1932

Abstract

The United States has a complex governmental public health system. Agencies at the federal, state, and local levels all contribute to the protection and promotion of the population's health. Whether the modern public health system is well situated to deliver essential public health services, however, is an open question. In some part, its readiness relates to how agencies are funded and to what ends. A mix of Federalism, home rule, and happenstance has contributed to a siloed funding system in the United States, whereby health agencies are given particular dollars for particular tasks. Little discretionary funding remains. Furthermore, tracking how much is spent, by whom, and on what is notoriously challenging. This review both outlines the challenges associated with estimating public health spending and explains the known sources of funding that are used to estimate and demonstrate the value of public health spending.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-publhealth-040617-013455
2018-04-01
2025-04-26
Loading full text...

Full text loading...

/deliver/fulltext/publhealth/39/1/annurev-publhealth-040617-013455.html?itemId=/content/journals/10.1146/annurev-publhealth-040617-013455&mimeType=html&fmt=ahah

Literature Cited

  1. 1. APHA (Am. Public Health Assoc.). 2015.. Prevention and Public Health Fund Dedicated to improving our nation's public health. Fact Sheet, APHA, Washington, DC:. https://www.apha.org/∼/media/files/pdf/topics/aca/2015_pphf_fact_sheet.ashx [Google Scholar]
  2. Armstrong GL. , Conn LA. , Pinner RW. 2. . 1999.. Trends in infectious disease mortality in the United States during the 20th century. . JAMA 281::6166 [Google Scholar]
  3. 3. ASTHO (Assoc. State Territ. Health Off.). 2011.. ASTHO Profile of Health, Vol. 2. Arlington, VA:: ASTHO. http://www.astho.org/uploadedFiles/_Publications/Files/Survey_Research/ASTHO_State_Profiles_Single%5B1%5D%20lo%20res.pdf [Google Scholar]
  4. 4. ASTHO (Assoc. State Territ. Health Off.). 2011.. Budget cuts continue to affect the health of Americans. Update, May. ASTHO, Arlington, VA: [Google Scholar]
  5. 5. ASTHO (Assoc. State Territ. Health Off.). 2014.. ASTHO Profile of Health, Vol. 3. Arlington, VA:: ASTHO. http://www.astho.org/Profile/Volume-Three/ [Google Scholar]
  6. 6. ASTHO (Assoc. State Territ. Health Off.). 2014.. Budget cuts continue to affect the health of Americans. Update, Sept. ASTHO, Arlington, VA:. http://www.astho.org/budget-cuts-Sept-2014/ [Google Scholar]
  7. Atchison C. , Barry MA. , Kanarek N. , Gebbie K. 7. . 2000.. The quest for an accurate accounting of public health expenditures. . J. Public Health Manag. Pract. 6::93102 [Google Scholar]
  8. Avery G. , Zabriskie-Timmerman J. 8. . 2009.. The impact of federal bioterrorism funding programs on local health department preparedness activities. . Eval. Health Prof. 32::95127 [Google Scholar]
  9. Barry M. , Bialek R. 9. . 2004.. Tracking our investments in public health: What have we learned?. J. Public Health Manag. Pract. 10::38392 [Google Scholar]
  10. Baum NM. , DesRoches C. , Campbell EG. , Goold SD. 10. . 2011.. Resource allocation in public health practice: a national survey of local public health officials. . J. Public Health Manag. Pract. 17::26574 [Google Scholar]
  11. Bekemeier B. 11. . 2016.. The Public Health Activities and Services Tracking study. Univ. Wash., Seattle:. https://phastdata.org/ [Google Scholar]
  12. Bekemeier B. , Singh S. , Schoemann A. 12. . 2018.. A uniform chart of accounts for public health agencies: an “essential ingredient” for a strong public health system. . J. Public Health Manag. Pract. In press [Google Scholar]
