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Public Health Infrastructure

 , April 03, 2020

April 3, 2020

As Congress undertakes the next iteration of legislation to speed the response to the COVID-19 pandemic, the undersigned organizations urge you to include a significant, long-term investment in public health infrastructure. This investment is critical to support the public health system as it rebuilds from the COVID-19 response, but also to strengthen it before the next pandemic hits and avoid the loss of life and social and economic disruption we are facing today. The importance of strong, predictable federal investment in this system is even more vital now as the economic impacts of the pandemic are felt nationwide. State and local governmental budgets, and therefore public health budgets, are likely to be devastated. This will leave our nation even more vulnerable to emerging health risks. By building the core public health infrastructure of states, localities, tribal governments and territories, as well as the Centers for Disease Control and Prevention (CDC), the nation will be better prepared for the next threat.

Our groups recommend $4.5 billion in additional annual funding for CDC, state, local, tribal and territorial core public health infrastructure to pay for such essential activities as disease surveillance, epidemiology, laboratory capacity, all-hazards preparedness and response; policy development and support; communications; community partnership development; and organizational competencies.
For too long, the nation has neglected basic public health capacity. More than 56,000 local public health jobs were eliminated between 2008 and 2017—nearly one quarter of the workforce.1 Health departments are still dependent on archaic methods of tracking diseases, including phone, fax and paper.2 CDC’s funding remains just above level with FY2008, when adjusting for inflation,3 and funding specific to state and local public health preparedness has been cut from $939 million in FY2003 to $675 million in FY2020. That means there has been little room to modernize, retain skilled workforce, and address emerging threats. In fact, only 51 percent of the U.S. population is served by a comprehensive public health system, and the estimated gap in funding foundational public health capabilities is about $13 per person per year, yielding the requested $4.5 billion.4

The COVID-19 pandemic is illustrating in the direst terms the consequences of underfunding public health. The delays in diagnostic testing are hampering communities’ ability to suppress the virus. Public health departments are attempting to conduct statewide situational awareness and management of medical supply shortages. The response is personnel-heavy – investigating cases, managing supplies and volunteers, conducting risk communications, coordinating with governmental and healthcare partners, and planning for the next phase of response.

The U.S. has followed a pattern of underfunding of vital public health services, followed by a crisis, a quick infusion of cash, and then dwindling investments over time.5 This pattern is placing American lives at risk. We must think not just of the short-term needs of this pandemic, but the long-term readiness of our nation. We applaud Congress for taking quick action to provide $8.3 billion for the initial response, which included $950 million for the state and local public health response. However, short-term, supplemental funding does not allow public health to recruit and retain the expert workforce needed for protecting the nation against emerging threats. We urge you to do act now to prevent and prepare for the next pandemic.

1 New Workforce Survey: Public Health Turnover Could Pose Threat to Community Health. de Beaumont Foundation, 2019.

2 Written statement of Janet Hamilton, Council of State and Territorial Epidemiologists before U.S. House of Representatives Subcommittee on Labor, Health and Human Services, Education and Related Agencies, April 9, 2019.
3 In FY 2008, CDC funding was $6.375 billion (at the program level). FY 2020 funding is $7.694 billion (program level). Adjusted for inflation, the 2008 number would be $7.5168 billion in 2020 dollars.
4 Public Health Leadership Forum. Developing a financing system to support public health infrastructure. Available at:
5 The Impact of Chronic Underfunding of America’s Public Health System: Trends, Risks, and Recommendations, 2019. Trust for America’s Health.

This letter signed by 160 organizations, including SGIM

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