Public Health Financing
Cuts to Public Health Budgets
Federal budget cuts to the CDC’s Prevention and Public Health Fund (PPHF), the country’s core fund for disease prevention and public health, from 2013-2020 1
Cuts to the PPHF under the Bipartisan Budget Act of 2018, 2021-2027 2
Total cuts to the PPHF, 2013-2027 3
Federal budget cuts to the CDC’s Public Health Emergency Preparedness fund, “the only federal program that supports the work of state and local health departments to prepare for and respond to emergencies,” 2002-2017 4
Source: Trust for America’s Health
Estimated annual underfunding of current public health efforts 5
Cuts to the Prevention Fund, 2013-2027 6
Proposed cut to the CDC’s budget in 2021 7
Proposed cut to the CDC’s chronic disease prevention and health promotion budget in 2021 8
Year the White House dissolved the National Security Council Directorate for Global Health Security and Biodefense 9
Trump’s proposed cut to federal public health preparedness funding in fiscal year 2021 10
Cuts to the federal Hospital Preparedness Program supporting regional health care systems, 2013-17 11
Cuts to evidence-based chronic illness prevention 12
Time since the last infusion of funds into the federal Public Health Emergency Fund (PHEF) 13
The balance of the PHEF since 2012 14
Number of states that cut their public health budgets from 2015 to 2017 15
1 Lang, Albert et. al (2018). "A Funding Crisis for Public Health and Safety." Trust for America’s Health.
https://www.tfah.org/report-details/a-funding-crisis-for-public-health-and-safety-state-by-state-and-federal-public-health-funding-facts-and-recommendations/.
5 Johnson, Steven (April 24, 2019). "Report: Public health funding falls despite increasing threats." Modern Healthcare.
https://www.modernhealthcare.com/government/report-public-health-funding-falls-despite-increasing-threats
7 Krisbberg, Kim (2020). "Trump budget proposal a disinvestment in US health: Cuts to CDC, HRSA." The Nation’s Health.
http://thenationshealth.aphapublications.org/content/50/2/1.2
9 Cameron, Beth (Mar 13, 2020). "I ran the White House pandemic office. Trump Closed It." Washington Post.
https://www-washingtonpost-com.stanford.idm.oclc.org/outlook/nsc-pandemic-office-trump-closed/2020/03/13/a70de09c-6491-11ea-acca-80c22bbee96f_story.html
11 Trust for America’s Health (2019). " Hospital Preparedness Program (ASPR)."
https://www.tfah.org/wp-content/uploads/2018/02/HPP-FY19-request.pdf
13 Katz, Rebecca et. al (Sept. 2017). "Funding Public Health Emergency Preparedness in the United States." American Journal for Public Health.
https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.303956
Cuts to Public Health Capacity
Estimated deficit of public health workers nationwide 16
The number of positions eliminated from local health departments, 2008-2017 17
Source: Trust for America’s Health
Increase from 2014 to 2017 in the proportion of government public health workers planning to leave their jobs, citing low pay, workplace environment, and lack of support as major reasons 18
Public health lab closures in California since 2003 19
Number of daily COVID-19 tests epidemiologists say is needed to contain the disease 20
Number of tests conducted by public health labs on April 13, 2020, one month after the national emergency declaration 21
Total daily tests conducted a month after the national emergency declaration 22
Estimated national shortfall of tests a month after the national emergency declaration 23
16 Wilson, Robin et. al (April 4, 2020). "A deficit of more than 250,000 public health workers is no way to fight Covid-19." Stat News.
https://www.statnews.com/2020/04/05/deficit-public-health-workers-no-way-to-fight-covid-19/
19 Schek, Tom et. al. (April 28, 2020). "Public Health Labs Suffered Budget Cuts Prior To The Coronavirus Pandemic." NPR.
https://www.npr.org/2020/04/28/845484900/public-health-labs-suffered-budget-cuts-prior-to-the-coronavirus-pandemic
20 See Stein, Rob et al. (May 7, 2020). “U.S. Coronavirus Testing Still Falls Short. How’s Your State Doing?” NPR. https://www.npr.org/sections/health-shots/2020/05/07/851610771/u-s-coronavirus-testing-still-falls-short-hows-your-state-doing; Begley, Sharon (April 27, 2020). “Many states are far short of Covid-19 testing levels needed for safe reopening, new analysis shows.” Stat News.
