Patchy Public Health

When cases of swine flu began to show up in Maine last year, the state health department diverted three-quarters of its staff to an inoculation campaign and put other infectious disease prevention programs on a back burner. In Minnesota, restaurant inspectors pitched in to help deliver vaccines and hundreds of Los Angeles County health workers set aside prevention programs for tuberculosis and sexually transmitted diseases to lend a hand.

In a year when flagging state and local economies forced major cuts in public health spending, federal grants for disease prevention and emergency preparedness failed to fill the breach, according to a new report from The Robert Wood Johnson Foundation and the Trust for America's Health, which advocate for increased health spending.

In 2009, federal grants to state for public health remained flat for the fifth consecutive year at about $13.5 billion not counting $1 billion in federal stimulus money, while state and local governments reduced their investment by $392 million, a 3.4 percent cut.   

In addition, federal funding fails to reach the states that need it most, the report released March 1, says. In 2009, Midwestern states saw the lowest total funding, Southern states were next, and Northeastern states — among the healthiest populations in the country — received the largest per capita share of money from a myriad of separate grant programs administered by the U.S. Department of Health and Human Services (HHS).

The disparities in federal funding results from the federal government's failure to coordinate an array of separately administered programs and target them based on need, says Richard Hamburg, Deputy Director of Trust for America's Health. Many programs are not even based on population, but set a flat funding level per state, he said.

As a result, states with strong support for health care funding, less opposition by interests such as tobacco companies and influential representation in Congress tend to get the biggest share, regardless of their so-called burden of disease, Hamburg says.  "It's kind of a chicken and egg question. Are the states with the most funding healthy because they've traditionally had better public health services, or do healthier states — which typically have more resources — tend to be more aggressive in seeking federal funding?"

Mississippi, for example, ranks at the top of the list when it comes to obesity, hypertension, tobacco use and percentage of people who are uninsured, and at the bottom when it comes to healthy lifestyles, access to medical care and total investment in public health, according to the report.

Alaska received the most federal dollars per capita from both granting units of HHS — the Centers for Disease Control (CDC) and the Health Resources and Services Administration (HRSA) — with Virginia in last place for CDC grants and Indiana last in HRSA money per capita.  Hawaii ranks first in state investments in public health at $169.49 per person in 2009 and Nevada ranks 50th at $3.54 per person.