Chronic underfunding and a depleted workforce for public health have hampered America's ability to respond to situations like the novel coronavirus pandemic, according to a new report.

The analysis from the nonprofit Trust for America's Health examined the country's investment in public health primarily through the lens of federal and state funding in recent years, and showed what authors summarized as a "mixed picture."

For example, while the overall budget for the Centers for Disease Control and Prevention – a front-line agency in the current coronavirus fight – increased by 9% in fiscal 2020 over the previous year, funding for the agency's public health preparedness and response programs decreased from $858 million to $850 million.

A 5% budget increase for chronic disease prevention and health promotion efforts also only translates to the agency having less than $3 per capita to spend on chronic disease prevention, when such problems – along with mental health conditions – account for more than $3 trillion in annual health care costs, according to the report.

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"CDC’s overall budget is far from what is needed to adequately fund CDC’s activities in public health," the report says, noting also that the agency "has historically lacked the funding to adequately support comprehensive public health systems at the federal, state, and local levels."

The report additionally highlights that while Congress recently reauthorized a crucial CDC funding source for state and local public health emergency preparedness and response, "this funding was cut by hundreds of millions of dollars over the past two decades" and remained flat in fiscal 2020.

"Funding was already insufficient to restore lost resources, making the United States less prepared for public health emergencies, which are becoming more frequent and increasingly severe," the report says.

The report examines other federal initiatives and agencies as well, and shows that the Department of Health and Human Services' Hospital Preparedness Program – "the single source of federal funding to help regional healthcare systems prepare for emergencies," according to the report's summary – saw its budget nearly halved from $515 million in fiscal 2004 to $275.5 million in fiscal 2020.

The shortfalls also extend to the public health workforce, as funding issues led to the estimated loss of more than 56,000 staff positions over a decade, the report notes. In 2017, it says, more than half of large local health departments reported a decrease in jobs.

Such issues are now coming into play as the nation tries to curb the coronavirus pandemic, according to the Trust for America's Health.

“COVID-19 has shined a harsh spotlight on the country’s lack of preparedness for dealing with threats to Americans’ well-being,” John Auerbach, the nonprofit's president and CEO, said in a statement. “Years of cutting funding for public health and emergency preparedness programs has left the nation with a smaller-than-necessary public health workforce, limited testing capacity, an insufficient national stockpile and archaic disease tracking systems – in summary, twentieth-century tools for dealing with twenty-first-century challenges.”

At the state level, the report says 11 states cut state spending on public health in fiscal 2019, with Wyoming and Alabama accounting for the largest cuts at 5.7% and 5%, respectively. In fiscal 2018, the report notes, funding was cut in 17 states and the District of Columbia.

On average, states received $23.53 per person in CDC grants for fiscal year 2019, according to the report, but the amount varied significantly by state, from $18.44 per person in New Jersey to $69.25 in Alaska.

The report recommends that the federal government substantially increase public health funding for fiscal year 2021, with goals of modernizing the nation’s public health surveillance infrastructure, bolstering the public health workforce and addressing social determinants of health.

And while the report's authors acknowledge Congress' passage of multiple COVID-19 response bills that include supplemental funding, the measures are only stopgaps, they say.