New Report Shows Uneven COVID-19 Response Was Years in the Making Due to Chronic Underfunding of Public Health
By John Auerbach, President and CEO Trust for America’s Health
Last week, Trust for America’s Health released its annual report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks and Recommendations, 2020, which tracks public health and emergency preparedness funding at the federal, state and local levels.
For over a decade, the report has documented the ways chronic underfunding has hollowed-out the nation’s public health infrastructure and made Americans less safe. In short, we are trying to manage 21st century public health challenges with 20th century tools – and it isn’t working. We have a smaller than needed public health workforce that is forced to work with antiquated systems.
The COVID-19 crisis highlights how this is not just an academic issue. A lack of resources and preparedness led to an uneven response to the pandemic and contributed to the loss of life. As a nation, how do we ensure this never happens again?
Mixed Picture for CDC FY 2020 Funding
The U.S. Centers for Disease Control and Prevention (CDC) is the nation’s leading public health agency. The CDC’s overall budget for FY 2020 is $7.92 billion, a slight increase over FY 2019 but not enough to restore years of cuts. In fact, CDC funding for FY 2020 was just slightly above its 2008 funding when adjusted for inflation. And, the largest 2020 increase was a onetime investment in repairing buildings and facilities (+$225 million). Other increases were for very specific purposes like the Ending HIV Initiative (+$140 million).
Emergency Preparedness Funding Down This Year and For Over a Decade
Funding for CDC’s public health preparedness and response programs decreased this year – down from $858 million in FY 2019 to $850 million in FY 2020. Alarmingly, CDC’s funding for state and local emergency preparedness in FY 2020 ($675 million) is nearly 50% less than it was in FY 2002 ($940 million) after adjusting for inflation.
Of critical concern right now is funding for HHS’s Hospital Preparedness Program, the only federal source of funding to help the healthcare delivery system prepare for and respond to emergencies, which has been cut by over 60 percent since 2003, when adjusted for inflation.
Last month’s federal action to enact three supplemental funding packages to support the pandemic response was critical; TFAH applauded Congress for taking those fast actions. But they were short-term adjustments—they don’t help us catch-up on over a decade of underinvesting in public health, allow for recruiting and retention of a public health workforce, or building the systems and programs needed to prevent disease.
The nation’s habitual neglect of public health, except during emergencies, is a longstanding problem. Emergencies that threaten Americans’ health, including storms and flooding, the opioid crisis, the increase in obesity and chronic illness, last year’s measles outbreak, serious lung injuries due to vaping, and now the worst pandemic in a century, are becoming more frequent and more severe. We must make consistent and adequate investments in public health in order to meet these growing challenges.
Federal Budget Cuts Impact State Spending for Public Health
In addition to supporting federal activities, federal dollars are the primary source of funding for most state and local public health programs. During FY 2018, 55 percent of states’ public health expenditures, on average, were funded from federal sources. Therefore, federal spending cuts have a serious trickle-down effect on state and local programs. Between FY 2016 and FY 2018, state expenditures of federal funding for public health activities decreased from $16.3 billion to $12.8 billion. On top of federal cuts, some states have also reduced public health funding—eleven have cut their public health funding between 2018 and 2019.
These cuts have led to significant reductions in the size of the public health workforce. Over the last decade, local public health departments have lost approximately 56,000 staff positions due to funding issues. Some of the positions were frontline public health staff who would have been mobilized to combat the COVID-19 pandemic. We fear this trend will worsen over the next few years as states deal with revenues losses caused by the pandemic.
What Now? How to Prepare for the Next Public Health Emergency
The immediate focus for responding to COVID-19 is saving lives and the steps that will allow us to safely begin to reopen the economy. But once the emergency abates attention will turn to how to ensure that we are better prepared to prevent or reduce the impact of the next health emergency. Four critical steps will be:
Rebuilding the nation’s public health and emergency preparedness infrastructure including: modernizing data systems and improving surveillance; testing and stockpile capacities; and strengthening the public health workforce.
Increasing the year-in, year-out funding for public health and breaking the pattern of only investing in public health and emergency preparedness during a crisis. TFAH endorses the call for $4.5 billion in annual investments in public health infrastructure and workforce.
Improving Americans’ health by investing to prevent the primary causes of death and disability, which include obesity, tobacco use, chronic disease, substance misuse and suicide.
Addressing the social conditions in people’s lives—such as ensuring safe and affordable housing, access to quality education, transportation, healthy foods, and jobs that pay a living wage—that currently drive poor health. The tragic and disproportionate rate of COVID-19 deaths in communities of color is rooted in these social conditions and inequitable access to economic and health-promoting opportunities.
The report includes 28 specific policy recommendations and endorses the call by more than 100 public health organizations for Congress to increase CDC’s budget by 22 percent by FY 2022.
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John Auerbach is the President and CEO of Trust for America’s Health (TFAH). TFAH is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @healthyamerica1