The Impact of Chronic Underfunding on Americas Public Health System: Trends, Risks, and Recommendations - 2023

Decades of underfunding have left the nation's public health system ill-equipped to protect the health of Americans. The COVID-19 crisis illuminated weaknesses in the nation's public health infrastructure, including antiquated data systems, insufficient public health laboratory capacity, an under-resourced public health workforce, and the need for improved public health communications. These foundational public health capacities require increased, flexible, and sustained funding.The U.S. Centers for Disease Control and Prevention (CDC), the primary source of public health funding for state, local, tribal, and territorial health departments, is itself reliant on the annual federal appropriations process. Over the past two decades (FY 2014 – 2023), the CDC's budget has increased by just 6 percent after adjusting for inflation, leading to insufficient funding in key program areas such as emergency preparedness and chronic disease prevention.In addition to the risks associated with health emergencies, the country faces a growing number of people living with chronic diseases and the associated healthcare costs. While evidence-based public health programs that help prevent chronic disease are doing important work, insufficient funding has limited their accessibility and impact in many communities.TFAH is calling for annual funding for CDC of at least $11.581 billion in FY 2024, the level requested in the President's FY 24 budget (FY 2023 CDC funding is$9.2 billion).Other policy recommendations within the report include:Increase and sustain disease-agnostic funding to strengthen public health infrastructure. Public health experts estimate an annual shortfall of $4.5 billion in necessary funding for state and local health departments to provide comprehensive public health services in their communities.Strengthen public health emergency preparedness, including within the healthcare system. Investments should include the restoration of funding to the Public Health Emergency Preparedness Cooperative Agreement, the Healthcare Readiness and Recovery Program, and programs designed to support vaccine infrastructure as well as prevent, detect, and contain antimicrobial-resistant infections.Modernize the public health data system to ensure comprehensive and real-time data sharing during public health emergencies. Public health experts estimate that at least$7.84 billion is needed over the next five years for CDC's Data Modernization Initiative to strengthen public health data collection and reporting at the state and local levels. Congress should also provide sustained funding for CDC's new Center for Forecasting and Outbreak Analytics.Bolster the recruitment and retention of the public health workforce. In 2021, it was estimated that state and local public health departments needed to hire an additional 80,000 employees to be able to deliver a minimum set of public health services. The one-time nature of short-term emergency funding means that health departments will continue to experience understaffing.Address health disparities and the root causes of disease by addressing the social determinants of health and investing in chronic disease prevention.Invest in programs to prepare for and mitigate the impacts of climate change

Outbreaks: Protecting Americans From Infectious Diseases 2015

Infectious diseases -- most of which are preventable -- disrupt the lives of millions of Americans each year. But the country does not sufficiently invest in basic protections that could help avoid significant numbers of outbreaks and save billions of dollars in unnecessary healthcare costs. U.S. investments in infectious disease prevention ebb and flow, where there is a major ramp up when a new eminent threat emerges, but then falls back when the problem seems contained.In the most recent example last year, the Ebola outbreak resulted in ephemeral attention and emergency supplemental funding to backfill gaps in the nation's ability to respond. But, lags in even emergency funding processes meant much of the support came too late to address immediate needs in states and in Africa. And the funding was not at a sufficient level to shore up ongoing gaps, leaving the United States still vulnerable for when the next emerging threat arises.Fighting infectious disease requires constant vigilance. Policies and resources must be in place to allow scientists and public health and medical experts to have the tools they need to: control ongoing outbreaks -- such as HIV/AIDS, antibiotic-resistant superbugs and foodborne illnesses; detect new or reemerging outbreaks -- such as Middle East Respiratory Syndrome Coronavirus (MERS-CoV), measles and avian flu; and monitor for potential bioterrorist threats -- such as anthrax or smallpox

Outbreaks: Protecting Americans From Infectious Diseases 2014

This report examines a range of infectious disease concerns. The report highlights a series of 10 indicators in each state that, taken collectively, offer a composite snapshot of strengths and vulnerabilities across the health system. These indicators help illustrate the types of policy fundamentals that are important to have in place not just to prevent the spread of disease in the first place but also to detect, diagnose and respond to outbreaks. In addition, the report examines key areas of concern in the nation's ability to prevent and control infectious diseases and offers recommendations for addressing these gaps. The Outbreaks report provides the public, policymakers and a broad and diverse set of groups involved in public health and the healthcare system with an objective, nonpartisan, independent analysis of the status of infectious disease policies; encourages greater transparency and accountability of the system; and recommends ways to assure the public health and healthcare systems meet today's needs and work across borders to accomplish their goals

A Blueprint for the 2021 Administration and Congress The Promise of Good Health for All: Transforming Public Health in America

The nation's public health system is dangerously inadequate and needs sustained attention and investment. This report provides an action plan for the administration and Congress taking office in 2021

State of Obesity 2021: Better Policies for a Healthier America

In 2020, 16 states had adult obesity rates at or above 35 percent, up from 12 states the previous year. These and other emerging data show that the COVID-19 pandemic changed eating habits, worsened levels of food insecurity, created obstacles to physical activity, and heightened stress, all exacerbating the decades long pattern of obesity in America.This report is based in part on newly released 2020 data from the CDC's Behavioral Risk Factors Surveillance System and analysis by Trust for America's Health (TFAH). It provides an annual snapshot of rates of overweight and obesity by age, race/ethnicity and state of residence for U.S. adults. In the report, TFAH calls for addressing the social determinants of obesity, for example, by ensuring access to no cost healthy school meals for all students, a program started during the pandemic

Ready or Not? Protecting the Public From Diseases, Disasters, and Bioterrorism 2017

In the 16 years since the 9/11 and anthrax tragedies, the country has had countless reminders demonstrating the need for a sufficient response to the public's health needs during major incidents—be they caused by extreme weather events, disease outbreaks or a contaminated food supply.The 2017 Atlantic Hurricane Season was particularly historic. After Hurricane Harvey made landfall in Texas, it hovered over Houston for days—dropping several feet of rain that caused unprecedented flooding and sank the Earth's crust around Houston two centimeters. Harvey was followed by two Category 5 storms–Hurricanes Irma and Maria, which had a profound impact on many Caribbean nations, Puerto Rico, the Florida Keys and other areas in the region. Out West, rain was scarce as communities were ravaged by one of the worst wildfire seasons ever.The fast-moving blaze in California's wine country killed 43 people, scorched 250,000 square miles and destroyed 8,900 structures.Despite the frequency of health threats, often the country is not adequately prepared to address them, even with all the prior lessons about what is needed for an effective response. Emergencies are a matter of when, not if; there is no reason to continue to be caught off guard when a new threat arises.The good news is that considerable progress has been made to effectively prepare for and respond to public health emergencies of all types and sizes,and much of what it takes to prepare for bioterrorism, major disease threats or major disasters is also essential to respond to ongoing health threats. The bad news is that the accomplishments achieved to improve public health and preparedness for all hazards are being undermined due to severe budget cuts and lack of prioritization