Yet Another Post on Public Health Spending

by JP Leider, PhD


Before 2020, before COVID, I think I may be received two or three media calls, ever, on public health funding. At this point, I and colleagues have published a couple dozen articles on the dearth of and underinvestment in public health funding. But not a lot of media interest.

Now, admittedly, that’s maybe more a reflection on my work than the topic. But even the high impact work of the Institute of Medicine and Trust for America’s Health haven’t yielded a lot of earned media on public health spending. Given the quality of the work they do, I suspect it is more the message than the messenger. There was a time, as I have written about previously, when the Prevention Fund established through the ACA appeared like it could be a nice source of sustained and sustainable investment in population health. But it quickly got raided, reduced, and now CDC subsists on it — the funding was mostly substituted, one source for another, rather than additive.

COVID has changed this focus. When COVID started, and we were still theoretically in the isolation and quarantine stage, there were questions about if or how public health was resourced. Focus then shifted back to the health care system. Now, though, we’re back to a little more focus on public health funding, per se. That is largely thanks to a team at Kaiser Health News and the AP that have begun an investigative project into public health funding. Their first big piece was posted July 1, and it’s quite a sight to see. The article, which has been reprinted across several media outlets and has also allowed a number of local media markets to look at their own state. It brings together data sources that I and colleagues have worked on for some time (and were pleased to share with the effort), like the State Health Expenditure Dataset. Reporters also go down to the local level, finding stories about how leaders are reacting and responding to the current environment.

It’s also worth mentioning and lauding the data efforts of this work. The visualizations are sharp, sure, but it also takes tremendous work to get right and to make accessible. This year, I have seen a few dataviz projects from the media that have been pretty impressive, that really expand our knowledge on COVID and related public health issues. I would say this is one of them.

This effort lines up well with the latest update to the SHED, published today in AJPH. As I’ve written about in JPHMP and elsewhere before, the fact that we have an inaccurate, inflated, official Public Health Activity Estimate for the United States seems pretty fitting. It’s one thing to say we don’t spend enough on public health, it’s another to say we don’t know how much we spend on it. The official estimate of governmental public health spending is perhaps double reality. I don’t need to rehash why that’s bad. But maybe I’ll say that, in the context of a public health disaster, it might be nice to know the real number. Just a thought.

Figure: Official Public Health Activity Estimate and Revised Estimate, 2000-2018

Source: Centers for Medicare and Medicaid Services; US Census Bureau; Author’s analysis.
Copyright: American Journal of Public Health, 2020

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Jonathon P. Leider, PhD

Jonathon P. (JP) Leider, PhD, is an independent consultant in the public health and health policy space, as well as a Senior Lecturer at the University of Minnesota and Associate Faculty at the Johns Hopkins Bloomberg School of Public Health. He has active projects and collaborations with foundations, national public health organizations, public health researchers and academics, and public health practitioners. His current projects focus on public health systems, the public health workforce, and public health finance. He holds a PhD in Health Policy and Management from the Johns Hopkins Bloomberg School of Public Health. [Full bio]