, finding the national average for state funding is $35 per person, ranging from $123 per person in Hawaii to $3.76 in Nevada.

TFAH estimates it would require an additional annual investment of a minimum of $2.6 billion from federal and state governments to address this disparity among states.

The new analysis, entitled "Shortchanging America's Health: A State-By-State Look at How Federal Public Health Dollars Are Spent - 2006," reviews key health statistics and key federal public health funding at a state-by-state level. The report finds funding levels for programs intended to protect the health of U.S. citizens vary dramatically among states. The study emphasizes that the country is falling short on achieving federally established goals for reducing disease and improving health, and there has not been sufficient funding to result in wide-scale change.

"Americans deserve and should expect basic health protections, no matter where they live," said Jeff Levi, PhD, Executive Director of TFAH. "Disease rates are all over the map, and we aren't systematically connecting the funding with the needs and priorities. We need to start spending smarter."

A subcommittee of the U.S. House of Representatives Committee on Appropriations met last week to consider funding levels for the CDC and other health programs as it marked up the Labor, Health and Human Services, Education, and Related Agencies bill. Despite the subcommittee's restoration of funding for some of the deep cuts proposed in the President's Fiscal Year 2007 budget request, core discretionary programs at the CDC are still slated for cuts of nearly $200 million. This leaves most health prevention and promotion programs with level funding, while others still received large cuts in the bill. Bioterrorism hospital grants would be cut by over $8 million, while rural health programs would drop by $61 million. The full House Appropriations Committee is expected to meet next week to finalize the bill.

Approximately 80 percent of the funding for the CDC, the federal agency devoted to disease prevention and control, is distributed to state and local health agencies through grant programs. The distribution of the grant funds are either based on formulas, such as the population of the state, or through competitive processes where states apply for limited funds. Often, CDC programs do not receive sufficient Congressional appropriations to fund all of the qualified states that apply.

Among some of the key health indicators in the report, adult diabetes rates are found to range from 4.1 percent in Alaska to 10.9 percent in West Virginia; adult asthma rates vary from a low of 10.3 percent in South Dakota to 16.2 percent in Oregon; and adult hypertension rates range from 18.8 percent in Utah to 33.6 percent in West Virginia. The report helps demonstrate how federal funding generally is not based on disease levels or needs.

Some of the programs in the state-level federal funding totals for public health programs include cancer prevention, chronic disease prevention, diabetes control, environmental health, HIV prevention, immunizations, infectious diseases, bioterrorism preparedness (states and hospitals), health professions grants, the Ryan White 2003 AIDS CARE Act, and the Maternal and Child Health Block Grant.