Public health funding is just a fraction of what the federal government spends anually. In 2014 the federal government will spend only 1.6 percent of its total $3.5 trillion budget on discretionary health programs;iv the equivalent of only 0.3 percent of our nations overall economy.vii

Of this, about half of the federal public health funding supports health research at the NIH, with the remainder supporting other public health activities—disease prevention and response, food and drug safety, workforce development, access to primary and preventive care, and other health research and data
collection activities.


When lawmakers and policy wonks in Washington talk about how and on what taxpayer dollars are spent, they generally think in terms of two types of programs—“mandatory” and “discretionary.” Mandatory programs include Social Security, Medicare, Medicaid, and Supplemental and Nutrition Assistance Program or “SNAP” (formerly “food stamps”). The funding for these programs generally flows automatically and is not determined by annual spending bills developed by Congress. Funding for discretionary programs is set each year through the annual budget process. That is, Congress retains complete “discretion” or choice, each year on whether and at what level to fund programs in the discretionary category, including public health and health research.viii

Seeking to reduce the deficit, lawmakers dramatically and disproportionately cut discretionary spending by enacting the Budget Control Act of 2011 (BCA), even though experts agree discretionary programs don’t contribute to our nation’s mid- and longer-term debt problem.ix The BCA established austere discretionary spending caps and triggered even deeper cuts to these caps through “sequestration.” By the time the Budget Control Act expires in 2021, discretionary spending on all “nondefense” programs, including public health, will represent just 12 percent of federal spending and 2.6 percent of our overall economy—the lowest level on record back to 1962—if lawmakers do not enact more
meaningful and comprehensive deficit reduction strategy.

Since 2010, federal funding for the Public Health Service has been cut nearly 11 percent with a wide variation in how these cuts are distributed across the agencies. Among the outliers, core budgets for the CDC and HRSA have been cut by 16 percent and 25 percent, respectively.

The bulk of federal public health dollars—for CDC, as much as 70 percent—flows directly to state and local health departments and other external partners. Thus federal cuts have real consequences for those who provide and benefit from services on the ground.x For example, more than 50,000 state and local public health professionals have been laid off since 2008—those who monitor and respond to outbreaks, immunize children and the elderly, and inspect restaurants.xi In addition, public health departments in 33 states and the District of Columbia report that they reduced their budgets between 2011 and 2013.xii These reductions, compounded by federal public health cuts, have led to reductions in public health services at the state and
local level.

The testimonials featured in this report demonstrate the ways in which federal public health cuts—often much deeper than expected—manifest in communities across the nation. They will also discuss the eroding public health infrastructure, and the opportunity costs of continued austerity. Americans are feeling the effects of policymakers’ budgetary decisions on their health, their access to health services, and in some cases, their career choices. Continued cuts to public health will do Americans more harm than good.


Losing one-fifth of the public health workforce at the state and local level has necessitated the elimination of critical services, including immunizations, maternal and child health, food and water safety, public hospitals and clinics, and programs that prevent diseases such as diabetes, cancer, and HIV/AIDS.

Dr. Terry Cline, Oklahoma Commissioner of Health, explains:

Approximately 60 percent of our agency’s revenue is derived from federal funding. Therefore, [cuts] in federal public heath programs could cripple or eliminate necessary public health functions in Oklahoma. It is imperative that Congress avert any further cuts to preparedness and response programs or any number of public health programs that protect our citizens and keep them safe and healthy. Any further damage to these programs will put millions of Oklahomans’ lives in danger and weaken our readiness across the United States.

Source: Potential Impact of Sequestration on Public Health, Association of State and Territorial Health Officials (Sept. 2012).


vi. Congressional Budget Office. Updated Budget Projections: 2014 to 2024. Congressional Budget Office, 14 Apr. 2014. Web. 28 May 2014.

vii. Bureau of Economic Analysis. “News Release: Gross Domestic Product.” News Release: Gross Domestic Product. http://www.bea.gov/newsreleases/national/gdp/gdpnewsrelease.htm (accessed May 28, 2014).

viii. Faces of Austerity: How Budget Cuts Have Made Us Poorer, Sicker, and Less Secure. NDD United. www.nddunited.org (Nov. 2013)

ix. Ibid.

x. CDC and America’s Health Security. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (available at www.cdc.gov/24-7)

xi. Budget Cuts Continue to Affect the Health of Americans, Association of State and Territorial Health Officials (Dec. 2012).

xii. Trust for America’s Health and Robert Wood Johnson Foundation http://healthyamericans.org/report/114/

xiii. Ibid.