The COVID-19 crisis brought a badly needed wave of support to chronically underfunded state and local public health agencies, which had long struggled to meet the needs of our growing nation and fulfill their responsibilities to prevent disease, respond to outbreaks, promote health education and encourage healthy lifestyles.
And although COVID-19 is still with us, that wave of funding—an estimated $800 billion funneled from the federal government to state and local jurisdictions for public health response and recovery—is fast receding as federal grants expire and programs reach the sunset stage. As much as we all would love to treat the pandemic solely as a distant (if painful) memory, we cannot afford to weaken the nation’s public health infrastructure or workforce and risk even more devastating consequences when the next crisis hits.
Learning from the past
The fact that state public health agency funding plummeted 16% in the years before the COVID-19 pandemic struck—and that the corresponding payroll cuts took away nearly 40,000 jobs at state and local public health agencies during that time—meant that our nation was tragically unprepared to mount an effective response to COVID-19.
The majority of public health spending takes place at the state level, and that funding was cut dramatically due to the Great Recession. These cuts sent state finances into a tailspin beginning in 2008. According to a study published in Health Affairs, state government spending on public health remained flat in the years that followed, exacerbating the impact of the pandemic.
Although overall U.S. health care spending approached $5 trillion in 2023, only a tiny fraction of that amount was dedicated to prevention and public health purposes. Legislators and policymakers nationwide who advance proposals to reduce expenditures for public health typically fail to grasp the tremendous return on investment that public health efforts can offer.
Health protection interventions such as vaccinations are a great example. An analysis of the federal “We Can Do This” COVID-19 vaccine campaign that was published in the American Journal of Preventive Medicine pegged the return on investment (ROI) at $89.54 for each $1 spent! Another analysis found that the median ROI for public health interventions is 14.3 to 1, meaning that allocating dollars to this purpose is one of the wisest investments that government at any level can take.
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Public health and the AMA
Improving public health is a core mission of the AMA. I was excited to learn last month that the AMA is one of 48 public health partners nationwide joining the National Partners Cooperative Agreement launched by the Centers for Disease Control and Prevention to bolster the nation’s public health infrastructure and boost its overall performance.
For its part in this five-year effort, the AMA will provide physicians and trainees with the tools and educational resources needed for effective, evidence-based public health interventions, such as screening for infectious disease, while also advancing policies and programs to reduce health inequities and improve health outcomes for all.
Looking to the future
Now is not the time to cut back our nation’s investment in public health. To the contrary, we need to embrace the benefits of a resilient, adequately funded public health system that is better prepared to confront both existing and emerging health threats. The next public health emergency will demand a faster, more comprehensive and much more effective response, which cannot be accomplished given our current boom-then-bust approach to public health spending.
A robust public health infrastructure represents our best defense against infectious disease and other threats. We can realize this by strengthening our public health workforce and our disease surveillance systems. At the same time, we must ensure that all communities have equitable access to public health funding and services.
The COVID-19 pandemic exposed multiple challenges faced by state and local health departments and public health agencies, from badly outdated IT and data collection systems to dire personnel shortages and more. We must address those needs and build a stronger and more agile public health system that can foster and sustain a healthier future for everyone across our nation.