  13. Bekemeier B. , Yang Y. , Dunbar MD. , Pantazis A. , Grembowski DE. 13. . 2014.. Targeted health department expenditures benefit birth outcomes at the county level. . Am. J. Prev. Med. 46::56977 [Google Scholar]
  14. Bernet P. 14. . 2016.. Florida expense loads. Data set, Fla. Atl. Univ. [Google Scholar]
  15. Berwick DM. , Nolan TW. , Whittington J. 15. . 2008.. The triple aim: care, health, and cost. . Health Aff. 27::75969 [Google Scholar]
  16. Briss PA. , Zaza S. , Pappaioanou M. , Fielding J. , Wright-De Agüero L. 16. , et al. 2000.. Developing an evidence-based Guide to Community Preventive Services—methods. . Am. J. Prev. Med. 18::3543 [Google Scholar]
  17. Brown TT. 17. . 2014.. How effective are public health departments at preventing mortality?. Econ. Hum. Biol. 13::3445 [Google Scholar]
  18. Brown TT. 18. . 2016.. Returns on investment in California County Departments of Public Health. . Am. J. Public Health 106::147782 [Google Scholar]
  19. Brown TT. , Martinez-Gutierrez MS. , Navab B. 19. . 2014.. The impact of changes in county public health expenditures on general health in the population. . Health Econ. Policy Law 9::25169 [Google Scholar]
  20. Buck JA. 20. . 2011.. The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act. . Health Aff. 30::140210 [Google Scholar]
  21. 21. CDC (Cent. Dis. Control Prev.). 1994.. Selected characteristics of local health departments–United States, 1992–1993. . MMWR 43::83943 [Google Scholar]
  22. 22. CDC (Cent. Dis. Control Prev.). 2015.. HHS FY2015 budget in brief. US Dep. Health Hum. Serv., Washington, DC:. https://www.hhs.gov/about/budget/fy2015/budget-in-brief/cdc/index.html [Google Scholar]
  23. 23. CDC (Cent. Dis. Control Prev.). 2017.. Grant funding profiles. Updated March 22 , CDC, Atlanta:. https://www.cdc.gov/fundingprofiles/index.htm [Google Scholar]
  24. 24. CDC (Cent. Dis. Control Prev.). 2017.. The public health system and the 10 essential public health services. Updated Sept. 20, CDC , Atlanta:. https://www.cdc.gov/stltpublichealth/publichealthservices/essentialhealthservices.html [Google Scholar]
  25. 25. CMS (Cent. Medicare Medicaid Serv.). 2014.. National Health Expenditure Accounts: Methodology Paper: Definitions, Sources, and Methods. Baltimore, MD:: CMS. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/downloads/dsm-14.pdf [Google Scholar]
  26. Costich JF. , Honoré PA. , Scutchfield FD. 26. . 2009.. Public health financial management needs: report of a national survey. . J. Public Health Manag. Pract. 15::30710 [Google Scholar]
  27. Cowell A. , McCarty D. , Cowell A. 27. . 2003.. Impact of federal Substance Abuse Block Grants on state substance abuse spending: literature and data review. . J. Ment. Health Policy Econ. 6::17379 [Google Scholar]
  28. Cutler D. , Miller G. 28. . 2005.. The role of public health improvements in health advances: The twentieth-century United States. . Demography 42::122 [Google Scholar]
  29. Emerson H. 29. . 1945.. Local Health Units for the Nation. New York:: Commonw. Fund [Google Scholar]
  30. Erwin PC. , Shah GH. , Mays GP. 30. . 2014.. Local health departments and the 2008 recession: characteristics of resiliency. . Am. J. Prev. Med. 46::55968 [Google Scholar]
  31. Fielding JE. , Teutsch S. , Koh H. 31. . 2012.. Health reform and Healthy People initiative. . Am. J. Public Health 102::3033 [Google Scholar]
  32. 32. Found. Public Health Serv. Subgroup. 2013.. Foundational Public Health Services Preliminary Cost Estimation Model. Final Report. Seattle, WA:: Agenda for Change [Google Scholar]
  33. Frieden TR. 33. . 2004.. Asleep at the switch: local public health and chronic disease. . Am. J. Public Health 94::205961 [Google Scholar]
  34. Frieden TR. 34. . 2015.. The future of public health. . N. Engl. J. Med. 373::174854 [Google Scholar]
