On the Bookshelf — The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2022

Trust for America’s Health, a nonprofit, nonpartisan entity focused on public health, recently released a report related to public health funding. Titled “The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2022,” the report summarized federal, state and local funding trends; described implications of the current approach to funding; and recommended policy actions.

While the themes of the report were generally negative, pointing to underfunded and ill-prepared public health systems, bright spots included a large increase in annual funding for public health infrastructure and capacity for the CDC as well as about $50 million for updating data systems. These funds, together with pandemic relief funding, will allow for overhauling data systems to improve data sharing across medical systems and public health entities. The CDC is also investing in disease modeling and forecasting capacity. Similar to weather forecasts, the newly established Center for Epidemic Forecasting and Outbreak Analytics will bring together experts in the areas of data generation, disease modeling and communications to better position the U.S. to anticipate future public health emergencies.

Likewise, the CDC will competitively fund $3.9 billion to state and territorial health departments to expand their size and workforce, improve systems and processes, update data systems and increase services.

However, despite these bright spots, the report pointed to ongoing decreases in critical federal funding meant to trickle down to state and local health departments. In describing the consequences, the report stated, “Understaffed health departments were in some cases using 20th-century tools, such as telephones and fax machines,^45,46 to respond to a 21st-century pandemic” (p. 14). Underscoring their importance, the authors pointed out that these funds are not just aimed at protecting against infectious diseases but also weather-related emergencies, environmental disasters and human-made disasters, like terrorism. Underfunding of existing programs, community programming, chronic disease prevention, substance misuse programming and suicide prevention were also described as areas that remain of concern.

The report also described state and local funding and presented a series of policy-based recommendations, in the areas of:

• Core funding for the public health infrastructure and workforce
• Investing in health security
• Addressing health inequities and root causes of disease
• Improving health across the lifespan

Find out more or download the complete report.