1932

Abstract

The financing of public health systems and services relies on a complex and fragmented web of partners and funding priorities. Both underfunding and “dys-funding” contribute to preventable mortality, increases in disease frequency and severity, and hindered social and economic growth. These issues were both illuminated and magnified by the COVID-19 pandemic and associated responses. Further complicating issues is the difficulty in constructing adequate estimates of current public health resources and necessary resources. Each of these challenges inhibits the delivery of necessary services, leads to inequitable access and resourcing, contributes to resource volatility, and presents other deleterious outcomes. However, actions may be taken to defragment complex funding paradigms toward more flexible spending, to modernize and standardize data systems, and to assure equitable and sustainable public health investments.

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2024-05-20
2024-05-21
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Literature Cited

  1. 1.
    ASTHO (Assoc. State Territ. Health Off.). 2023.. Profile of state and territorial public health. . Association of State and Territorial Health Officials. https://www.astho.org/topic/public-health-infrastructure/profile/
    [Google Scholar]
  2. 2.
    ASTHO (Assoc. State Territ. Health Off.), NORC Univ. Chicago. 2012.. State public health agency classification: understanding the relationship between state and local public health. Rep. , ASTHO, NORC Univ. Chicago, Chicago:. https://www.norc.org/content/dam/norc-org/pdfs/ASTHO%20NORC%20Governance%20Classification%20Report.pdf
  3. 3.
    Bekemeier B, Singh SR, Schoemann AW. 2018.. A uniform chart of accounts for public health agencies: an “essential ingredient” for a strong public health system. . J. Public Health Manag. Pract. 24::28991
    [Crossref] [Google Scholar]
  4. 4.
    Bradley EH, Canavan M, Rogan E, Talbert-Slagle K, Ndumele C, et al. 2016.. Variation in health outcomes: the role of spending on social services, public health, and health care, 2000–09. . Health Aff. 35::76068
    [Crossref] [Google Scholar]
  5. 5.
    Brownson RC, Burke TA, Colditz GA, Samet JM. 2020.. Reimagining public health in the aftermath of a pandemic. . Am. J. Public Health 110::160510
    [Crossref] [Google Scholar]
  6. 6.
    Castrucci BC, Valdes Lupi M. 2020.. When we need them most, the number of public health workers continues to decline. . de Beaumont Foundation Blog, May 19. https://debeaumont.org/news/2020/when-we-need-them-most-the-number-of-public-health-workers-continues-to-decline
    [Google Scholar]
  7. 7.
    Cave D. 2022.. How Australia saved thousands of lives while Covid killed a million Americans. . New York Times, May 15. https://www.nytimes.com/2022/05/15/world/australia/covid-deaths.html
    [Google Scholar]
  8. 8.
    CDC (Cent. Dis. Control Prev.). 2021.. Funding by recipient previous fiscal year allocations. . Preventive Health and Health Services (PHHS) Block Grant Program. https://www.cdc.gov/phhsblockgrant/allocation/archive.htm
    [Google Scholar]
  9. 9.
    CDC (Cent. Dis. Control Prev.). 2021.. Funding by topic area. . Preventive Health and Health Services (PHHS) Block Grant Program. https://www.cdc.gov/phhsblockgrant/funding/index.htm
    [Google Scholar]
  10. 10.
    CDC (Cent. Dis. Control Prev.). 2022.. Funding by recipient. . Preventive Health and Health Services (PHHS) Block Grant Program. https://www.cdc.gov/phhsblockgrant/allocation/index.htm
    [Google Scholar]
  11. 11.
    CDC (Cent. Dis. Control Prev.). 2022.. Health department governance. . Public Health Professionals Gateway. https://www.cdc.gov/publichealthgateway/sitesgovernance/index.html
    [Google Scholar]
  12. 12.
    CDC (Cent. Dis. Control Prev.). 2023.. Emergency preparedness funding. . Office of Readiness Response. https://www.cdc.gov/orr/epf/index.htm
    [Google Scholar]
  13. [Google Scholar]
  14. 14.
    Comm. Assur. Health Public 21st Century, Inst. Med. 2003.. The Future of the Public's Health in the 21st Century. Washington, DC:: Natl. Acad. Press. https://doi.org/10.17226/10548
  15. 15.
    Comm. Public Health Strateg. Improve Health, Inst. Med. Natl. Acad. 2012.. For the Public's Health: Investing in a Healthier Future. Washington, DC:: Natl. Acad. Press. https://doi.org/10.17226/13268
  16. 16.
    Comm. Study Future Public Health, Inst. Med. 1988.. The Future of Public Health. Washington, DC:: Natl. Acad. Press. https://doi.org/10.17226/1091
  17. 17.
    de Beaumont Found. 2021.. Adapting and aligning public health strategic skills. Rep. , de Beaumont Found., Bethesda, MD:
  18. 18.
