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U.S. public health spending declining

An analysis of public health expenditures found that spending has fallen by 9.3% since 2008, according to data published in the American Journal of Public Health.

"Public health spending has declined, potentially undermining prevention and weakening responses to health inequalities and new health threats," David U. Himmelstein, MD, a professor at City University of New York School of Public Health at Hunter College, and colleague wrote.

The researchers used data from the National Health Expenditure Accounts, which included figures from 1960 through 2013 and projections for 2014 through 2023. They also used Census Bureau population estimates.

Their analysis demonstrated that per capita public health expenditures increased from $39 in 1960 to a peak of $281 in 2008, after adjusting for inflation. Since then, they have fallen by 9.3% to $255 in 2014.

Additionally, the public health's share of total health expenditures increased from 1.36% in 1960 to a peak of 3.18% in 2002. It fell by 17% to 2.65% in 2014. Himmelstein and colleagues project that the public health's share of total health expenditures will continue to fall to 2.4% in 2023, which would be 25% less than the figure in 2002.

There are various economic and political forces at play that affect these numbers, the researchers wrote. They noted that while the Affordable Care Act pledged $15 billion to public health funding, a 2012 law and sequestration has drastically cut the funding.

"There is no absolute measure of the optimal level of public health spending," Himmelstein and colleague wrote. "However, an Institute of Medicine panel recently concluded that public health agencies are markedly underfunded, and that U.S. health spending is out of balance, with spending for clinical care disproportionately high compared with spending for 'population-based activities that more efficiently and effectively improve the nation's health.' The current trajectory of health spending seems unlikely to close the funding gap identified by the Institute of Medicine panel." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.