  35. Frieden TR. , Bassett MT. , Thorpe LE. , Farley TA. 35. . 2008.. Public health in New York City, 2002–2007: confronting epidemics of the modern era. . Int. J. Epidemiol. 37::96677 [Google Scholar]
  36. Georgeson M. , Thorpe LE. , Merlino M. , Frieden TR. , Fielding JE. 36. , Big Cities Health Coalit . 2005.. Shortchanged? An assessment of chronic disease programming in major US city health departments. . J. Urban Health 82::18390 [Google Scholar]
  37. Gerzoff RB. , Gordon RL. , Richards TB. 37. . 1996.. Recent changes in local health department spending. . J. Public Health Policy 17::17080 [Google Scholar]
  38. Gordon RL. , Gerzoff RB. , Richards TB. 38. . 1997.. Determinants of US local health department expenditures, 1992 through 1993. . Am. J. Public Health 87::9195 [Google Scholar]
  39. Handler AS. , Turnock BJ. 39. . 1996.. Local health department effectiveness in addressing the core functions of public health: essential ingredients. . J. Public Health Policy 17::46083 [Google Scholar]
  40. Handler AS. , Turnock BJ. , Hall W. , Potsic S. , Munson J. 40. , et al. 1995.. A strategy for measuring local public health practice. . Am. J. Prev. Med. 11::2935 [Google Scholar]
  41. Hartman M. , Martin AB. , Lassman D. , Catlin A. 41. , Natl. Health Expend. Acc. Team. 2015.. National health spending in 2013: growth slows, remains in step with the overall economy. . Health Aff. 34::15060 [Google Scholar]
  42. Hearne S. , Castrucci BC. , Leider JP. , Rhoades EK. , Russo P. , Bass V. 42. . 2015.. The future of urban health: needs, barriers, opportunities, and policy advancement at large urban health departments. . J. Public Health Manag. Pract. 21:(Suppl. 1):S413 [Google Scholar]
  43. Himmelstein DU. , Woolhandler S. 43. . 2016.. Public health's falling share of US health spending. . Am. J. Public Health 106::5657 [Google Scholar]
  44. Holsinger JW Jr.. , Scutchfield FD. 44. . 2012.. Introduction: History and Context of Public Health Care. . In Contemporary Public Health: Principles, Practice, and Policy, pp. 124. Lexington:: Univ. Press Ky. [Google Scholar]
  45. Honoré PA. 45. . 2012.. Measuring progress in public health finance. . J. Public Health Manag. Pract. 18::3068 [Google Scholar]
  46. Honoré PA. , Clarke RL. , Mead DM. , Menditto SM. 46. . 2007.. Creating financial transparency in public health: examining best practices of system partners. . J. Public Health Manag. Pract. 13::12129 [Google Scholar]
  47. Honoré PA. , Leider JP. , Singletary V. , Ross DA. 47. . 2015.. Taking a step forward in public health finance: establishing standards for a uniform chart of accounts crosswalk. . J. Public Health Manag. Pract. 21::50913 [Google Scholar]
  48. Honoré PA. , Simoes EJ. , Jones WJ. , Moonesinghe R. 48. . 2004.. Practices in public health finance: an investigation of jurisdiction funding patterns and performance. . J. Public Health Manag. Pract. 10::44450 [Google Scholar]
  49. Ingram RC. , Bernet PM. , Costich JF. 49. . 2012.. Public health services and systems research: current state of finance research. . J. Public Health Manag. Pract. 18::51519 [Google Scholar]
  50. 50. IOM (Inst. Med.), Comm. Public Health Strateg. Improve Health. 2012.. For the Public's Health: Investing in a Healthier Future. Washington, DC:: Natl. Acad. Press [Google Scholar]
  51. 51. IOM (Inst. Med.), Comm. Study Future Public Health. 1988.. The Future of Public Health. . Washington, DC:: Natl. Acad. Press
  52. 52. IOM (Inst. Med.), Comm. Valuing Community-Based Non-Clin. Prev. Polic. Wellness Strateg. 2012.. An Integrated Framework for Assessing the Value of Community-Based Prevention. Washington, DC:: Natl. Acad. Press [Google Scholar]
