New Jersey received the lowest level of public health funding per person from a critical federal agency last year, according to a recent report that said support for these life-saving, cost-reducing programs has not kept pace with demand nationwide.
In addition, the Garden State ranked 14th for total public health dollars provided by the federal Centers for Disease Control and Prevention, according to the Trust for America’s Health, a nonprofit research and advocacy organization. And four of the states that received more money have fewer residents than New Jersey.
In all, the CDC allocated $152.3 million to New Jersey in 2018, funds that are distributed through dozens of grant programs to help pay for vaccination programs, infant and childhood health initiatives, chronic disease prevention, infectious disease tracking and much more. Overall, the agency pledged $7.37 billion that year to help states boost public health efforts and support related community programs.
Public health programs also receive support through a number of other federal agencies, and states and municipalities contribute their own dollars to this work, but the Trust report said CDC funding is the primary source for much of the work to protect communities from health threats and prevent the spread of disease.
While CDC funding for states increased by nearly $1 billion between 2017 and 2018, the report’s authors claim the level of support has not kept pace with the nation’s health needs, given rising levels of obesity, addiction and weather-related emergencies.
Spending to save
“Such underfunding flouts overwhelming evidence of the life-saving cost-effectiveness of programs that prevent diseases and injuries and prepare for disasters and health emergencies,” the authors wrote in the report, which was funded in part by the Robert Wood Johnson Foundation, an NJ Spotlight supporter. “Moreover, many such interventions save money,” they added, noting one review found a 14-to-1 return on investment in public health spending.
“Public health is the kind of thing you only hear about when it doesn’t work well,” said Joel Cantor, a public policy professor at Rutgers University and director of the Center for State Health Policy. Unfortunately, it often takes an emergency — like a measles outbreak — to underscore the need for these programs among political leaders, he explained.
Despite the Garden State’s population of nearly 9 million and myriad
health concerns — including record-setting deaths from addiction and a growing measles outbreak — the less populous states of Arizona, Maryland, Virginia and Washington all were allotted more from the CDC in 2018. And while the average CDC funding per person was $22.54 nationwide, New Jerseyans were slated to collect just over $17 each last year.
However, in documents detailing each state’s funding, the CDC cautions against making these types of comparisons, noting that it has many different types of state grant programs that use different mechanisms to award funding, including competitive processes, per-capita analysis, and assessments of disease burden. In addition, it also funds national organizations that work in multiple states.
The distribution in part reflects a state’s capacity to address its own health problems, Cantor added. “Less wealthy states have higher needs,” he said. (New Jersey has one of the highest income levels nationwide.)
NJ ‘relies heavily on the funding’
According to the state Department of Health, not all the dollars identified by the Trust are readily available. In fact, the largest pool of CDC funding — $77.2 million for children’s vaccines — is not provided to the state up front but set aside in an account against which it can draw down as needed to purchase supplies and run the program. That said, the Trust did not appear to count some $4.7 million in emergency funding from the CDC for opioid treatment programs and other needs, the DOH said; the state has also recently applied for an additional $13.7 million in CDC money for various programs.
“The Department has had a very aggressive strategy in applying for CDC funding,” spokeswoman Donna Leusner said. “Like all states,” she said, New Jersey “relies heavily on the funding and expertise of the CDC.”
“We continue to advocate for New Jersey with the CDC, the U.S. Department of Health and Human Services and our other federal partners to apply for every feasible opportunity to get more dollars,” Leusner added.
But studies show New Jersey has a history of being short-changed by Washington, D.C. A report released in January by the Rockefeller Institute of Government found that the state paid some $21.3 billion more in income taxes and other fees than it received in federal funding in 2018; that placed it second to New York, which lost $35.6 billion that year.
According to Rockefeller researchers, Connecticut, Massachusetts and a half dozen other states also pay more into the federal system then they get back. Generally, they share one important characteristic: high-income populations, whose taxes are funding an outsized share of the spending nationwide.
State increased funding in 2018
The Trust for America’s Health report also detailed how states use their own taxpayer dollars to support various public health programs and fill gaps left by limited federal dollars. According to its researchers, New Jersey committed $251.4 million to these needs in 2018, an increase of 4.5 percent over the previous year.
“The Murphy Administration recognizes the essential role of public health in preventing diseases like measles and protecting the public during health emergencies and natural disasters,” Leusner said. “That’s why an additional $2.5 million is included in the FY2020 Department budget to strengthen our local health departments.”
But, according to the Trust’s figures, some 13 states — including Alabama, Tennessee and New Mexico — invested more total dollars on public health in 2018 than New Jersey, That said, some of these bigger spenders had actually invested more the previous year, researchers found, and few were growing their public health budgets the way New Jersey had.
To address the nation’s public health needs, the Trust report urged federal officials to boost the CDC’s budget for state programs by more than $3 billion before 2022. In particular, it called for greater support for community preparedness and disease prevention programs, with a focus on efforts to address opioid addiction and mental health needs and support an aging baby-boom demographic.
“Adequately protecting and improving the health of Americans requires greater federal investment in public health. Given bipartisan support among American voters for public health protections and the proven cost-effectiveness of public health interventions and policies, investing in public health is the most efficient, commonsense way to improve health and health equity,” the authors wrote.