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End Boom and Bust Funding of Public Health

Reductions in public health funding in recent years have impacted the COVID-19 response.

by Eric Holdeman / May 10, 2020

The following is my May Disaster Zone column that is appearing in the IAEM Bulletin.

End Boom and Bust Funding of Public Health

By Eric Holdeman

Congress likely feels that they have done their job by throwing billions of dollars for public health at the current coronavirus epidemic here in the United States. The only reason a supposedly quick fix is needed is because public health preparedness has been ignored for years at the local, state and federal levels. Note, there are no quick fixes in public health!

Anyone who has been reading about COVID-19 has heard the mantra, “State and local public health officials have the lead in responding to this health emergency’’ and the federal government’s role is to support them.” This is a true statement. The sorry state of affairs is that, in general, elected officials only support public health with the bare minimum of funding. Any surge in public health capacity or capability has come from federal funding. In truth, this current infusion of federal funding will likely reinforce state and local electeds in believing that it is up to the federal government to provide additional funding to “their” public health department.

Immediately following the 9/11 attacks and the subsequent anthrax attack, funding for public health preparedness was ramped up by the federal government. As we have seen again and again, time and distance from an event that prompted increases in funding for public health, means that the funding decreases rapidly as the risk is perceived as having gone away.

In 2008, with the Great Recession, local health departments lost 55,590 staff due to layoffs or attrition. Once we bounced back economically from the recession, the funding for public health did not have the same recovery. Trust for America’s Health reported, “Except for one- time, short-term funding to contain the Ebola and Zika viruses, core emergency preparedness [federal] funding has been cut by more than one-third (from $940 million in FY 2002 to $667 million in FY 2017) since the program was established.”

As many have noted, the president’s 2021 budget proposed more cuts to the Centers for Disease Control’s (CDC) budget. I can easily predict that those cuts will be reversed, and even more funding appropriated for public health purposes — but how many years will that last? This cycle of feast or famine in funding public health must stop!

The current coronavirus pandemic exemplifies our interconnected world and how we need a well-funded and vigilant public health capability. The economies of nations are entwined and so is the health of each nation’s people.

If public health is a state and local responsibility, then it is appropriate that elected officials at the state and local levels step up and fund their public health departments at a level that goes beyond the very basics. Public health readiness is like disaster preparedness. Regular financial investment in readiness pays dividends when calamity arrives at your front door. Public health capability is not an easy-peasy process that can expand and contract at the whim of budget makers or the vicissitudes of worldwide disease outbreaks. If you want to have a public health capability, you must fund it. Recent $8B in one-time funding passed by Congress cannot replace a consistent approach to building a public health capability over the many years that it takes to have people, plans, processes, equipment and supplies in place to respond.

I am not optimistic that any lessons will be learned long-term from our current situation. A new crop of elected officials will rotate into council chambers and legislatures. Our cycle of boom and bust in public health funding will repeat itself in the future. A quote I love is, “The lessons will continue to be taught, until they are learned.” As a people, we are slow learners.


by Eric E. Holdeman, Senior Fellow, Emergency Management magazine. He blogs at


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