Inadequate funding continues to hold back public health despite the increase of federal dollars allocated during the COVID-19 pandemic, a recent report from Trust for America’s Health says. Ample, steady funding is needed to strengthen public health as the nation recovers from the pandemic.

Released in July, the report details the lack of investments in core public health sectors as federal dollars for pandemic support ends. TFAH joins other public health groups in calling for an annual $4.5 billion investment in public health infrastructure at the state, local, tribal and territorial levels.

“The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations” shows the lack of self-sustainability within the public health system, said Nadine Gracia, MD, MSCE, president and CEO of TFAH.

“What we see with the trend of public health funding is that there's often this boom and bust cycle of public health funding where, in non-emergency times, public health receives little funding because there's not some type of an emergent public health threat,” Gracia told The Nation’s Health. “Then the crisis arises and there is an infusion of emergency funding to support that public health threat and response.”

The U.S. needs to step away from the unstable funding cycle that peaks during health emergencies, and instead focus on steady funding of everyday public health, the report said. This includes support to strengthen and modernize public health infrastructure and data systems.

“There are still health departments that rely on faxes to send information to the federal government when they're reporting things,” said Donald Hoppert, APHA director of government relations and a contributor to the TFAH report. “There has not been enough funding for the public health system to have an updated modern data system where everything is seamlessly linked together so that these federal, state and local entities can all talk to each other and exchange data.”

Also emphasized is the need for payroll funding to retain and expand the public health workforce. Given that many other health fields typically pay more than public health and the additional stress placed on workers during the pandemic, health departments are losing workers.

“Who's going to want to go work for a health department when they know that their job is going to be gone in two years?” Hoppert told The Nation’s Health. “That's why it's really critical to have sustained funding, so people know that the pay and the job is going to be there for the long term. And we just haven't seen that.”

Funding for health promotion, prevention and equity also need sustained growth. The U.S. spent $4.1 trillion on health in 2020, but only 5.4% of that targeted public health and prevention, the report noted.

Increased funding is needed to address contributors to health inequities, such as poverty, problems accessing to care and structural barriers.

"By advocating for increasing investment in addressing the social determinants of health, it will actually help toward addressing these root causes of health disparities as well as addressing what we see as rising rates in chronic disease and other health conditions,” Gracia said.

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