The report found large disparities in state public-health spending, with Hawaii ranking the highest, spending $144.99 per person and Missouri ranking the lowest, spending an estimated $5.88 per person. A total of 33 states and the District of Columbia reported decreasing their public-health budgets in fiscal year 2013 from the prior year’s funding, with 16 states reporting cuts for the past three years.
“There’s good evidence that—spent in the right way—larger state and local health-department budgets do actually improve health outcomes and therefore result in lower healthcare costs,” said the report’s author Jeffrey Levi, TFAH executive director and a professor of health policy at the Milken Institute of Public Health at George Washington University. “We certainly recognize, in difficult fiscal times, that states have made across-the-board budget cuts, but at a time when our country is so focused on containing healthcare costs, we need to recognize that the investments that are made in public-health spending do have a payoff on the healthcare side of the ledger.”
The report found that federal public-health funding also has declined in recent years. The Centers for Disease Control and Prevention saw a 15% budget decrease in state-allocated funding over the last decade, from $7 billion in fiscal year 2005 to $5.98 billion in fiscal year 2013.
The report called for a significant boost to current public-health funding levels. It also requested a revamp of the federal government’s Prevention and Public Health Fund, created as part of the Patient Protection and Affordable Care Act. The fund is earmarked to invest in prevention and public-health programs, and to help the U.S. modernize its approach to public health.
Budget cuts have had a negative impact on state and local health programs aimed at preventive care, such as those that provide nutritional assistance, maternal and child support, tobacco cessation, child vaccinations, and services for those with HIV/AIDS. In all, the report found that nearly half of all local health departments reduced or eliminated services for at least one program during 2012.
According to a 2013 research brief by the Association of State and Territorial Health Officials, a total of 52 public-health agencies in 48 states, three territories and the District of Columbia reported budget cuts in 2012, compared to just 13 agencies who reported cuts in 2008. An estimated 91% of state-health agencies experienced job losses through layoffs and furloughs that affected more than 10,000 employees between 2008 and 2012.
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