Public Health Leadership Forum

Developing a Financing System to Support Public Health Infrastructure

“An effective public health system that can assure the nation’s health requires the collaborative efforts of a complex network of people and organizations in the public and private sectors, as well as an alignment of policy and practice of governmental public health agencies at the national, state, and local levels. In the United States, governments at all levels (federal, state, and local) have a specific responsibility to strive to create the conditions in which people can be as healthy as possible. For governments to play their role within the public health system, policy makers must provide the political and financial support needed for strong and effective governmental public health agencies.”

- The Future of the Public’s Health in the 21st Century, Institute of Medicine, 2003

Written 15 years ago by the IOM (now NASEM), this statement underscores the fundamental obligation of government to promote and protect the health of people in America through investment in public health. Today, this investment is lacking. Current best research indicates an annual cost of $32 per person to put in place the basic public health capabilities needed to promote health across the nation. Yet national investment in public health capabilities is currently about $19 per person, leaving a $13 per person gap in annual spending. To “create the conditions in which people can be as healthy as possible,” and to protect national security, this gap must be filled.

To do so, The Public Health Leadership Forum convened national experts in the public health community, policy arena and key partner sectors to begin developing policy options for long-term, sustainable financing. This group aligned around core principles and a set of criteria necessary to establish a sustainable financing structure. The proposed Public Health Infrastructure Fund for state, territorial, local and tribal governmental public health would provide the $4.5 billion needed to fully support core public health foundational capabilities, allocated in accordance with the determined principles. Their deliberations, research, and proposal are reflected in the resultant white paper, Developing a Financing System to Support Public Health Infrastructure.