From flooding to wildfires to the novel coronavirus, health emergencies have dominated and redefined public life in the last year. Experts say that keeping Americans safe from these disasters requires a well-funded public health system focused on three key areas: prevention, preparedness, and surveillance. According to a new report, the United States is significantly underfunded in these essential tasks, exacerbating the COVID-19 pandemic.
Trust for America’s Health (TFAH), a nonprofit, nonpartisan public health policy, research, and advocacy organization issued this month its report, “The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2020”, to highlight a pattern of chronic underfunding. The United States spends an estimated $3.6 trillion annually on health, but less than 3 percent of that money is allocated for public health and prevention.
“Years of cutting funding for public health and emergency preparedness programs has left the nation with a smaller-than-necessary public health workforce, limited testing capacity, an insufficient national stockpile, and archaic disease tracking systems – in summary, twentieth-century tools for dealing with twenty-first-century challenges,” said John Auerbach, TFAH CEO.
The researchers say that public health spending as a proportion of total health spending has decreased since 2000. This includes the Hospital Preparedness Program (HPP) — part of the Office of the Assistant Secretary for Preparedness and Response (ASPR) in the U.S. Department of Health and Human Services — that prepares regional healthcare systems for emergencies. The program’s budget was cut by almost half, from $515 million in 2004 to $275.5 million in 2020, according to the report.
After the 9/11 terrorist attacks, Congress established the HPP to give federal assistance to healthcare groups and hospitals if a regional or national emergency were to occur. The program has supported organizations in the aftermath of Hurricane Katrina, the H1N1 pandemic, and the Boston Marathon bombings. Under ASPR, the HPP and 360 healthcare coalitions — comprised of at least one hospital, a local health department, an emergency management organization, and an emergency medical service — received more than $5.9 billion since 2002, yet 50 percent in reductions have been made to this work in the last 16 years, the authors wrote.
Essential to safeguarding public health is preparing a trained, well-resourced workforce. However, between 2016 and 2019, the number of full-time state workers in public health declined from 98,877 to 91,540. Factors for the reduction were lack of pay and burn out, as public health professionals are “continually asked to do more with less,” wrote the report’s authors. Additionally, about 25 percent of this workforce is eligible for retirement this year.
As for the Centers for Disease Control and Prevention, it oversees the Public Health Emergency Preparedness (PHEP) Cooperative Agreement, which provides funding to 50 states, four cities, and eight U.S. territories to improve response preparedness for everything from environmental disasters to measles to seasonal flu. It enables states to fund epidemiologists, laboratory staff, health educators, and field staff to investigate and address public health threats. The researchers recommend Congress increase funding for the PHEP to $824 million by 2021, what it was in 2006.
According to the report: “In 2019, Congress passed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act reauthorizing CDC’s PHEP Cooperative Agreement through fiscal year 2023. Despite being the primary source of federal support for state and local public health emergency preparedness and response, this funding was cut by hundreds of millions of dollars over the past two decades … Following recent small increases, PHEP funding remained flat in fiscal year 2020. Funding was already insufficient to restore lost resources, making the United States less prepared for public health emergencies, which are becoming more frequent and increasingly severe.”
Additionally, the researchers say public health investment is prioritized when there is a crisis, meaning that lawmakers borrow from existing public health budgets typically meant to fight chronic disease to pay for emergency response. The authors recommend that $4.5 billion is needed to bolster core public health capabilities at the regional and tribal levels across the country.
The researchers made more than two dozen recommendations to safeguard and expand several public health initiatives, including:
– Creating a $4.5 billion Public Health Infrastructure Annual Fund to address health departments’ infrastructure needs;
– Establishing significant funding for one or both of the recently proposed response funds: the Infectious Diseases Rapid Response Reserve Fund, dedicated to funding infectious disease emergencies, and the Public Health Emergency Fund, which can be used for any declared public health emergency;
– Providing at least $474 million to the Hospital Preparedness Program, the only federal source of funding to assist the healthcare delivery system in preparing for and responding to disasters;
– Improving funding for the CDC by 22 percent by 2022;
– Significantly increasing investments in public health initiatives to combat antimicrobial resistance.
“As TFAH worked on this report, the novel coronavirus continued to spread across the globe. The increasing number of threats to Americans’ health — from infectious disease to weather events to vaping — demonstrate the critical importance of a robust public health system,” Auerbach said. “Being prepared is often the difference between harm or no harm during emergencies.”