The Issue

Quality and affordable medical treatment is important, but staying healthy and disease-free depends even more on where we live, learn, work and play. Do we have clean drinking water, smoke-free workplaces and protections from health threats like pandemic flu? The answers to those critical questions play an enormous role in our ability to lead a healthy life.

The nation's public health system—our network of federal agencies and state and local health departments, as well as partners from the public, private and nonprofit sectors—exists to help us stay healthy by working to prevent deadly, costly, preventable diseases such as diabetes and heart disease and to ensure that we're prepared for emergencies.

But public health has never been funded in a systematic, strategic way in the United States. Federal funds are a mixture of population-based and competitive grants, so some states receive funding and others do not. State and local funding varies dramatically based on the structure of a state's public health department. This patchwork approach is further complicated by the fact that the current economic climate has forced many state and local health departments to cut budgets, reduce staff and provide fewer services for their communities. In 2009-2010, 40 percent of local health departments cut or reduced programs or services, including emergency preparedness efforts and preventive health services for pregnant women, mothers and children.

Ensuring a consistent funding stream for public health is just one step toward strengthening the nation's public health system. We also need to build the evidence for what programs, policies and services are most effective in keeping people healthy and safe. Smarter laws and policies—those that are based on sound, scientific research demonstrating their effectiveness, such as seatbelt laws and clean indoor air regulations—protect millions of people. Communities can also use sound data to help them determine how to improve health outcomes like mortality (how long people live) and morbidity (how healthy people are). And state and local health departments can use this data to help direct limited resources toward priority health concerns through proven programs and services.

Why This Matters

• America spends more than $2 trillion annually on health care—more than any other nation—yet less than four cents of every health care dollar we spend goes toward prevention and public health. Tens of millions of Americans, especially those in low-income communities, still suffer every day from preventable illnesses and poorly managed chronic diseases. And despite our health care spending, the United States ranks 36^th for life expectancy, our infant mortality is higher than that of many less affluent countries and health disparities persist.
• Many of the leading causes of death in the United States are largely preventable, with 80 percent of the risk factors being behavior-related. Behavior choices such as smoking, unhealthy eating and physical inactivity increase the chances of developing deadly, costly diseases. But too many Americans are denied affordable, healthy food to eat, clean air to breathe and safe places to exercise. Americans at every income and education level should have the same opportunities to be healthy.
• Public health makes staying healthy easier. From smoke-free air laws that promote clean indoor air to community farmers' markets that offer fresh, nutritious produce, public health lays the groundwork for the kinds of choices that ultimately help people stay healthy and prevent disease.
• Where we live, learn, work and play has a dramatic impact on our health. Everyone deserves an opportunity for a long and healthy life. Yet despite trillions of dollars in annual health care spending, millions of Americans live sicker, shorter lives because of differences in education, wealth, race/ethnicity, and where and how they live. Public health helps overcome these disparities in order to protect our nation''s most vital resource—its health.
• Right now there are no consistent standards and measures across the country that let public health departments know how well they are doing. As a result, communities can't share best practices and can't be assured that scarce public health dollars are being spent as effectively as possible. One of the best ways to achieve a stronger, more coordinated public health system is by establishing consistent standards and motivating continual quality improvement, ensuring that every community—from Maine to Alaska—has access to the best safeguards for protecting and promoting health. The new national voluntary accreditation system for state, local and tribal health departments, set to launch in September 2011, will help ensure that people can expect the same quality of public health programs and services no matter where they live.

Policy Context:

If we want a healthier nation, we need to find smarter ways to prevent disease and health crises in the communities where we live, learn, work and play. The public health system, comprised of federal agencies and state and local health departments, lays the groundwork for the kinds of choices that ultimately help people stay healthy and prevent disease.

Several states have slashed their support for public health preparedness over the last decade. This was one reason for the creation of the Prevention and Public Health Fund—a mandatory fund created by the Affordable Care Act (ACA)—aimed at assisting state and community efforts to prevent illness and promote health, so that all Americans can lead longer, more productive lives. The Fund represents an unprecedented investment—$15 billion over 10 years—that will help prevent disease, detect it early and manage conditions before they become severe. However, recent cuts by Congress to the Centers for Disease Control and Prevention budget and other federal health programs are cause for concern. Moreover, local public health departments reported losing 29,000 jobs from 2008 to 2010, approximately 19 percent of the 2008 nationwide LHD workforce. To make matters worse, as the number of public health professionals and the resources available to them has fallen, preventable disease rates and the number of public health emergencies have gone up. A new, sustained public health paradigm is necessary to reverse this trend.