About Health Funding
Health is all Around You
The Founding Fathers granted Congress the power to collect taxes to provide for the “common Defence and general Welfare” of the United States. As the size, economy, and complexity of the nation expanded, so too did the federal government’s roles and responsibilities in protecting Americans—providing for societal needs when the market does not and when individuals are unable to address these needs themselves. Maintaining a strong military is one of government’s fundamental responsibilities. But it takes more than just the Department of Defense to keep Americans safe and secure. Public health—which by definition affects the public, writ large—is an essential pillar of national security, and one that the government is best positioned to support.
Public health is the science and art of protecting and promoting health in communities where we live, work, and learn. These activities are such a part of daily living they are often invisible, and almost always taken for granted. The federal agencies and programs of the Department of Health and Human Services (HHS) work in partnership with state and local governments, universities, hospitals and health centers, charitable organizations, private industry, and each other to:
- Assure the safety of our food, water, drugs, and environment
- Protect, respond, and rebuild in times of crisis
- Prevent and treat disease and disability
- Promote well-being and responsible choices
- Educate the next generation of health professionals and scientists
- Provide our nation’s most vulnerable populations access to basic care
From detecting and responding to public health threats, to enhancing knowledge through scientific discovery, to ensuring access to health services and the professionals who deliver them, the government is a critical partner in preserving and protecting the health of every American.
Evolution of the Public Health Enterprise
Public health is one of the oldest federal functions, dating back to 1798 when Congress first authorized the Marine Hospital Service to deliver care to merchant seamen who had a higher incidence of disease. From this single federal investment stemmed the beginnings of the Public Health Service, first codified by the Public Health Service Act in 1944. Today’s HHS is comprised of the Office of the Secretary, 11 operating divisions—including the eight agencies authorized by the Public Health Service Act and three human services agencies—10 regional offices, and the U.S. Public Health Service Commissioned Corps, which is a uniformed service of more than 6,000 health professionals serving in many HHS and other federal agencies.
Detecting and Responding to Threats
In 1946, the Communicable Disease Center was founded with the primary mission of limiting the spread of malaria across the nation. With just 400 employees and a $10 million budget, the Communicable Disease Center was able to largely eradicate the disease from its hotspot in Atlanta and limit the spread of the disease to other parts of the nation. Today, the federal government’s role in detecting and responding to public health threats expands far beyond malaria. The Centers for Disease Control and Prevention (CDC) administers national programs in partnership with state and local governments to prevent and control the spread of communicable and vector-borne diseases, develop and implement programs to improve environmental health, direct and enforce foreign quarantines, and consult with and assist other nations and international bodies. In times of crisis, CDC works in concert with other federal agencies and state and local partners to help those exposed to environmental health hazards, bioterrorism attacks, and epidemics.
Expanding Health Knowledge
Health research has a strong presence in American History, stemming from a single laboratory and young scientist at the Marine Hospital Service in 1887. After just a few months in his “hygiene laboratory,” Joseph J. Kinyoun discovered the bacteria responsible for cholera, which was causing severe illness in seamen. With his discovery, physicians were able to deliver accurate, positive diagnoses to those infected. Today, the federal government supports different types of health research through the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality (AHRQ), and the other Public Health Service agencies. The components of the health research continuum—from basic and clinical research, to population-based and health services research—work in concert to improve health from the bench, to the bedside, to the curbside and beyond.
Assuring Access to Services
The Marine Hospital Service was also one of the first federal programs to expand access to health care. By collecting a federal tax on each privately employed seaman, the government was able to build a network of hospitals specifically equipped to treat sailors. These programs improved access to appropriate care to address the spread of communicable diseases. Today, the Public Health Service agencies carry out a similar mission to a much greater degree. The Indian Health Service (IHS), the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), CDC, and others—directly or in partnership with state and local governments and nongovernmental organizations—deliver care and other essential services to vulnerable populations. Such services include but are not limited to mental health and substance abuse treatment, preventive and primary care services for children and families, dental care and for patients with HIV/AIDS, and support for those with disabilities.
Educating the Public Health Workforce
Policymakers first became aware of the nation’s primary care provider shortage in the 1950s, as physicians retired and the next generation sought careers in specialized medicine. In response, Congress established the National Health Service Corps in 1972 to provide tuition assistance for medical professionals who chose to pursue careers in general medicine and committed to practice in underserved areas for a specified period of time. The Public Health Service agencies—principally HRSA and CDC—now support many training and incentive programs to recruit talented individuals into careers that advance the public’s health, including physicians and physician assistants, nurses, dentists, pharmacists, epidemiologists, scientists, and other public health professionals. Through tuition assistance, loan repayments, fellowships, and other training opportunities, the government ensures a pipeline for qualified public health professionals in the public health areas most in need.
Federal Role: Principal Public Health Service Agencies
The Public Health Service agencies comprise a small portion of the Department of Health and Human Services’ overall budget—just 5.5 percent—but they provide the building blocks Americans need to live healthy, successful lives. These agencies touch every American, providing millions of children, families, and seniors with access to care, keeping the food on Americans’ shelves safe and infectious diseases at bay, and pushing the boundaries of how we diagnose and treat disease.
The Centers for Disease Control and Prevention (CDC) is the nation’s first responder in health emergencies, and supports people in living healthier, longer.
The Food and Drug Administration (FDA) ensures that food, drugs, medical devices, and cosmetics that come to market are safe and effective.
The Health Resources and Services Administration (HRSA) supports the pipeline for new health providers and delivers health services in our nation’s communities.
The Indian Health Service (IHS) funds health services and local facilities that serve American Indian and Alaska Native populations.
The Substance Abuse and Mental Health Services Administration (SAMHSA) supports communities in providing treatment and prevention to those in need.
The Agency on Healthcare Research and Quality (AHRQ) provides evidence to improve health care costs, quality, and access through funding to local universities and research centers.
The National Institutes of Health discovers cures and treatments for illness—physical and behavioral—through funding to local universities and research centers.