  53. Kinner K. , Pellegrini C. 53. . 2009.. Expenditures for public health: assessing historical and prospective trends. . Am. J. Public Health 99::178091 [Google Scholar]
  54. Knudson AD. , Hernandez A. , Kronstadt J. , Allis P. , Meit M. 54. , et al. 2012.. A Profile of Tribal Health Departments. Bethesda, MD:: NORC, Univ. Chicago. http://www.norc.org/PDFs/Walsh%20Center/KnudsonA_Profile_Tribal_Health_Dept_FINAL_2012.pdf [Google Scholar]
  55. Koh HK. , Sebelius KG. 55. . 2010.. Promoting prevention through the Affordable Care Act. . N. Engl. J. Med. 363::129699 [Google Scholar]
  56. Leep CJ. , Shah GH. 56. . 2012.. NACCHO's National Profile of Local Health Departments study: the premier source of data on local health departments for surveillance, research, and policymaking. . J. Public Health Manag. Pract. 18::18689 [Google Scholar]
  57. Leider JP. 57. . 2016.. The problem with estimating public health spending. . J. Public Health Manag. Pract. 22::E111 [Google Scholar]
  58. Leider JP. , Castrucci BC. , Hearne S. , Russo P. 58. . 2015.. Organizational characteristics of large urban health departments. . J. Public Health Manag. Pract. 21:(Suppl. 1):S1419 [Google Scholar]
  59. Leider JP. , Castrucci BC. , Russo P. , Hearne S. 59. . 2015.. Perceived impacts of health care reform on large urban health departments. . J. Public Health Manag. Pract. 21:(Suppl. 1):S6675 [Google Scholar]
  60. Leider JP. , Resnick B. , Kass N. , Sellers K. , Young J. 60. , et al. 2014.. Budget- and priority-setting criteria at state health agencies in times of austerity: a mixed-methods study. . Am. J. Public Health 104::109299 [Google Scholar]
  61. Leider JP. , Resnick B. , Sellers K. , Kass N. , Bernet P. 61. , et al. 2015.. Setting budgets and priorities at state health agencies. . J. Public Health Manag. Pract. 21::33644 [Google Scholar]
  62. Leider JP. , Resnick BA. , Sensenig AL. , Alfonso N. , Brady E. , Bishai DM. 62. . 2016.. Assessing the Public Health Activity Estimate from the National Health Expenditure Accounts: why public health expenditure definitions matter. . J. Health Care Financ. 43::22540 [Google Scholar]
  63. Leider JP. , Sellers K. , Shah G. , Pearsol J. , Jarris PE. 63. . 2012.. Public health spending in 2008: on the challenge of integrating PHSSR data sets and the need for harmonization. . J. Public Health Manag. Pract. 18::35563 [Google Scholar]
  64. Lenihan P. 64. . 2005.. The public health system: an idea whose time has come. . J. Public Health Manag. Pract. 11::16567 [Google Scholar]
  65. Levi J. , Juliano C. , Richardson M. 65. . 2007.. Financing public health: diminished funding for core needs and state-by-state variation in support. . J. Public Health Manag. Pract. 13::97102 [Google Scholar]
  66. Lin F. , Lasry A. , Sansom SL. , Wolitski RJ. 66. . 2013.. Estimating the impact of state budget cuts and redirection of prevention resources on the HIV epidemic in 59 California local health departments. . PLOS ONE 8::e55713 [Google Scholar]
  67. Lindley MC. 67. . 2013.. Billing practices of local health departments providing 2009 pandemic influenza A (H1N1) vaccine. . J. Public Health Manag. Pract. 19::22023 [Google Scholar]
  68. Madamala K. , Sellers K. , Pearsol J. , Dickey M. , Jarris PE. 68. . 2010.. State landscape in public health planning and quality improvement: results of the ASTHO survey. . J. Public Health Manag. Pract. 16::3238 [Google Scholar]
  69. 69. Mays GP, Public Health Cost Estim. Workgr. 2014.. Estimating the Costs of Foundational Public Health Capabilities: A Recommended Methodology. Lexington, KY:: Univ. Ky. Natl. Coord. Cent. Public Health Serv. Syst. Res. [Google Scholar]
  70. Mays GP. , Smith SA. 70. . 2011.. Evidence links increases in public health spending to declines in preventable deaths. . Health Aff. 30::158593 [Google Scholar]
