CDC funding varies widely by state, report says

Robert Roos

Apr 2, 2008 (CIDRAP News) – State shares of federal spending to combat public health problems ranging from bioterrorism to obesity vary widely, with midwestern states generally getting the slimmest slices, the nonprofit group Trust for America's Health (TFAH) reported today.

Midwestern states received an average of $16.24 per person from the Centers for Disease Control and Prevention (CDC) in fiscal year 2007, whereas southern states received an average of $29.40 per person, says TFAH, a nonpartisan public health advocacy group based in Washington, DC.

In between were states in the West, with $19.74 per person, and the Northeast, with $23.37 per person, the group said. The figures come from a 144-page report, titled "Shortchanging America's Health: A State-by-State Look at How Federal Public Health Dollars Are Spent," released today.

The CDC funding by state ranged all the way from $13.61 per person for Kansas to $69.76 per person for Alaska, according to the report.

The report also examines states' shares of federal hospital preparedness funds and funds to provide healthcare access for medically underserved populations. It also catalogs how much states spend on public health from their own treasuries.

In the document, TFAH argues for increased public health spending and for better monitoring of how public health dollars are spent and what the public gets in return.

"Congress currently has no way of determining whether federal public health dollars are being spent effectively at the state and local levels," the report says.

State and local governments use CDC funds for a variety of public health programs, including bioterrorism preparedness, environmental health, immunizations, and preventing infectious disease outbreaks, chronic diseases, cancer, and HIV, TFAH officials noted.

Sharing dwindling CDC funds
In fiscal year 2007 the CDC had a total budget of $6.0 billion, a 5% drop from the previous year, the report says. About 80% of CDC funds are distributed to state and local health agencies through grants or cooperative agreement programs, TFAH said in a news release accompanying the report. Allocations to the states in 2007 totaled about $5.2 billion, a chart in the report shows.

The national average per-person allocation, calculated by dividing the CDC's total grants to the states by the overall US population, is $17.23, the chart shows.

That figure shows how funding has gone down, according to Jeff Levi, PhD, executive director of TFAH. "The last time we did this report [in 2006], the national average was $3.76 higher," he told CIDRAP News.

Levi said there's no simple explanation for the wide differences in state shares of CDC funds.

'There's not a logic for why state funding varies so widely," he said. "There are probably theories of explanations, none of which would apply across the board. Some states probably receive earmarks—when you see Alaska at the top, with [Sen.] Ted Stevens, that comes to mind. There are some programs for which CDC doesn't have enough money to fund every state, such as obesity. Some states do a better job of aggressively seeking CDC funding."

Levi said a large percentage of CDC grants are not based on disease prevalence, so differences in disease burden are not a big reason for the funding disparities.

The report also lists states' shares of federal funds for hospital preparedness for major health emergencies, such as an influenza pandemic. In 2007 the HHS Office of the Assistant Secretary for Preparedness and Response distributed about $430 million to the states for this purpose, amounting to about $100,000 per hospital, TFAH says.

On a per capita basis, state shares of the hospital preparedness funds ranged from 75 cents for New York to $2.21 for Wyoming, with a national average of $1.43.

Also in the report are state shares of about $5.16 billion in federal spending to improve healthcare access for underserved populations. The shares ranged from $8.73 for Kansas to $57.57 for Alaska. The money is distributed by HHS's Health Resources and Services Administration.

In addition, the report shows state public health budgets for fiscal year 2006-07. Here too, per-person spending covered a wide range—from $3.46 in Nevada to $152.66 in Hawaii. The national median was $33.26, the amount North Dakota spent.

Also included is a chart of health indicators and related data for each state, with state rankings for each indicator. The charts also include estimates of potential cases and deaths in a severe flu pandemic, assuming a 30% attack rate and a 2.5% case-fatality rate. Levi said the estimates were included in a 2007 TFAH report that estimated the state-by-state economic impact of a pandemic. Estimated pandemic-related financial losses are also included in the state charts.

More accountability needed
The report contends that the nation is in sore need of better information on public health spending and what it achieves. For example, information released by the CDC about its spending is limited and is inconsistent from year to year, it says. "As a result, accountability for public health programs is virtually impossible and will remain so until there is greater transparency and comparability of budget and health data."

The document also details how states report on public health spending in different ways, making comparisons difficult.

The report calls for "transparent budget information at the local, state, and national levels." This would allow the public and government officials "to compare spending levels and program outcomes by state and localities to determine best practices for protecting and improving overall population health."

Feb 11 CIDRAP News story "CDC says state preparedness much improved since 2001"

Jul 11, 2007, CIDRAP News story "HHS to give states $430 million for hospital preparedness"

Mar 22, 2007, CIDRAP News story "Pandemic could cause deep, uneven recession, group predicts"