Per capita public health spending has dropped 9.3% since 2008, reflecting a $40.2 billion loss to disease prevention and related programs from 2009 through 2014, according to an article published in the American Journal of Public Health.

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Public health spending is down in the US.

The Affordable Care Act (ACA) stresses the importance of disease prevention, for example, by mandating insurance coverage of clinical preventive services such as mammograms.

But the current research indicates that funding for public health programs to prevent disease has actually been declining in recent years.

There is no absolute measure of the optimal level of public health spending, but an Institute of Medicine panel recently concluded that public health agencies are markedly underfunded.

Drs. David Himmelstein and Dr. Steffie Woolhandler, both of the City University of New York (CUNY) School of Public Health at Hunter College and Harvard Medical School, Boston, MA, examined 5 decades of data from the National Health Expenditure Accounts (NHEA) compiled by the US Department of Health and Human Services and from the US Census Bureau.

They found that after adjustments for inflation, public health spending per head of population rose from $39 in 1960 to $281 in 2008, but it has fallen by 9.3% since then.

Public health’s share of total health expenditure rose from 1.36% in 1960 to 3.18% in 2002, then fell to 2.65% in 2014. It is projected to fall to 2.40% in 2023.

The authors note that if funding had remained at the 2008 level of $281 per capita, this would have enabled an extra $40.2 billion to be devoted to public health between 2009 and 2014.

Dr. Himmelstein comments:

Obamacare was supposed to add $15 billion to public health funding. But in 2012, Congress cut that by $6.25 billion, and sequestration imposed further cuts in 2013. This year, public health will get less than half of the $2 billion promised by the ACA. And state and local government public health spending has also fallen, even while their other health expenditures have continued to rise.”

Dr. Woolhandler believes that the US health care system is “dangerously out of balance,” as increasing amounts are spent on treating disease, but less and less on prevention.

She adds that while spending is high on hepatitis C and cancer drugs, there is a lack of funding for drug abuse prevention, needle exchange programs and anti-smoking campaigns.

The authors acknowledge that many state and local governments – the main source of public health funding – have faced financial challenges, but point out that state medical care spending has increased, while public health spending has not. They suggest that the decline in public health spending could undermine prevention and weaken responses to health inequalities and new health threats.

Medical News Today reported on research back in July 2014 showing that growth in US public spending on health has slowed.