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Sunday, February 5th, 2023

Trust for America’s Health calls for robust public health system funding

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America’s historically underfunded public health system played a major role in the nation’s laggard COVID-19 response, according to a new report released by the Trust for America’s Health (TFAH).

And while it’s too soon to calculate with precision, it is likely that the United States might have averted spending much of the trillions of dollars that the COVID-19 pandemic cost if it had invested just a few billion dollars more in public health spending earlier, write the authors of The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021.

“What the system urgently needs is sustained, predictable funding that allows it to grow and maintain its workforce and invest in modern data systems and all-hazards preparedness planning on a year-in, year-out basis,” said John Auerbach, president and CEO of TFAH, a non-partisan public health policy, research and advocacy organization.  

To prepare for, respond to and mitigate threats like COVID-19, the United States must sustain higher year-to-year funding and proactively invest resources in planning, workforce and infrastructure. “Not doing so is akin to hiring firefighters and purchasing hoses and protective equipment amid a five-alarm fire,” write report authors Matt McKillop, TFAH senior health policy researcher and analyst, and Dara Alpert Lieberman, TFAH director of government relations.

Founded 20 years ago, TFAH has consistently called for federal, state, local, territorial, and tribal leaders to provide adequate funding for the nation’s public health system, both to promote health in good times and to prevent catastrophes in bad times, McKillop and Lieberman write.

“Unfortunately, a pattern has emerged: the country temporarily pays attention to public health investment when there is a crisis and then moves on when the emergency passes,” according to the report. “This boom-bust cycle has left the nation’s public health infrastructure on weak footing.” 

Going forward, TFAH advocates for two key pieces of congressional action. First, the organization recommends enactment of the Public Health Infrastructure Saves Lives Act, S. 674, introduced on March 10 by bill sponsor U.S. Sen. Patty Murray (D-WA) and 19 other Democrats. The measure would establish and directly fund, at a level ramping up to $4.5 billion annually, a Core Public Health Infrastructure Program at the Centers for Disease Control and Prevention (CDC).

The CDC then would redistribute most of the money in grants to state, local, tribal, and territorial health departments to build foundational capabilities in areas such as public health assessment, preparedness and response, policy development and support, communications, community partnership development, organizational competencies, accountability, and equity, according to the TFAH report.

The Trust also supports President Joe Biden’s fiscal year 2022 budget request of $153 million to bolster social determinants of health (SDOH) activities across the CDC and to provide grants to state, local, tribal, and territorial agencies that would allow agencies to act as or complement the chief health strategists in their communities, the report says, noting that partners across sectors then could build integrated systems and programs that improve health and health equity.  

“Given appropriate funding and technical assistance, more communities could engage in opportunities to address SDOHs that contribute to high healthcare costs and preventable disparities in health outcomes,” write the report’s authors.

At the same time, increased funding levels won’t be effective, the authors write, unless funders, agencies and grantmaking institutions recognize that some communities may need higher funding levels and resources for technical assistance and capacity building.

Additionally, funding can’t be a one-shot deal or limited to a few years when the most effective approaches require a longer window of time to measure efficacy. One-time funding is not a solution to years of underfunding, which have hollowed out the system and made it less able to spend emergency funds quickly and efficiently, the report says.

Such considerations should be taken “into account when planning resource allocation,” the authors write.

Among several other recommendations, the TFAH report says Americans’ health should be safeguarded and improved by investing in chronic disease prevention, as well as the prevention of substance misuse and suicide. Sustaining a qualified, ample workforce also should be prioritized, says the report.

America’s underfunded public health system for decades has made the nation less prepared and put lives at risk, Auerbach said, noting that the pandemic has amplified the seriousness of those risks. 

“We must learn from the COVID tragedy and dramatically increase annual support of the public health workforce, programs and infrastructure,” he said. “If we fail to learn the lessons from the pandemic, we will be doomed to repeat them.”