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Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

How Much Do We Spend? Creating Historical Estimates of Public Health Expenditures in the United States at the Federal, State, and Local Levels

TitleHow Much Do We Spend? Creating Historical Estimates of Public Health Expenditures in the United States at the Federal, State, and Local Levels
Publication TypeJournal Article
Year of Publication2018
AuthorsLeider, JP, Resnick, B, Bishai, D, Scutchfield, FD
JournalAnnu Rev Public Health
Volume39
Pagination471-487
Date PublishedApr 1
ISBN Number0163-7525
Accession Number29346058
Keywordspublic health finance, public health spending, public health systems, public health systems research
Abstract

The United States has a complex governmental public health system. Agencies at the federal, state, and local levels all contribute to the protection and promotion of the population's health. Whether the modern public health system is well situated to deliver essential public health services, however, is an open question. In some part, its readiness relates to how agencies are funded and to what ends. A mix of Federalism, home rule, and happenstance has contributed to a siloed funding system in the United States, whereby health agencies are given particular dollars for particular tasks. Little discretionary funding remains. Furthermore, tracking how much is spent, by whom, and on what is notoriously challenging. This review both outlines the challenges associated with estimating public health spending and explains the known sources of funding that are used to estimate and demonstrate the value of public health spending.