Public Health Funding in Indiana

Indiana

The United States public health system aims to keep Americans safe and healthy through health promotion, preparedness and surveillance programs, and serves as the first line of defense against epidemics. Community-based health programs can reduce preventable health care spending: One study shows that investing in school-based substance misuse programs can return up to $20 in benefits for every $1 spent. Yet, governmental public health activities accounted for less than 5% of total U.S. health care spending in 2022. 

The public health response to the recent COVID-19 pandemic exposed critical weaknesses caused by chronic underfunding of these systems at state and national levels, driving home the importance of prioritizing this area.

Public health funding promotes the health of all individuals. 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-income 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.

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 $1.2 billion 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.

The effectiveness of a public health intervention depends on the power of the community receiving it. Effective interventions must 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 that can be improved through community-led policy solutions. 

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 from 2010 to 2020 and disparities in state resources, health departments rely on inconsistent streams of public health dollars to provide necessary services. In order to reduce disparities and improve public health for all Americans, state and federal governments must prioritize adequate and sustained funding for local health departments.

Addressing gaps in public health financing involves securing consistent and adequate funding for foundational public health services, standardizing financial data collection and monitoring, and ensuring more equitable resource distribution among communities.

Iton, Anthony, Robert K. Ross, and Pritpal S. Tamber. “Building Community Power To Dismantle Policy-Based Structural Inequity In Population Health.” Health Affairs 41, no. 12 (December 2022). https://doi.org/10.1377/hlthaff.2022.00540.

Johns, Marquisha, and Jill Rosenthal. “How Investing in Public Health Will Strengthen America’s Health.” Center for American Progress, May 17, 2022. https://www.americanprogress.org/article/how-investing-in-public-health-will-strengthen-americas-health/.

Mays, Glen P., and Cezar B. Mamaril. “Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities.” Health Services Research 52, no. S2 (2017): 2357–77. https://doi.org/doi:10.1111/1475-6773.12785.

McKillop, Matt, and Dara Alpert Leiberman. “The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations 2024.” Issue Report. Washington, D.C.: Trust for America’s Health, August 2024. https://www.tfah.org/report-details/funding-2024/.

McKillop, Matt, and Dara Alpert Lieberman. “The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations 2023.” Issue Report. Washington, D.C.: Trust for America’s Health, June 2023. https://www.tfah.org/wp-content/uploads/2023/06/TFAH-2023-PublicHealthFundingFINALc.pdf.

Orr, Jason M., Jonathon P. Leider, Rachel Hogg-Graham, J. Mac McCullough, Aaron Alford, David Bishai, and Glen P. Mays. “Contemporary Public Health Finance: Varied Definitions, Patterns, and Implications.” Annual Review of Public Health 45 (2024): 359–74. https://doi.org/10.1146/annurev-publhealth-013023-111124.

Sen-Crowe, Brendon, Mark McKenney, and Adel Elkbuli. “Public Health Prevention and Emergency Preparedness Funding in the United States: Are We Ready for the Next Pandemic?” Annals of Medicine and Surgery 59 (November 2020): 242–44. https://doi.org/10.1016/j.amsu.2020.10.007.