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G5O5. Increase funding and investment throughout Indiana for public health activities

Increase public health funding to Indiana


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Story Behind the Curve

Public Health Funding

U.S. Value: $116

Healthiest State: Alaska: $449

Least-healthy States: Nevada, Wisconsin: $72

Definition: State dollars dedicated to public health and federal dollars directed to states per person by the Centers for Disease Control and Prevention and the Health Resources & Services Administration (2-year estimate)

Data Source & Year(s): CDC, HRSA and Trust for America's Health, 2019-2020

Suggested Citation: America's Health Rankings analysis of CDC, HRSA and Trust for America's Health, United Health Foundation,, accessed 2022.


Public health systems are important to keeping Americans safe and healthy through prevention, preparedness and surveillance programs and serve as the first line of defense against disease epidemics. The public health response to the COVID-19 pandemic was weakened by chronic underfunding of these systems at the state and national levels. Increased spending on public health programs is associated with a decrease in mortality from preventable causes such as cardiovascular disease, diabetes, stroke and cancer.

Public health program spending represents just around 10% of all health care spending in most countries, yet its impact can be substantial. An investment of $10 per person per year in evidence-based community health programs could save the country more than $16 billion annually. That is a potential savings of $5.60 for every $1 invested.


Populations that are most affected by public health funding include: 

  • Children and infants, whose coverage for childhood immunizations and developmental screenings have been crucial in protecting infants and children from potentially life-threatening preventable diseases early in life when they are most vulnerable.
  • Low-resource communities: People living in these communities experience the largest health and economic benefits from increased local public health spending. 
  • Medicare enrollees: A 2017 study found a 10% increase in local public health spending per capita was associated with a 0.8% reduction in adjusted Medicare expenditures per person after one year and a 1.1% reduction after five years. Last accessed 06/14/2022

What Works


The effectiveness of a public health intervention, in part, depends on the resources of the community receiving the intervention. Studies have found that public health interventions focusing on behavior change are more successful in populations with a high socioeconomic status, while those with low socioeconomic status or other disadvantages tend to benefit less from these interventions. Adopting a social determinants of health view of public health, which focuses on the conditions in which people live, work and play, is essential to improving health and reducing health disparities. 

The Prevention and Public Health Fund was established by the Affordable Care Act to expand and sustain national investments in evidence-based strategies to improve health outcomes and health care quality. The Prevention Fund supports nearly $893 million in prevention grants throughout the United States to implement programs that aim to improve health for all, including efforts to prevent infectious diseases such as measles and influenza, and chronic diseases like diabetes and heart disease. Last accessed 06/14/2022


Source: Indiana Governor's Public Health Commission Report

The National Academy of Medicine estimated that $24 billion of federal investment would be needed “to build a governmental public health infrastructure that will be able support the type of population health strategies that are needed to improve the health of Americans and limit the growth of expenditures on medical care services.” The CDC's budget (who primarily funds state and LHDs) fell by 2% in 2021 in relation to 2012. Indiana consistently ranks among the lowest states in per capita expenditures. Most Indiana LHDs have Per Capita Funding Levels Below the National Average.

According to a 2020 analysis by the IU Richard M. Fairbanks School of Public Health (the “2020 Fairbanks Report”), total per capita revenues vary widely across Indiana’s LHDs, with the vast majority of LHDs well below the NACCHO-reported national median ($41) and 25th percentile ($23). 32 (Figure 8) The 2020 Fairbanks Report notes that per capita spending ranges from a low of $1.25 in Shelby County to a high of $82.71 in Marion County and that at least 37 counties have local public health per capita spending of less than $10.

About half of the IDOH funding is passed through or sub-granted to LHDs, WIC providers, health clinics, and other entities. In most cases, this funding is siloed — tied to specific diseases or other categorical purposes, which inhibits the ability of LHDs to use the funds to develop and maintain strong foundational capabilities.34

Source: Last accessed 12/27/2022

Corrective Action

Last accessed Dec 2022

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