As states have faced ongoing pressure to respond to the evolving COVID-19 crisis, state public health funding levels have come under scrutiny. Funding for public health indicates not only the extent to which a state prioritizes public health infrastructure but also the state’s preparedness for health emergencies like COVID-19.

New data collected by the Trust for America’s Health show that most states (43) and the District of Columbia maintained or increased total public health funding levels in FY 2020 amid the COVID-19 public health emergency. However, seven states decreased their total public health funding during this time, and TFAH points out that increases due to state-supported COVID-19 response funding are unlikely to lead to sustained funding growth. It will be important to continue monitoring state funding for public health activities throughout and after the COVID-19 emergency, as these activities have been persistently underfunded over time.¹

A new SHADAC brief provides an overview of TFAH’s FY 2020 data on state public health funding--which we standardize to the estimated population of each state to create per-capita estimates--looking at state variation in 2020 and trends over the last decade. SHADAC’s State Health Compare web tool provides access to these per-capita estimates, which are available for data years 2005 through 2020.²

Highlights from the brief are below.

Wide State Variation in Per Capita Public Health Funding Persisted in 2020
As in 2019, there was a wide gap between state public health funding levels among states in 2020, with state-provided funding ranging from $7 per capita in Missouri to $365 per capita in the District of Columbia. While Missouri’s spending held steady at $7 per capita between 2019 and 2020, the District of Columbia increased its funding by $2 per capita and stayed far ahead of the next-highest funding rate of $215 per capita seen in Alaska. Kentucky held the median spot for 2020, spending $36 per person on public health.

Figure 1. Per Person Public Health Funding, 2020

A Handful of States Consistently Near the Top for Public Health Spending
Five states (Alaska, Hawaii, Idaho, New York, and California) and the District of Columbia were consistently among the top 10 for public health funding over the course of the last 10 years (2011 through 2020). Alaska, the District of Columbia, and Hawaii were among the top five for public health spending during each of the last ten years as well, with Alaska and Hawaii each having been the top spending state four times.

A Few States Consistently among Lowest-Ranked for Public Health Spending
There was more movement among the ranks of the states with the lowest public health spending than among the highest-ranking states from 2011 to 2020.  Just three states were consistently among the bottom 10 for public health spending during this time: Missouri, Nevada, and Mississippi. Missouri and Nevada were among the bottom five for public health spending during each of the last ten years as well, and each of the two states was the lowest spending state overall five times.

Download a PDF of the brief.

Explore Additional Public Health Data at State Health Compare
Visit State Health Compare to explore national and state-level estimates for the following public health indicators:

• Weight Assessment in Schools
• School Nutrition Standards Stronger than USDA
• School Required to Provide Physical Activity
• Smoke Free Campuses
• Cigarette Tax Rates

State Health Compare also features a number of other indicator categories, including health insurance coverage, cost of care, access to and utilization of care, care quality, health behaviors, health outcomes, and social determinants of health.