  71. McCullough JM. , Leider JP. 71. . 2016.. Government spending in health and nonhealth sectors associated with improvement in county health rankings. . Health Aff. 35::203743 [Google Scholar]
  72. McCullough JM. , Leider JP. , Riley WJ. 72. . 2015.. Local fiscal allocation for public health departments. . Am. J. Prev. Med. 49::92129 [Google Scholar]
  73. Meit M. , Knudson A. 73. . 2009.. Why is rural public health important? A look to the future. . J. Public Health Manag. Pract. 15::18590 [Google Scholar]
  74. Meit M. , Sellers K. , Kronstadt J. , Lawhorn N. , Brown A. 74. , et al. 2012.. Governance typology: a consensus classification of state-local health department relationships. . J. Public Health Manag. Pract. 18::52028 [Google Scholar]
  75. Miller CA. 75. . 2015.. The use of local tax dollars in Kentucky local health departments to sustain programs from 2009–2013. PhD Thesis, Univ. Ky., Coll. Public Health [Google Scholar]
  76. Moulton AD. , Halverson PK. , Honoré PA. , Berkowitz B. 76. . 2004.. Public health finance: a conceptual framework. . J. Public Health Manag. Pract. 10::37782 [Google Scholar]
  77. Novick LF. , Morrow CB. , Mays GP. 77. . 2007.. Public Health Administration: Principles for Population-Based Management. Sudbury, MA:: Jones & Bartlett [Google Scholar]
  78. Ogden LL. , Sellers K. , Sammartino C. , Buehler JW. , Bernet PM. 78. . 2012.. Funding formulas for public health allocations: federal and state strategies. . J. Public Health Manag. Pract. 18::30916 [Google Scholar]
  79. 79. PHNCI (Public Health Natl. Cent. Innov.). 2016.. Aligning Accreditation and the Foundational Public Health Capabilities. Alexandria, VA:: PHNCI [Google Scholar]
  80. 80. PHNCI (Public Health Natl. Cent. Innov.). 2016.. Foundational Public Health Services. Washington, DC:: PHNCI. http://phnci.org/ [Google Scholar]
  81. 81. Public Health Leadersh. Forum. 2014.. Defining and constituting foundational “capabilities” and “areas” version 1. March. RESOLVE, Washington, DC:. http://www.resolv.org/site-healthleadershipforum/files/2014/03/Articulation-of-Foundational-Capabilities-and-Foundational-Areas-v1.pdf [Google Scholar]
  82. Reschovsky A. , Zahner SJ. 82. . 2016.. Forecasting the revenues of local public health departments in the shadows of the “Great Recession.”. J. Public Health Manag. Pract. 22::12028 [Google Scholar]
  83. Resnick B. , Bishai D. , Leider JP. , Colrick I. 83. . 2017.. State Health Expenditure Dataset (SHED), 2000–2013. ICPSR 36741, Univ. Mich., Ann Arbor. http://www.icpsr.umich.edu/icpsrweb/ICPSR/studies/36741 [Google Scholar]
  84. Resnick B. , Leider J. , Le J. , Kish N. , Brady E. 84. , et al. 2015.. State-level spending on public health by all governmental agencies: using Census of Government data to create a new finance dataset for the field. Presented at Am. Public Health Assoc. Annu. Meet. Expo., 143rd, Oct. 31—Nov. 4, Chicago [Google Scholar]
  85. Riley WJ. , Gearin KJ. , Parrotta CD. , Briggs J. , Gyllstrom ME. 85. . 2013.. Tax levy financing for local public health: fiscal allocation, effort, and capacity. . Am. J. Prev. Med. 45::77681 [Google Scholar]
  86. Rosenbaum S. 86. . 2011.. The Patient Protection and Affordable Care Act: implications for public health policy and practice. . Public Health Rep. 126::13035 [Google Scholar]
  87. Schlenker T. , Huber CA. 87. . 2015.. A unique funding opportunity for public health in Texas. . J. Public Health Manag. Pract. 21:(Suppl. 1):S8186 [Google Scholar]
  88. Sensenig AL. 88. . 2007.. Refining estimates of public health spending as measured in national health expenditures accounts: the United States experience. . J. Public Health Manag. Pract. 13::10314 [Google Scholar]
