Investments in Governmental Public Health — Who Got Funded and How Will the Money Get Used?

The COVID-19 pandemic exposed the cracks in the public health system in the United States. According to recent estimates, before the COVID-19 pandemic started there was a need for almost 54,000 additional employees in local health departments. Despite these workforce shortages, it has been challenging for health departments to improve their workforce capacity by hiring additional employees or training existing employees and helping them update their skill sets. Recent grants and other investments such as funds appropriated through the American Rescue Plan Act (ARPA) towards various public health ventures have helped improve capacity, particularly to hire contact tracers necessary during the pandemic.

In August 2022, CDC announced the Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems grant (Public Health Infrastructure Grant Program, PHI), which was also partially funded by the ARPA. The goal of the PHI grant program is to enhance public health infrastructure across the United States to ensure that “every U.S. community has the people, services, and systems needed to promote and protect health.”

Agencies eligible for funding included state governments, county governments serving populations of 2,000,000+, city and township governments serving populations of 400,000+, special district governments, and certain other government organizations. A total of 107 agencies were funded under the new grant – all 50 states, Washington D.C, 21 cities, 27 counties, and 8 territories. Everyone in the U.S. now lives in a jurisdiction that received funding under the PHI grant program.

What does this mean for the funded agencies?

Although the grant gives recipients a lot of flexibility in how to use the dollars, utilization generally falls in three categories – workforce, foundational capabilities, and data modernization. For the work plans for improving foundational capabilities and data modernization, funded agencies will receive funds each year for a total of five years. The dollars they receive to execute workforce development initiatives will all be disbursed in year one ie, in FY 2023. On average state health departments received $43,517,689.9 per agency, and city, county, and other health departments received $15,813,732; $19,500,187.8; and $7,750,547 respectively and the per capita funding received was similar across states (it ranged between $7 and $12. Although this funding allows for several exciting possibilities to develop and update public health infrastructure, there are two major shortcomings.

First, the amount received by individual departments is limited, so they can only use it to implement a small set of activities. Second, the funding is temporary, hence it cannot be used to increase staffing capacity by hiring additional permanent employees. Agencies thus need to utilize the incoming funds strategically. For instance, they can use it to train and update the skills of existing staff. Or the funding can be used to increase efficiency within health departments, for example by developing new data management protocols or other systems that do not require large upkeep expenditures. Although a lot needs to be done to increase the resiliency of health departments sustainably, this is a small step in acknowledging the needs of the public health system in the United States.

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Harshada Karnik, PhD, is a researcher at the Center for Public Health Systems at the University of Minnesota. Her research interests include public health workforce, food and governmental health systems, program evaluation, rural/community development, and health equity. She holds a PhD in applied economics and master’s in public policy from the University of Minnesota.