Investing in America's Health

A State-By-State Look At Public Health Funding And Key Health Facts

March 2011

Investing in disease prevention is the most effective, common-sense way to improve health. It can help spare millions of Americans from developing preventable illnesses, reduce health care costs, and improve the productivity of the American workforce so we can be competitive with the rest of the world.

Tens of millions of Americans are currently suffering from preventable diseases such as cancer, heart disease, and diabetes.  And, today's children are in danger of becoming the first generation in American history to live shorter, less healthy lives than their parents.

For seven years, the Robert Wood Johnson Foundation has supported the Trust for America's Health in releasing an annual Investing in America's Health report to examine public health funding and key health facts in states around the country. 

Where you live should not determine how healthy you are.  But, we've found that disease rates vary dramatically from city to city and region to region - and funding for public health and disease prevention programs also vary dramatically from neighborhood to neighborhood, community to community, city to city and state to state.

The nation's public health system is responsible for improving the health of Americans.  But, the public health system has been chronically underfunded for decades.  Analyses from the Institute of Medicine (IOM), The New York Academy of Medicine (NYAM), the U.S. Centers for Disease Control and Prevention (CDC), and a range of other experts have found that federal, state, and local public health departments have been hampered due to limited funds and have not been able to adequately carry out many core functions.

In our analysis, we found that federal funding for public health has remained at a relatively flat and insufficient level for years. The budget for CDC has decreased from a high of $6.62 billion in 2005 to $6.12 billion in 2010.

At the state and local levels, public health budgets have been cut at drastic rates in recent years.  According to a TFAH analysis, 33 states and Washington, D.C. cut funding for public health from fiscal year (FY) 2008-2009 to 2009-2010, and 15 of these states cut funding for a second year in a row.  According to the Center on Budget and Policy Priorities (CBPP), states have experienced overall budgetary shortfalls of $425 billion since FY 2009.  In January 2010, 53 percent of local health departments reported that their core funding had been cut from the previous year, and 47 percent anticipate cuts again in the coming year.  Approximately 23,000 jobs - totaling 15 percent of the local public health workforce - have been lost since January 2008. 

TFAH's analysis of public health funding and disease rates finds wide variation in funding for public health - and for rates of disease around the country. 

DIFFERENCES IN FEDERAL FUNDING FOR STATES:  Federal public health spending through the U.S. Centers for Disease Control and Prevention (CDC) averaged out to only $20.25 per person in FY 2010.  And the amount of federal funding spent to prevent disease and improve health in communities ranged significantly from state to state, with a per capita low of $13.96 in Ohio to a high of $51.89 in Alaska.

DIFFERENCES IN STATE FUNDING:  This report also examined state funding and found that the median amount in state fiscal years 2009-2010 for public health equaled only $30.61 per person, with ranges from a low of $3.40 per person in Nevada to a high of $171.30 per person in Hawaii.  Regionally there were large differences in state funding.

DIFFERENCES IN HEALTH STATISTICS BY STATE:  The report finds major differences in disease rates and other health factors in states around the country.  For instance, rates of uninsured range from a low of 4.4 in Massachusetts to a high of 26.1 in Texas, while obesity rates range from a low of 18.9 in Colorado to a high of 32.5 in Mississippi.

There is little strategic rationale for the differences in funding - and therefore, for the way public health is funded in America.  The federal funds are a mixture of population-based formula grant programs and a series of competitive grants - where some states receive funding and others do not, but there is no officially defined mode or coordination for targeting or strategically focusing the funds.  State and local funding varies dramatically based on the structure of a state's public health department. 


Overall, the report concludes that a sustained and sufficient level of investment in prevention is essential to improving health in the United States, and that differences in disease rates will not change unless an adequate level of funding is provided to support public health departments and prevention efforts.

America's future economic well-being is inextricably tied to our health.  High rates of preventable diseases are one of the biggest drivers of health care costs in the country.  And right now, Americans are not as healthy and productive as they could or should be to compete in the global economy.

The report recommends that:

1. Core funding for public health - at the federal, state, and local levels - be increased;

2. Funding be considered strategically - so funds are used efficiently to maximize effectiveness in lowering disease rates and improving health;

3. The Prevention Fund be implemented quickly and strategically to effectively and efficiently reduce rates of disease; and

4. Accountability must be a cornerstone of public health funding - that the use of funds and the outcomes achieved from the use of the funds be transparent and clearly communicated with the public.