    Deliso M. 2021.. COVID-19 vaccines rescued by boat amid severe flooding in Kentucky. . ABC News, March 2. https://abcnews.go.com/US/covid-19-vaccines-rescued-boat-amid-severe-flooding/story?id=76209316
    [Google Scholar]
  19. 19.
    DeSalvo K, Parekh A, Hoagland GW, Dilley A, Kaiman S, et al. 2019.. Developing a financing system to support public health infrastructure. . Am. J. Public Health 109::135861
    [Crossref] [Google Scholar]
  20. 20.
    DeSalvo KB, Wang YC, Harris A, Auerbach J, Koo D, O'Carroll P. 2017.. Public health 3.0: a call to action for public health to meet the challenges of the 21st century. . Prev. Chronic Dis. 14::E78
    [Crossref] [Google Scholar]
  21. 21.
    Donnellan J. 2023.. New coalition formed to modernize and advance the U.S. public health system. Bipartis. Policy Cent. News Release, Sept. 25. https://bipartisanpolicy.org/press-release/new-coalition-formed-to-modernize-and-advance-the-u-s-public-health-system/
  22. 22.
    Elliott NS, Arrieta A, Page TF. 2023.. The impact of public health funding on population health outcomes. . Popul. Health Manag. 26::8391
    [Crossref] [Google Scholar]
  23. 23.
    Galewitz P, Weber L, Whitehead S. 2022.. States have yet to spend hundreds of millions of federal dollars to tackle Covid health disparities. . KFF Health News, May 16. https://khn.org/news/article/covid-health-disparities-federal-funding-state-spending/
    [Google Scholar]
  24. 24.
    Hearld LR, Tafili A, Kelly RJ. 2023.. Patterns and trends in local health departments' efforts to promote access to care in local communities throughout the United States: the contributions of governance structures. . Int. J. Health. Plan. Manag. 38::128499
    [Crossref] [Google Scholar]
  25. 25.
    Himmelstein DU, Woolhandler S. 2016.. Public health's falling share of US health spending. . Am. J. Public Health 106::5657
    [Crossref] [Google Scholar]
  26. 26.
    Honore PA, Zometa C, Thomas C, Edmiston A. 2019.. The Public Health Uniform National Data System (PHUND$): a platform for monitoring fiscal health and sustainability of the public health system. . J. Public Health Manag. Pract. 25::36672
    [Crossref] [Google Scholar]
  27. 27.
    Hsuan C, Rodriguez HP. 2014.. The adoption and discontinuation of clinical services by local health departments. . Am. J. Public Health 104::12433
    [Crossref] [Google Scholar]
  28. 28.
    Intern. Revenue Serv. 2023.. Requirements for 501(c)(3) hospitals under the Affordable Care Act—Section 501(r). . Internal Revenue Service. https://www.irs.gov/charities-non-profits/charitable-organizations/requirements-for-501c3-hospitals-under-the-affordable-care-act-section-501r
    [Google Scholar]
  29. 29.
    Katz R, Attal-Juncqua A, Fischer JE. 2017.. Funding public health emergency preparedness in the United States. . Am. J. Public Health 107::S14852
    [Crossref] [Google Scholar]
  30. 30.
    Leider JP. 2020.. New workforce estimates show public health never recovered from the Great Recession. Then came COVID-19. . JPHMP Direct, May 20. https://jphmpdirect.com/2020/05/20/new-workforce-estimates-show-public-health-never-recovered-from-the-great-recession-then-came-covid-19/
    [Google Scholar]
  31. 31.
    Leider JP, Resnick B, Bishai D, Scutchfield FD. 2018.. How much do we spend? Creating historical estimates of public health expenditures in the United States at the federal, state, and local levels. . Annu. Rev. Public Health 39::47187
    [Crossref] [Google Scholar]
  32. 32.
    Leider JP, Resnick B, McCullough JM, Alfonso YN, Bishai D. 2020.. Inaccuracy of official estimates of public health spending in the United States, 2000–2018. . Am. J. Public Health 110::S19496
    [Crossref] [Google Scholar]
  33. 33.
    Leider JP, Resnick BA, Sensenig AL, Alfonso N, Brady E, et al. 2016.. Assessing the public health activity estimate from the national health expenditure accounts: why public health expenditure definitions matter. . J. Health Care Finance 43::22640
    [Google Scholar]
  34. 34.
    Mamaril CB, Mays GP. 2014.. Cost estimates of foundational public health capabilities: pilot test results of an expert consensus methodology in Kentucky. . Health Manag. Policy Present. https://uknowledge.uky.edu/hsm_present/79
    [Google Scholar]
  35. 35.
    Masters R, Anwar E, Collins B, Cookson R, Capewell S. 2017.. Return on investment of public health interventions: a systematic review. . J. Epidemiol. Commun. Health 71::82734
    [Crossref] [Google Scholar]
  36. 36.
