Us public health neglected: Flat or declining spending left states ill equipped to respond to covid-19

Y. Natalia Alfonso, Jonathon P. Leider, Beth Resnick, J. Mac Mccullough, David Bishai

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


The COVID-19 pandemic has prompted concern about the integrity of the US public health infrastructure. Federal, state, and local governments spend $93 billion annually on public health in the US, but most of this spending is at the state level. Thus, shoring up gaps in public health preparedness and response requires an understanding of state spending. We present state spending trends in eight categories of public health activity from 2008 through 2018. We obtained data from the Census Bureau for all states except California and coded the data by public health category. Although overall national health expenditures grew by 4.3 percent in this period, state governmental public health spending saw no statistically significant growth between 2008 and 2018 except in injury prevention. Moreover, state spending levels on public health were not restored after cuts experienced during the Great Recession, leaving states ill equipped to respond to COVID-19 and other emerging health needs.

Original languageEnglish (US)
Pages (from-to)664-671
Number of pages8
JournalHealth Affairs
Issue number4
StatePublished - Apr 1 2021

Bibliographical note

Funding Information:
This study was funded by the Robert Wood Johnson Foundation through its Systems for Action Research (Grant No. 78116). The authors thank the Census Bureau for provision of data and Rebecca Reif for assistance with data

Publisher Copyright:
© 2021 Project HOPE.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't


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