Under-Resourced Public Health System: Government Allocates Fewer Funds Than Estimated to Public Health

AURORA, CO, December 7, 2020 – COVID-19 exposed a chronically under-resourced public health system, and new research suggests that far fewer dollars support this system than is indicated by official government estimates.

new study from Johns Hopkins University (JHU) found that when counting only dollars spent on public health activities -- excluding personal medical care services – state governmental public health spending in the United States ranges between 34%–61% of official figures. Research also highlighted geographic disparities — rooted in structural, economic, and social spending differentials — that continue to grow.

"This research shows that government investments in true population-based public health activities are much smaller than most of us realize," says Glen P. Mays, PhD, Director of Systems for Action, which funded the study. “As a consequence, our responses to population-wide threats like COVID-19 or even obesity can’t be as robust nor as equitable as we need them to be.”

In addition to the findings, the JHU study outlined recommended actions to improve the alignment between individual health care, public health, and social services spending. The recommendations included clarifying the value of public health, prioritizing funding to ensure the public's health is protected, engaging across sectors to improve community health and well-being, achieving equity, and delineating spending on public health activities from medical care spending.

"We get what we pay for in public health, so a more accurate accounting of these expenditures will allow us to allocate government resources more effectively and equitably as we respond to the pandemic," says Mays. 

This study was funded by Systems for Action, a national research program of the Robert Wood Johnson Foundation and based at the Colorado School of Public Health. The research focused explicitly on state government expenditures for public health activities by analyzing data collected through the U.S. Census Bureau’s Annual Survey of State and Local Government Finances.

View the research studies by S4A investigators David Bishai, MD, PhD, JP Leider, PhD and Mac McCullough, PhD and Beth Resnick, DrPh, MPH.

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Author:           Debra Clark