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Shortchanging America’s Health: A State-By-State Look at How Public Health Dollars Are Spent and Key State Health Facts – 2010


Where you live in America impacts how healthy you are. Per capita public health funding by state governments ranged from $3.55 to $169.92 annually depending on the state. This report released by the Robert Wood Johnson Foundation’s Trust for America’s Health (TFAH – explores America’s health in relation to where Americans live. After an examination of the relationships between funding, states, and public health, the report offers recommendations and action steps for local governments on how to “modernize public health.” 

Key Points

Education, employment, income, family and social support, community safety, and the physical environment have an impact on public health in communities across the U.S. But a big factor in the health of a community is whether or not they have a strong public health system (in this report that term excludes Medicaid, CHIP or any program to cover low income residents).

The report makes the case that the wide range of per capita healthcare spending across the states results in unequal opportunities for healthier lives. It then sets forth roles and responsibilities for federal, state and local governments to spend more on prevention and wellness programs.

Other highlights include:

  1. State governments have reduced their investment in public health spending by almost $400 million (page 8), and CDC federal funding has been “flat or declined” for five years (page 3). The report argues this leads to increased rates of preventable diseases, which in turn results in higher healthcare costs and an increasingly unhealthy workforce.
  2. A 2008 report by TFAH found that “an investment of $10 per person per year in proven community programs to increase physical activity, improve nutrition, and prevent tobacco use could save the U.S. more than $16 billion annually. This is a return of $5.60 for every $1 spent on prevention” (page 2). States view public health as discretionary, rather than core services.
  3. Over half of all Americans (56%) report to have delayed healthcare due to cost concerns (page 11). This increases potential health complications in the long-term.
  4. A study by the Association of Schools of Public Health estimates that “by 2020 state and local health departments will need an additional 250,000 public health workers” (page 11).

How to Use

The recommendations and action steps presented here are for states seeking ways to increase the quality of their public health. Cost is related to health, and poor health is more likely as we age. Viewing public health investment as core, rather than discretionary, budget items can help local governments lower overarching costs even as they struggle to replace or extend an aging workforce. Using the report to compare spending and health between states also serves as a barometer in determining how well a state is competing nationally.

View full report: Shortchanging Americas Health: A State-By-State Look at How Public Health Dollars Are Spent and Key State Health Facts – 2010 (PDF – 426 KB)

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