Public health is in trouble.
Last month, President Trump released his proposed budget for fiscal year 2018. It was more of an outline, really, and didn’t provide many details, but it did call for a nearly 18 percent cut to the U.S. Department of Health and Human Services and for block granting the budget at the Centers for Disease Control and Prevention. At the same time, the White House supports repealing the Affordable Care Act. That repeal would also eliminate the Prevention and Public Health Fund, which now accounts for about 12 percent of CDC’s budget and funds critical public health activities, such as laboratory and epidemiology capacity as well as immunization efforts.
Sure, presidential budget proposals don’t get enacted as is — Congress is surely readying for an epic budget fight — but let’s be clear: the kinds of combined cuts supported by the White House would devastate public health.
And a new report from the Trust for America’s Health (TFAH) illustrates just how serious the situation is. Released yesterday, “A Funding Crisis for Public Health and Safety: State-by-State Public Health Funding and Key Health Facts, 2017” reports that funding for CDC’s core budget has decreased by more than $580 million since 2010. Much of those funds — about 75 percent — are redistributed to state and local public health. However, state appropriators haven’t stepped up to the federal funding gap either. Since 2010, TFAH reported, state public health spending has remained pretty much static.
The report also noted that federal Public Health Emergency Preparedness funds for states and localities have already been cut by more than one-third per year since the program began after the Sept. 11 terrorist attacks. In that time, public health did receive one-time, emergency funds to combat Ebola and Zika. But one-time funding isn’t enough considering the complexity required to detect, investigate, contain and monitor varying dangerous disease threats on a continuous basis. (And, yes, there will always be another dangerous disease threat. The report noted that every year for the last three decades, one new contagious disease has emerged on average. If you can’t remember many beyond Zika and Ebola, that’s because public health workers contained the threat before it impacted your life.)
Here’s how the TFAH report begins:
Despite the $3.36 trillion spent annually on healthcare, it has not translated into better health for the country. Today, only 3 percent of all health spending is directed to public health, which includes federal, state and local resources. That equates to an average of around $255 per person. By contrast, total healthcare spending per person is $10,345 per person.
Investing in public health is one of the most common sense and effective ways to improve the health of Americans and bring down healthcare costs. A national survey of registered voters found that nearly three-quarters (73 percent) of Americans support increasing investments to improve the health of communities.
Insufficient funding has hampered the ability of the Centers for Disease Control and Prevention and state and local health departments to keep pace with modern advancements in technology, approaches and systems — contributing to health epidemics and adding avoidable healthcare costs.
Here’s the thing — if you want to reduce the cost of health care and get healthier at the same time, invest in public health. At its very core, public health is laser-focused on the prevention of disease, injury and premature death. The field’s practitioners know how to prevent disease and injury and they know how to get results. But perhaps even more importantly, the everyday, routine work of public health — protecting us from dangerous diseases and ensuring safe food, water, air and housing — make up the very foundations from which we all go about our daily lives.
Cutting public health funding doesn’t save money in the long run. Allowing our public health systems to slowly erode will only cause more preventable illness, suffering, disability and death. And it will come with a hefty financial and emotional price tag for us all.
Download the new TFAH report here to learn more about the funding crisis as well as the positive ROI on public health funding.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.
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