Chronic underfunding has created a public health system that cannot address the nation’s health security needs, its persistent health inequities, as well as emerging threats, and, was a contributing factor in the inadequate response to the COVID-19 pandemic – The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2022

This report tracks federal, state, and local investment in public health and how underinvestment in public health programs impacted the COVID-19 response, exacerbates health inequities, and continues to put Americans’ lives and livelihoods at risk. It calls for increased investment of $4.5 billion annually to build up the public health infrastructure at the state, local, tribal, and territorial levels. The report analyzes current public health funding trends including federal public health funding and CDC funding, provides recommendations for policy actions including new investments for the public health infrastructure and workforce, addressing health inequities and root causes of disease, and safeguarding and improving health across the lifespan. 

The report calls upon Congress and other agencies that impact public health funding to increase investment in public health. Recommendations are aimed at the federal level of change but can be used by leaders at all levels of agency and government. Learn more at

The Impact of Chronic Underfunding on America’s Public Health System report was developed by Trust for America’s Health (TFAH) and included leaders from academic, foundation, nonprofit and other sectors on the board of directors.

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