Shortchanging America's Health 2009

A State-By-State Look at How Federal Public Health Dollars are Spent

March 2009

Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation's (RWJF) report examines how the economic downturn could lead to serious cuts to disease prevention and emergency preparedness programs at the state level. Researchers found that Midwestern and Southern states received less funding from the federal government than Northeastern and Western states did in fiscal year (FY) 2008 for disease prevention programs, which can amount to millions of dollars in differences.

The report found that states receive $17.60 per person on average from the U.S. Centers for Disease Control and Prevention (CDC) to spend on public health. Midwestern states received an average of $15.40 per person and Southern states received $17.89 per person, while Northeastern states received $18.99 and Western states received $18.15 per person from the CDC.

Alaska received the most funding from CDC of any state at $52.78 per person in FY 2008, while Indiana received the least at $12.74 -- a $40 difference. Approximately 75 percent of CDC's budget is distributed through grants or cooperative agreements to states and communities to support programs to prevent diseases and prepare for health disasters.

Public health programs are supported through a combination of federal, state, and local resources. State funding is expected to drop significantly as state governments face severe budget crises. According to the Center on Budget and Policy Priorities (CBPP), at least 46 states are facing shortfalls to their 2009 and/or 2010 budgets. CBPP estimates that combined budget gaps for states in the remainder of 2009, 2010, and 2011 could total more than $350 billion.

Some health programs at-risk for cuts include:

Cancer, diabetes, obesity, and other chronic disease prevention;
HIV/AIDS, MRSA, TB, and other infectious disease prevention;
Food and water safety;
Environmental health improvement; and
Bioterrorism and health emergency preparedness.

In addition, more than 11,000 state and local public health jobs have already been cut, and another 10,000 may be cut, according to surveys conducted by state and local health departments.

The American Recovery and Reinvestment Act provided an additional $1 billion for public health programs for next year, which will help provide additional support in many communities.