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Shortchanging America's Health 2009

June 26 2009

Shortchanging America's Health 2009
A State-By-State Look at How Federal Public Health Dollars are Spent

Shortchanging America's Health 2009Every American should have the opportunity to be as healthy as he or she can be. Every community should be safe from threats to its health. Protecting the health and safety of Americans should be a top responsibility of our nationís leaders.

Currently, serious gaps exist in the nationís ability to safeguard health, and with the current state of the economy, these gaps will only get worse, putting our families, communities, states, and nation at risk. The country does not devote the resources needed to adequately help prevent disease and protect the health of Americans.

The nation spends more than $2 trillion annually on health care, more than any other nation in the world, but still tens of millions of Americans suffer every day from chronic diseases like cancer, diabetes, and Alzheimerís, and preventable infectious diseases that rob them of their health and quality of life.1 Experts believe many of these diseases could be prevented through better public health measures, such as encouraging people to make healthier choices and building healthier communities.

Quality, affordable health care is essential, but a strong public health system focused on prevention must also be part of the solution. The health crisis calls for urgent action by putting prevention at the center of the nationís health strategy.

Health care has focused for too long on caring for people after they become sick or harmed instead of trying to prevent disease. Prevention means improving the quality of peopleís lives, sparing individuals from needless suffering, and eliminating unnecessary costs from the health system. Helping people to be healthier is one of the best ways to keep health care costs down. The nationís public health system is responsible for improving the health of Americans.

However, the public health system has been chronically underfunded in the United States for decades. There has been a shortfall of $20 billion annually -- across state, local, and federal government -- in funding for critical U.S. public health programs, according to an analysis by The New York Academy of Medicine (NYAM) and Trust for Americaís Health (TFAH), conducted in consultation with a panel of leading experts in 2008.

The analysis found that federal, state, and local public health departments have been unable to adequately carry out many core functions, including programs to help prevent disease and prepare for health emergencies. Approximately $1 billion of this shortfall is due to cuts to the U.S. Centers for Disease Control and Prevention (CDC) budget over the past five years.

In this report, TFAH examines how much the federal government spends to try to keep the country well. A state-by-state review of fiscal year 2008 spending reveals that federal funding (through CDC) for public health varies, often significantly, with a per capita low of $12.74 to a per capita high of $52.78.

The national average is $17.60 per person, a fraction of what is spent on health care costs. The report also examines state funding for public health. Each state allocates and reports its budget in a different way. States also vary widely in the level of specific detail they provide, which makes comparisons across states a challenge.

This analysis looks at ways to begin comparing budgets across states, and how increased transparency and accountability could help create an understanding of how spending on public health programs can have a positive impact on peopleís health. The median state spending on public health is $33.71 per person, with a range of $3.37 per person in Nevada to $172.21 per person in Hawaii.

To demonstrate the variation in health across states, this report examines a sample of key health indicators in each state. For instance, an examination of state data finds that adult obesity rates range from a low of 18.4 percent in Colorado to a high of 31.7 percent in Mississippi, and rates of uninsured adults range from a low of 5.4 percent in Massachusetts to a high of 25.2 percent in Texas.

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Trust for America's Health (TFAH) is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

For more information, visit

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nationís largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change.

For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they needóthe Foundation expects to make a difference in our lifetime.

For more information, visit

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Last Updated ( June 26 2009 )
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