STIMULUS A "DOWN PAYMENT" FOR WHAT STATES CAN DO

Volume 30, Issue 535                                         March 16, 2009

Katherine Rogers

State and local health officials applauded the inclusion of significant public health spending in the stimulus bill signed by President Obama last month, which included $650 million for community prevention programs and another $500 million for bolstering the health and public health workforce.  However, a new report suggests that prevention and public health programs remain in danger and suggests ways for states to create long-term funding streams. 

The report, released March 9 by the Trust for America's Health (TFAH), reports that in recent years, significant cuts in federal public health spending may have weakened states' ability to prevent outbreaks, curb chronic illness and limit the growth of health spending.

The report notes that an estimated 11,000 public health jobs have already been lost, a number that may continue to grow. Another TFAH report released in December found federal funding to states for state and local preparedness has fallen 25 percent since 2005. 

Significant Returns

Most health-care experts agree that public health spending may deliver a significant return by preventing costly illnesses and outbreaks.  "Even in these troubled times, prevention is an investment we can count on to deliver a big payoff—sparing millions of people from developing preventable diseases while saving billions in health care costs," said Risa Lavizzo-Mourey, president and CEO of The Robert Wood Johnson Foundation, which funded the TFAH study.

Public health spending, however, has traditionally been dwarfed by health-care expenditures, which averaged about $3,500 per capita in 2006, according to the Centers for Disease Control and Prevention (CDC). "Even in better economic times, the country's investment in keeping the public healthy and safe is a tiny fraction of what we spend on treating people after they've become sick," said Jeff Levi, executive director of TFAH.

The report examines federal and state funding of traditional public health programs, as well as some key health indicators, and finds wide variations in all. CDC grants—awarded both through a competitive application process and based on states' needs—ranged in 2008 from $12.74 per capita in Indiana, to $52.78 per capita in Alaska, a $40 difference (see map below).  Midwestern and southern states collected the fewest federal public health dollars, with Midwestern states receiving $15.40 on average, about $2 less per capita than the national average.
Data from Shortchanging America's Health: A State-by-State Look at How Federal Public Health Dollars Are Spent, Trust for America's Health, 2009.

In 2008, states spent a median $33.71 per person for public health; state expenditures ranged widely, from $3.37 in Nevada to $172.21 in Hawaii (in state-only spending). The report notes that each state allocates and reports its budget in a different way, so comparisons are difficult.

As for health indicators, an examination of state data found that adult obesity rates ranged from a low of 18.4 percent in Colorado to a high of 31.7 percent in Mississippi, and rages of uninsured adults varied from a low of 5.4 percent in Massachusetts to a high of 25.2 percent in Texas.

A role for states

States play a significant role in public health.  Among many other tasks, they are responsible for monitoring and investigating emerging health issues, informing the public about health, enforcing state health laws, and preparing for and responding to disasters and health crises.

To take on such a large role in protecting the public health, states need the support of the federal government and the necessary resources.  The TFAH report notes that these resources must be coupled with increased accountability for states and localities to ensure funding is being used in the most effective ways and achieving desired health outcomes.  Novel options include granting states and localities greater flexibility in spending for increased reporting and accountability to federal funders, tying Medicaid or federal health spending to state investment in prevention programs, or establishing standard guidelines or benchmarks for core public health functions. 

Increased funding paired with improved accountability may provide states and the federal government with an opportunity to promote public health programs and protect their investment—a long term solution from which everyone can benefit.

© Copyright 2009, State Health Notes.