  89. Sensenig AL. , Resnick BA. , Leider JP. , Bishai DM. 89. . 2017.. The who, what, how, and why of estimating public health activity spending. . J. Public Health Manag. Pract. 23::55659 [Google Scholar]
  90. Shah GH. , Ye J. , Leep CJ. , Leider JP. 90. . 2016.. Local health departments' approaches to deal with recession: what strategies are used to minimize the negative impact on public health services to community?. J. Public Health Manag. Pract. 22::53741 [Google Scholar]
  91. Shemilt I. , Mugford M. , Drummond M. , Eisenstein E. , Mallender J. 91. , et al. 2006.. Economics methods in Cochrane systematic reviews of health promotion and public health related interventions. . BMC Med. Res. Methodol. 6::55 [Google Scholar]
  92. Shila Waritu A. , Bulzacchelli MT. , Begay ME. 92. . 2015.. Use of fees to fund local public health services in Western Massachusetts. . J. Public Health Manag. Pract. 21::16775 [Google Scholar]
  93. Singh SR. 93. . 2014.. Public health spending and population health: a systematic review. . Am. J. Prev. Med. 47::63440 [Google Scholar]
  94. Singh SR. , Bakken E. , Kindig DA. , Young GJ. 94. . 2016.. Hospital community benefit in the context of the larger public health system: a state-level analysis of hospital and governmental public health spending across the United States. . J. Public Health Manag. Pract. 22::16474 [Google Scholar]
  95. Stewart ST. , Cutler DM. 95. . 2014.. The contribution of behavior change and public health to improved US population health. Natl. Bur. Econ. Res. Work. Pap. 20631 [Google Scholar]
  96. Suen J. , Christenson GM. , Cooper A. , Taylor M. 96. . 1995.. Analysis of the current status of public health practice in local health departments. . Am. J. Prev. Med. 11::5154 [Google Scholar]
  97. 97. Trust for America's Health. 2012.. Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts. Washington, DC:: Trust for America's Health. http://healthyamericans.org/assets/files/Investing.pdf [Google Scholar]
  98. Turnock BJ. 98. . 2004.. Public Health: What It Is and How It Works. Sudbury, MA:: Jones & Bartlett Learn. [Google Scholar]
  99. Turnock BJ. , Handler A. , Hall W. , Potsic S. , Nalluri R. , Vaughn EH. 99. . 1994.. Local health department effectiveness in addressing the core functions of public health. . Public Health Rep. 109::65358 [Google Scholar]
  100. 100. US Bur. Census. 2006.. Government Finance and Employment Classification Manual. Washington, DC:: US Bur. Census. https://www2.census.gov/govs/pubs/classification/2006_classification_manual.pdf [Google Scholar]
  101. 101. US Census Bur. 2016.. Consolidated Federal Funds Report. . Baltimore, MD:: Fed. Financ. Stat. Progr.
  102. 102. US OMB (Off. Manag. Budg.). 1980.. Catalog of Federal Domestic Assistance. Washington, DC:: US Gov. Print. Off. [Google Scholar]
  103. 103. US OMB (Off. Manag. Budg.). 2015.. Historical tables. OMB, Washington, DC:. https://obamawhitehouse.archives.gov/omb/budget/Historicals [Google Scholar]
  104. 104. US Public Health Serv. 2014.. History. Updated Sept. 5, US Dep. Health Hum. Serv., Washington, DC:. https://www.usphs.gov/aboutus/history.aspx [Google Scholar]
  105. Willard R. , Shah GH. , Leep C. , Ku L. 105. . 2012.. Impact of the 2008–2010 economic recession on local health departments. . J. Public Health Manag. Pract. 18::10614 [Google Scholar]
  106. Williams SL. , Nichols BL. , Barton MK. , De LaCruz M. , Hernandez B. 106. . 2015.. Local leadership and the Affordable Care Act. . J. Public Health Manag. Pract. 21:(Suppl. 1):S8792 [Google Scholar]
/content/journals/10.1146/annurev-publhealth-040617-013455
Loading
/content/journals/10.1146/annurev-publhealth-040617-013455
Loading

Data & Media loading...

Supplementary Data

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error