Just 11 of 19 public health-related provisions of the Patient Protection and Affordable Care Act have received funding, keeping public health worker positions from being created and jeopardizing the goals of the reform law, according to a report from the American Public Health Association, Washington.

Public health workforce funding for the Affordable Care Act so far has focused on adding clinical staffers such as primary-care physicians and nurses—a fraction of the public-health workforce, according to an APHA news release on the report, The Affordable Care Act’s Public Health Workforce Provisions: Opportunities and Challenges (PDF). Just two of five programs in the law aimed at training public health workers has received funding, and one of those trains physicians, according to the report.

“Under health reform, we have a real opportunity to transform our nation's health system—by moving from a sick-care system to one that prioritizes prevention and wellness—and saves lives and money,” Dr. Georges Benjamin, executive director of the APHA, said in the release.

The economic slowdown has further cut into the nation's ability to maintain the public's health, with research indicating that 19% of the governmental public-health workforce has been lost since 2008. The report also points to data that says 89% of state agencies cut services between 2008 and 2010.

“With the fiscal situation only worsening, the future funding situation of the ACA's health promotion provisions is very unclear,” the report authors wrote.