As policymakers debate the weighty issues of federal spending, budget deficits and health care reform, it is easy to lose sight of the small things that have the greatest consequences for our health and well-being.
Americans have added 30 years to their life expectancy during the past century, and 25 of those additional years result from public-health protections that prevent disease and injury in communities.
Public health has produced these improvements for only pennies on the dollar. Of the $2.7 trillion the U.S. spends annually on health and medical services, only about 3 percent supports public health programs.
Unfortunately, these modest investments in powerful health protections are eroding in the wake of the economic recession and the budget battles in Washington. State and local governments provide the lion's share of funding for public health programs across the nation and here in Kentucky, but the recession has compelled significant cuts since 2008.
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On top of these cuts, federal spending on public health programs has been pared back due to sequestration — the across-the-board spending reductions of 5 percent to 7 percent that went into effect earlier this year as part of Congress' 2011 agreement to raise the federal borrowing limit.
Even public health investments authorized by the controversial Affordable Care Act have been cut back due to sequestration and competing needs for funds to implement other components of the federal health reform law. The Prevention and Public Health Fund created by this law was cut by half in 2013, from $1.25 billion to $617 million.
Shortchanging public health is risky business, given that seven in 10 deaths in the U.S. are related to preventable diseases such as obesity, diabetes, high blood pressure, heart disease and cancer, and given that 75 percent of our health-care dollars are spent treating diseases we fail to prevent.
The reductions not only diminish state and local public health agencies' ability to maintain the very programs that produced our health gains during the 20th century, but they also slow our progress in discovering new prevention strategies and in keeping the public health work force up-to-date on 21st-century advances.
Here at the University of Kentucky College of Public Health, cuts to the Prevention Fund translated into an 83-percent reduction in funds for the Kentucky and Appalachia Public Health Training Center — a program that has helped Kentucky's public health workers stay current with the latest technical, scientific and managerial strategies for health protection.
Sequestration will eliminate or significantly reduce future budget appropriations for the 37 training centers across the country, as well as funds for the Public Health Traineeship program, which had provided scholarships to UK public-health students pursuing advanced degrees in areas of specialization that are underrepresented in the work force, especially in Appalachia.
The public-health impact of budget reductions does not end with the Prevention Fund. Sequestration's 5 percent cut to the U.S. Centers for Disease Control and Prevention fiscal year 2013 operating budget translated into $33 million reductions in disaster-response funds to state and local organizations, 175,000 fewer HIV tests and $200 million cuts to programs that prevent cancer, heart attacks, strokes and diabetes.
Sequestration also dealt a blow to the National Institutes of Health, resulting in the award of 700 fewer new research grants than originally projected for FY 2013. The NIH supports not only basic science research on the biological mechanisms of disease but also innovative strategies to prevent the individual and structural causes of disease.
For example, the NIH recently funded UK's College of Public Health and College of Medicine researchers to lead a three-year planning effort with grass-roots community organizations to address the problem of access to healthy food in Appalachian Kentucky. But the resources needed to move from planning to action are becoming increasingly scarce.
Although the immediate effects of reductions in public-health funding are substantial, the costs to the future health and well-being of Americans will be much greater. If present trends continue, the next generation of public-health scientists and practitioners will face waning support, driving many to choose other occupations.
The public-health system will not be equipped to control the complex chronic health problems that already burden our medical care system and constrain our global economic competitiveness. Americans will continue to fall further behind other developed countries in longevity and health status. As the public-health community braces itself for another possible round of cuts in the current budget negotiations, we hope that policymakers will not lose sight of the long-term savings in lives and dollars that modest public-health investments can yield. Protecting the health and well-being of our communities and our children depends on it.
About the authors
: Margaret McGladrey is assistant dean for research, Glen P. Mays is Scutchfield professor of health services and systems research and Stephen W. Wyatt is dean and professor at the University of Kentucky College of Public Health.