NJ, Feds Both Spending Less Money on Public Health Programs

Study finds Garden State is near average in state spending, trails in federal dollars

New Jersey is near the national average for state spending on public health. But it trails other states in how much federal funding it receives for public health efforts.

The newly issued report Investing in America’s Health 2014 found that New Jersey ranked 26th in state public-health spending in 2012-13, at $24.96 per capita.

But the state was only 45th in the amount that it received from the U.S. Centers for Disease Control & Prevention (CDC), at $15.70 per capita, and 34th in federal Health Resources and Services Administration (HRSA) funding, at $18.67 per capita.

The last several years have been a time of dwindling federal and state spending on public health, according to the report by the Washington, D.C.,-based Trust for America’s Health and the Plainsboro-based Robert Wood Johnson Foundation.

CDC funding has fallen from $7.07 billion in 2005 to $5.98 billion in 2013, while most states have been cutting their public health spending.

New Jersey reflects this pattern. Gov. Chris Christie’s budget proposal includes $339.3 million for the Department of Health, down from $354.4 million in the fiscal year that ended in 2013.

Per-capita state funding for public health varies widely, from $144.99 in Hawaii to $5.86 in Missouri. New York, with an estimated population of 19.7 million that is only slightly more than twice the 8.9 million of New Jersey, spends more than 10 times as much on public health, according to the report.

The report also notes wide state disparities in public health indicators, for both adults and children. New Jersey adults rank first in the country in the percentage who have received pneumococcal vaccines, but they score poorly in areas like the percentage who are physically inactive.

The 75 percent of CDC funding that is distributed to states is spent based on formulas that include state population, the need for the funds and competitive grants, according to the report.

The biggest areas where New Jersey received CDC money were for vaccines for children, at $65.2 million; infectious diseases, at $35.7 million; and public health preparedness and emergency response, a total of $15.2 million.

New Jersey received more federal funds than any other state for birth defects and developmental disabilities, at $6.41 million, but it received a fraction of the amount suggested by its population size in areas like chronic disease prevention and health promotion, which at $7.85 million, was less than the amount received by smaller states including high-income Maryland, with $14.75 million, and low-income Mississippi, with $9.7 million.

The report says federal government funding to states is frequently uncoordinated and inconsistent.

Federal “public health programs, as currently structured, do not actively promote a set of baseline, consistent capabilities that every community across the country should be able to achieve,” according to the report. “There is little strategic rational for the way public health is funded in America, including for the variances in funding for different places around the country.”

HRSA funding is more predictable than the CDC funds. It is centered on two programs: community and migrant health centers, and HIV programs funded by the Ryan White Act. The basis for the funding is either competitive or based on local disease burdens.

The report makes a series of recommendations to improve public health efforts and decrease disparities between states and localities. It recommended raising core funding for public health at every level of government, considering funding strategically so that it will be used more efficiently, and increasing accountability for how the money is spent.

The Prevention and Public Health Fund including in the 2010 Affordable Care Act, which provides $12.5 billion over 10 years, “should be targeted to help modernize the nation’s approach to public health,” according to the report.

New Jersey is ahead of other states in pursuing health accreditation, one of the strategies that the report recommends for assuring there is a foundational set of public-health services available everywhere in the country.

As part of the accreditation process, the state has developed a strategic plan, which includes initiatives to improve the health of newborn babies, increase residents’ access to primary care and boost the rate of childhood immunization, as well as efforts to stem growing problems with heart disease and obesity.

State Health Commissioner Mary E. O’Dowd said Tuesday that New Jersey could be one of the first states to be accredited by the Public Health Accreditation Board, a national nonprofit that aims to set standards for health departments and push them to continuously improve.

“We expect new Jersey’s application to build on our leadership on public health issues,” she said.

The World Health Organization defines public health as “all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole.” The report focused on government public-health spending, excluding programs that provide health coverage for low-income residents, like Medicaid and the Children’s Health Insurance Program.

Disclosure: The Robert Wood Johnson Foundation provides funding for NJ Spotlight’s health reporting.