U.S. Value: $116 (2020); $ 183 (2021 & 2022)  

Healthiest State: Alaska: $449 (2020) ; Alaska: $465 (2021 & 2022).

Least-healthy States: Nevada, Wisconsin: $72 (2020); Michigan, Wisconsin: $128  (2021 & 2022).

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

Data Source and Years: CDC, HRSA and Trust for America's Health, 2021-2022

Suggested Citation: America's Health Rankings analysis of CDC, HRSA and Trust for America's Health, United Health Foundation, AmericasHealthRankings.org, accessed 2024.

WHY DOES THIS MATTER?

Public health funding saves lives and money. The United States public health system aims to keep Americans safe and healthy through prevention, preparedness and surveillance programs, and serves as the first line of defense against epidemics. 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 accounts for less than 10% of all health care expenditures 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 U.S. more than $16 billion annually. That is a potential savings of $5.60 for every $1 invested. 

WHO IS AFFECTED?

Populations that are most affected by public health funding include: 

• Children and infants: Financial coverage for childhood immunizations and developmental screenings are crucial for 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 that a 10% increase in local public health spending per capita was associated with decreases in Medicare expenditures, particularly among low-income and low-access populations.

https://www.americashealthrankings.org/explore/annual/measure/PH_funding/state/ALL Last accessed March 2024.

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 behavioral changes are more successful in populations with high socioeconomic status, while those with low socioeconomic status or other disadvantages benefit less from these interventions. Effective interventions must therefore adopt a social determinants of health lens, which recognizes the conditions in which people live, work and play as key influences on and indicators of health. 

State and local health departments are primarily responsible for funding and implementing public health activities, with supplemental financial support from federal agencies. Between the CDC’s steadily decreasing budget between 2010 and 2020 and disparities in state resources, this means that health departments are relying on inconsistent streams of public health dollars to provide necessary services. In order to reduce disparities and improve the state of public health for all Americans, it is critical that state and federal governments prioritize adequate and sustained funding for local health departments.

https://www.americashealthrankings.org/explore/annual/measure/PH_funding/state/ALL Last accessed March 2024.

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.

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: https://www.in.gov/health/files/GPHC-Report-FINAL-2022-08-01_corrected.pdf Last accessed March 2024.

The Affordable Care Act established the Prevention and Public Health Fund to expand and sustain national investments in evidence-based strategies to improve health outcomes and health care quality. The Prevention Fund supports $903 million in Centers for Disease Control and Prevention (CDC) grants for public health programs throughout the U.S., including efforts to reduce tobacco use, increase vaccine access and expand mental health and injury prevention programs.

Health First Indiana is an initiative created by Senate Enrolled Act 4, legislation passed by the 2023 Indiana General Assembly that transforms public health. The legislation provides funding so counties can determine the health needs of their community and implement evidence-based programs focused on prevention. Health First Indiana establishes a public health infrastructure through a state and local partnership where services are delivered at the county level. Counties decide whether to opt-in to the new funding and providing the core public health services, including trauma and injury prevention, chronic disease prevention, maternal and child health and more.

https://www.americashealthrankings.org/explore/annual/measure/PH_funding/state/ALL Last accessed March 2024.

https://www.in.gov/healthfirstindiana/quick-facts/  Last accessed March 2024.

https://www.americashealthrankings.org/explore/annual/measure/PH_funding/state/IN Last accessed March 2024.