https://www.statnews.com/2020/04/27/coronavirus-many-states-short-of-testing-levels-needed-for-safe- reopening/
21 Centers for Disease Control (updated May 19, 2020). “Previous U.S. Viral Testing Data.”
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/previous-testing-in-us.htm
22 The COVID Tracking Project (updated June 5, 2020). “US Historical Data.” The Atlantic.
. https://covidtracking.com/data/us-daily
Public Health Spending in Context
CDC budget per person (fiscal year 2017) 24
Estimated public health budget per person in Missouri (the lowest amongst all states) 25
Estimated public health budget per person in Alaska (the highest) 26
Per capita loss in U.S. GDP, January – June 2020 27
Cost of the 2017 tax cuts (2017-2027), 203 times more than Congress cut from the PPHF over the same period. (By 2027, 82.8% of the tax cuts will go to the top 1% of households.) 28
Proportion of the $76.2 billion spent on public health contributed by the federal government. (State and local governments contributed the rest.) 29
Percentage of GDP that the U.S. and France spend on social care programs (such as education, housing assistance, and food security), respectively. 30
Compensation of the seven highest-paid executives at UnitedHealth Group in 2019 31
The CDC’s total funding for emerging and infectious diseases in 2019 32
Percentage of total national healthcare spending spent on public health in 2017 33
27 The CBO projects a $724 billion loss in real GDP in the first two quarters of 2020. The Census Bureau estimates a U.S. population of 329,750,942 on June 5, 2020. See Congressional Budget Office (June 1, 2020). “Comparison of CBO’s May 2020 Interim Projections of Gross Domestic Product and Its January 2020 Baseline Projections.” https://www.cbo.gov/publication/56376#:~:text=In%20the%20May%202020%20report,previously%20forecast%20in%20January %202020.; U.S. Census Bureau (viewed June 5, 2020). “U.S. and World Population Clock.”
https://www.census.gov/popclock/
28 Congressional Budget Office (February 28, 2019). “How the 2017 Tax Act Has Affected CBO’s GDP and Budget Projections Since January 2017. https://www.cbo.gov/publication/54994#:~:text=CBO%20estimated%20that%20the%20economic,income%20and%20thus%20federal%20revenues.; $9.1 billion has been cut from the PPHF from 2017-2027. See Lang et al. (2018), footnote 1; Tax Policy Center (December 18, 2017). “Distributional Analysis of the Conference Agreement for the Tax Cuts and Jobs Act.”
https://www.taxpolicycenter.org/publications/distributional-analysis-conference-agreement-tax-cuts-and-jobs-act
29 Forsberg, Vanessa et. al. (2012). "The Prevention and Public Health Fund." American Public Health Association.
https://www.apha.org/-/media/files/pdf/topics/aca/apha_prevfundbrief_june2012.ashx?la=en&hash=9479BAE5B4BF25D9B258B4EACEFA39CD7A9C9BF6
30 American Public Health Association (Mar 2016). "Investing in the healthiest nation."
." https://www.apha.org/what-is-public-health/generation-public-health/take-action/invest-in-health
31 UnitedHealth Group (April 17, 2020). "2020 Proxy Statement."
https://www.sec.gov/Archives/edgar/data/731766/000104746920002403/a2241322zdef14a.htm
32 Department of Health and Human Services (2020). "Justification of Estimates for Appropriation Committees."
https://www.cdc.gov/budget/documents/fy2020/fy-2020-cdc-congressional-justification.pdf
Lives and Dollars Saved Through Public Health Investment
Estimate annually national savings within 5 years from a $2.9-billion investment in community-based disease prevention programs 34
Savings per enrollee achieved through the evidenced-based Diabetes Prevention Program 35
Projected savings in future health costs for every $1 spent on prevention 36
Estimated reduction in deaths from the following preventable causes for every 10% increase in funding for community-based public health programs 37
Source: American Public Health Association
34 American Public Health Association (2015)."Prevention and Public Health Fund: Dedicated to improving our nation’s public health."
https://www.apha.org/~/media/files/pdf/topics/aca/2015_pphf_fact_sheet.ashx
35 Trust for America’s Health (2017). "The Value of Prevention."
https://www.tfah.org/wp-content/uploads/2018/02/The-Value-of-Prevention.pdf
36 American Public Health Association (Oct. 2012). “Public Health Infographic.” https://www.apha.org/news-and-media/multimedia/infographics/public-health-infographic.; McCullough JM (June 2018). “The Return on Investment of Public Health System Spending.” AcademyHealth.
https://www.academyhealth.org/sites/default/files/roi_public_health_spending_june2018.pdf