The headquarters for the Centers for Disease Control and Prevention located in Atlanta. Credit: Katherine Welles via Shutterstock

The United States spent $4.1 trillion on health in 2020 but only 5.4% of that amount went toward public health — the prevention of illness and death, a new report has found.

The Trust for America’s Health offered this stark example, among others, of what it called “chronic underfunding of public health at both the federal and state levels,” which has left the nation “ill-prepared for public health emergencies and impedes prevention of many of the major causes of illness and death in the United States.” The trust, a nonprofit, non-partisan health policy group, reported that:

  • While federal funding to state and local health departments surged in 2021 because of the COVID-19 pandemic, this was “one-time money” that for the most part “could not be used to address longstanding deficits in the public health system.”
  • The budget for Public Health Emergency Preparedness programs at the Centers for Disease Control and Prevention rose slightly from fiscal years 2021 to 2022, from $840 million to $862 million, but has been trimmed overall by about one-fifth since 2002. Adjusted for inflation, it’s been cut in half.
  • The Department of Health and Human Services’ Hospital Preparedness Program has seen inflation-adjusted funding fall by more than two-thirds over the past two decades.

In an interview Wednesday with Public Health Watch, the trust’s president and CEO, J. Nadine Gracia, said the everyday work of public health — giving vaccinations, educating people on the dangers of tobacco and alcohol — is often “invisible until there’s a time of emergency.” This, she said, leads to a “boom-and-bust” cycle of funding: An infusion of money when there’s a crisis, like the pandemic, and static or reduced funding the rest of the time.

This phenomenon affects public-health programs across the board, compounding health inequities that allow chronic conditions to go untreated, the trust found. Gracia said the U.S. has an “obesity crisis,” for example, yet the CDC program designed to address the problem only has funding to cover 16 states.

In its report, the trust called for an annual investment of $4.5 billion in “public health infrastructure at the state, local, tribal, and territorial levels.” It cited a 2021 analysis by the de Beaumont Foundation that found state and local health departments need an 80% increase in the size of their work forces to perform their duties properly. Public Health Watch chronicled low morale and high levels of stress among employees of these departments in a story last fall.