    Mays GP, Smith SA. 2009.. Geographic variation in public health spending: correlates and consequences. . Health Serv. Res. 44::1796817
    [Crossref] [Google Scholar]
  37. 37.
    McCullough JM, Leider JP. 2016.. Government spending in health and nonhealth sectors associated with improvement in county health rankings. . Health Aff. 35::203743
    [Crossref] [Google Scholar]
  38. 38.
    McCullough JM, Leider JP. 2019.. The importance of health and social services spending to health outcomes in Texas, 2010–2016. . South. Med. J. 112::9197
    [Crossref] [Google Scholar]
  39. 39.
    McCullough JM, Leider JP, Riley WJ. 2015.. Local fiscal allocation for public health departments. . Am. J. Prev. Med. 49::92129
    [Crossref] [Google Scholar]
  40. 40.
    McCullough JM, Robins M. 2023.. The opportunity cost of COVID for public health practice: COVID-19 pandemic response work and lost foundational areas of public health work. . J. Public Health Manag. Pract. 29::S6472
    [Crossref] [Google Scholar]
  41. 41.
    McCullough JM, Singh SR, Leider JP. 2019.. The importance of governmental and nongovernmental investments in public health and social services for improving community health outcomes. . J. Public Health Manag. Pract. 25::34856
    [Crossref] [Google Scholar]
  42. 42.
    McKillop M, Farberman RK, Lieberman DA. 2023.. Ready or not: protecting the public's health from diseases, disasters, and bioterrorism. Rep. , Trust for America's Health, Washington, DC:. https://www.tfah.org/wp-content/uploads/2023/03/2023-ReadyOrNot-FINALc.pdf
  43. 43.
    McKillop M, Lieberman DA. 2021.. The impact of chronic underfunding on America's public health system: trends, risks, and recommendations, 2021. Rep. , Trust for America's Health, Washington, DC:. https://www.tfah.org/wp-content/uploads/2021/05/2021_PHFunding_Fnl.pdf
  44. 44.
    Melton-Fant CE. 2023.. Heterogenous effects of local government spending on mortality across racial groups among working-age adults in the U.S. . AJPM Focus 2::100085
    [Crossref] [Google Scholar]
  45. 45.
    Mueller B, Lutz E. 2022.. U.S. has far higher Covid death rate than other wealthy countries. . New York Times, Feb. 1. https://www.nytimes.com/interactive/2022/02/01/science/covid-deaths-united-states.html
    [Google Scholar]
  46. 46.
    NACCHO (Natl. Assoc. County City Health Off.). 2020.. 2019 national profile of local health departments. Rep. , NACCHO, Washington, DC:. https://www.naccho.org/uploads/downloadable-resources/Programs/Public-Health-Infrastructure/NACCHO_2019_Profile_final.pdf
  47. 47.
    Natl. Netw. Public Health Inst. 2021.. Challenges and opportunities for strengthening the US public health infrastructure: findings from the scan of the literature. Rep. , Natl. Netw. Public Health Inst., Washington, DC:. https://nnphi.org/wp-content/uploads/2021/06/NNPHI-E2A-Kresge-Report-Web.pdf
  48. 48.
    Orr JM, Leider JP, Singh S, Balio CP, Yeager VA, et al. 2022.. Regarding investment in a healthier future: impact of the 2012 Institute of Medicine Finance report. . J. Public Health Manag. Pract. 28::E31623
    [Crossref] [Google Scholar]
  49. 49.
    Resnick BA, Fisher JS, Colrick IP, Leider JP. 2017.. The Foundational Public Health Services as a framework for estimating spending. . Am. J. Prev. Med. 53::64651
    [Crossref] [Google Scholar]
  50. 50.
    Simpson L, Cope E, Khan M, Froeb K, Weinberg S. 2023.. Ensuring an evidence-based approach to [re]building the public health system. . AcademyHealth, Sept. 25. https://academyhealth.org/about/programs/ensuring-evidence-based-approach-rebuilding-public-health-system
    [Google Scholar]
  51. 51.
    Singh SR, Bekemeier B, Leider JP. 2020.. Local health departments’ spending on the foundational capabilities. . J. Public Health Manag. Pract. 26::5256
    [Crossref] [Google Scholar]
  52. 52.
    Singh SR, McCullough JM. 2022.. Exploring the relationship between local governmental spending on the social determinants of health and health care costs of privately insured adults. . Popul. Health Manag. 25::19298
    [Crossref] [Google Scholar]
  53. 53.
    Vilda D, Walker BC, Hardeman RR, Wallace ME. 2023.. Associations between state and local government spending and pregnancy-related mortality in the U.S. . Am. J. Prev. Med. 64::45967
    [Crossref] [Google Scholar]
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