Public Health Financing

Health Care by the Numbers
Updated: June 10, 2020

Cuts to Public Health Budgets

-$7 billion

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

-$4.85 billion

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
$4.5 billion

Estimated annual underfunding of current public health efforts 5

-$12 billion

Cuts to the Prevention Fund, 2013-2027 6

-$693 million

Proposed cut to the CDC’s budget in 2021 7

-$426 million

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

> $25 million

Trump’s proposed cut to federal public health preparedness funding in fiscal year 2021 10

-$259 million

Cuts to the federal Hospital Preparedness Program supporting regional health care systems, 2013-17 11

-$66 million

Cuts to evidence-based chronic illness prevention 12

20 years

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.

2 Ibid.

3 Ibid.

4 Ibid.

5 Johnson, Steven (April 24, 2019). "Report: Public health funding falls despite increasing threats." Modern Healthcare.

6 Lang et al. (2018). See footnote 1.

7 Krisbberg, Kim (2020). "Trump budget proposal a disinvestment in US health: Cuts to CDC, HRSA." The Nation’s Health.

9 Cameron, Beth (Mar 13, 2020). "I ran the White House pandemic office. Trump Closed It." Washington Post.

11 Trust for America’s Health (2019). " Hospital Preparedness Program (ASPR)."

12 Lang et. al (2018). See footnote 1.

13 Katz, Rebecca et. al (Sept. 2017). "Funding Public Health Emergency Preparedness in the United States." American Journal for Public Health.

14 Ibid.

15 Lang et al. (2018). See footnote 1.

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

350,000 – 900,000

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

216,779 to 776,779

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.

17 Lang et al. See footnote 1.

18 Wilson, Robin et. al (2020). See footnote 9.

19 Schek, Tom et. al. (April 28, 2020). "Public Health Labs Suffered Budget Cuts Prior To The Coronavirus Pandemic." NPR.

20 See Stein, Rob et al. (May 7, 2020). “U.S. Coronavirus Testing Still Falls Short. How’s Your State Doing?” NPR.; Begley, Sharon (April 27, 2020). “Many states are far short of Covid-19 testing levels needed for safe reopening, new analysis shows.” Stat News. reopening/

21 Centers for Disease Control (updated May 19, 2020). “Previous U.S. Viral Testing Data.”

22 The COVID Tracking Project (updated June 5, 2020). “US Historical Data.” The Atlantic.

23 350,000 and 900,000 minus 133,221.

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

$1.843 trillion

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

22% vs. 36%

Percentage of GDP that the U.S. and France spend on social care programs (such as education, housing assistance, and food security), respectively. 30

$169.2 million

Compensation of the seven highest-paid executives at UnitedHealth Group in 2019 31

$186.8 million

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

24 Lang et al. (2018). See footnote 1.

25 Ibid.

26 Ibid.

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.”,previously%20forecast%20in%20January %202020.; U.S. Census Bureau (viewed June 5, 2020). “U.S. and World Population Clock.”

28 Congressional Budget Office (February 28, 2019). “How the 2017 Tax Act Has Affected CBO’s GDP and Budget Projections Since January 2017.,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.”

29 Forsberg, Vanessa et. al. (2012). "The Prevention and Public Health Fund." American Public Health Association.

30 American Public Health Association (Mar 2016). "Investing in the healthiest nation."

31 UnitedHealth Group (April 17, 2020). "2020 Proxy Statement."

32 Department of Health and Human Services (2020). "Justification of Estimates for Appropriation Committees."

33 Johnson (2019). See footnote 5.

Lives and Dollars Saved Through Public Health Investment

$16.5 billion

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

$14.30 – $16.50

Projected savings in future health costs for every $1 spent on prevention 36

1 to 7%

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."

35 Trust for America’s Health (2017). "The Value of Prevention."

36 American Public Health Association (Oct. 2012). “Public Health Infographic.”; McCullough JM (June 2018). “The Return on Investment of Public Health System Spending.” AcademyHealth.

37 American Public Health Association (2015). See footnote 34.