By Rabah Kamal and Julie Hudman Chart Collections Health Spending Posted: September 30, 2020
Public
health efforts aim to promote population health and wellbeing and generally
include a variety of initiatives, such as disaster preparedness,
nutrition and education programs, disease prevention programs, and
epidemiological surveillance. The COVID-19 pandemic is testing governments’
capacities to address a public health crisis, with some countries struggling more
than others to respond. In the U.S., there are concerns regarding the public
health system’s capacity to respond to the current pandemic and future public
health crises.
The
following charts explore high-level trends in public health and related
spending over time in the U.S. and other similarly wealthy countries (OECD
nations with above average GDP and GDP per capita), as well as spending for
public health at the federal vs. state and local levels in the U.S.
Preventive care spending is higher in the U.S.
than in many comparably wealthy countries
While
it is difficult to compare how each country funds specific public health
interventions, OECD data provide comparisons of national spending on
“preventive care,” which generally includes spending on programs for public
health information, education, and counseling; immunization, early disease
detection, healthy condition monitoring programs (e.g., for monitoring
pregnancy, child growth and development, general health check-ups);
epidemiological surveillance; and emergency preparedness and disaster response.
As these efforts largely reflect public health initiatives rather than personal
healthcare services, comparing preventive care spending offers a rough
comparison. It should be noted that “preventive care” spending as documented by
the OECD is more inclusive than the definition of “public health” spending in
CMS National Health Expenditure Accounts data for the U.S. For example, for the
U.S., OECD estimates of preventive care spending include some spending on
maternal and child health and school health programs, which are not reported as
public health activities in the U.S. National Health Expenditure Accounts.
Preventive
care spending in the U.S. constituted 2.9% of total health expenditures in 2018
– slightly higher than similarly large and wealthy countries on average (2.4%).
Spending on preventive care has declined as
share of total health spending in the U.S. while remaining flat across
comparable countries
Over
time, spending on preventive care in the U.S. has declined as a percent of
total national health spending, from 3.7% in 2000 to 2.9% in 2018. Meanwhile,
in similarly wealthy countries, spending on preventive care as a portion of
total health spending has remained about flat on average.
State and local spending accounts for most
public health spending in the U.S.
In the
U.S., state and local governments account for the majority of national spending
on public health activities. In 2018, state and localities spent $81.5 billion
on public health, while federal public health spending was $12.0 billion.
Federal
stimulus funding may help to alleviate some of the current pandemic’s burden on
the public health infrastructure. The Coronavirus Preparedness and Response Supplemental Appropriations
Act allocated nearly $6.2 billion to the Department of Health
and Human Services, including $1.9 billion towards Centers for Disease Control
(CDC) response efforts. Appropriations under the CARES Act included $4.3 billion for CDC
coronavirus-related activities and $275 million for the Health Resources and
Services Administration’s related activities. Additionally, some states have
committed funding towards their pandemic response.
The U.S. has a higher rate of preventable
deaths than comparable countries
Preventable
deaths are those that could have been thwarted by public health interventions
like vaccination programs or widespread screening for diseases like
tuberculosis and diabetes. The U.S. has long had a higher rate of preventable
deaths than all comparable countries. The rate of these deaths had been
dropping overall in the U.S. through 2012, after which the rate of preventable
deaths began to increase in the U.S. but continued to fall in comparable
countries. This increase in U.S. preventable deaths parallels deaths due to the
U.S. opioid epidemic, which has been characterized by waves of increases
in drug overdose deaths, including a wave of overdose
deaths due to heroin beginning in 2010 and another wave due to synthetic
opioids beginning in 2013.
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