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What’s one of the top problems in public health in the United States? Why is public health spending so underfunded?
Public health spending in the U.S. is extremely low compared to other developed countries, and it has been for decades. Primary areas of concern are data infrastructure and preventive measures, such as public education and health screenings.
Keep reading to learn more about the underfunding problem in the U.S. public health system.
The Problem of Underfunding in Public Health
The Covid-19 pandemic caught the U.S. flat-footed, resulting in preventable suffering and deaths, in large part because the nation has been underfunding public health for decades. And, from all indications, we’re set to follow the same path in future health crises, making underfunding one of the top problems in public health.
Public health refers to programs and infrastructure meant to prevent or treat illness on a large scale. For example, public health includes sanitation programs, disease research, health education, and regulations that protect us from various pollutants and poisons. Public health spending is how the government funds these programs and services.
Why Public Health Spending Matters
There’s a clear link between low public health spending and high rates of preventable deaths. Strong public health programs reduce infant mortality rates, along with deaths from cardiovascular disease and cancer—experts believe this is thanks in large part to preventive measures like education and screening services.
Also, one of the major purposes of public health spending is to prevent and respond to large-scale disease outbreaks, such as the Covid-19 pandemic and the ongoing monkeypox outbreak. However, the long-term underfunding of the U.S. public health system has left the country unable to respond quickly or efficiently to such crises.
In fact, experts believe that weak public health infrastructure—including the problems of outdated systems for collecting and sharing data, many of which aren’t even compatible with each other—was a major reason the U.S. suffered over a million deaths from Covid. At a time when doctors and scientists needed to act quickly, much of their time and manpower was spent simply trying to get the necessary information. In short, underfunding of public health is an issue that affects all Americans, and leaves the country vulnerable to ongoing and future disease outbreaks.
How We Got Here
Public health in the U.S. is suffering from decades of underinvestment. Regardless of which political party is in power, funds for public health education and disease prevention are a small percentage of overall health care spending. Even the Affordable Care Act of 2010, which included large investments in public health, only delivered a fraction of the money it promised.
Furthermore, the U.S. tends to only invest in public health when a crisis is looming—and, because there’s no money earmarked for such a crisis, it must borrow from already-underfunded health budgets to do so. This only serves to further weaken public health once the crisis has passed, leaving the country even more vulnerable to the next one.
These problems in public health aren’t due to a lack of money; in fact, the U.S. has the highest per capita health care spending in the world. Rather, the issue is where that money goes. For example, one study found that clinical care is very highly funded, while efforts to keep people healthy in the first place are severely underfunded—in other words, the U.S. buys pounds of cure instead of ounces of prevention.
Furthermore, over the last decade, the federal government spent some $38 billion to improve the data systems of private health care organizations, yet neglected to update its own systems.
Perspective: The China Study
In The China Study, authors T. Colin Campbell, Ph.D., and his son Thomas M. Campbell II, MD claim that America spends more money on healthcare, per capita, than any country in the world. So Americans must be the healthiest, right? Not quite.
According to them, the problem of the costliness of our public health system impacts us as individuals and as a country.
Firstly, the system is expensive for our government. We spend more money on health care than any other country in the world. In 1997, that was $3,912 per person per year. The next closest country in spending was Germany, at $2,364 per person. Korea spent only $870 per person.
With all the money spent, you’d think our healthcare system would be the best in the world. It’s not. Ours is regularly rated one of the worst. One year, the World Health Organization ranked the U.S. healthcare system 37th best in the world.
Evidently, the system doesn’t need to be expensive to be effective. Switzerland spends substantially less on health care than we do, but its citizens live an average of 4.5 years longer than Americans.
Secondly, not only is the system expensive for the government, it’s expensive for individuals. We spend huge amounts of our own money to be healthy.
In the 1980s, this meant a moderate 9% of our disposable incomes. But in 2011, that percentage doubled, and it’s projected to be almost 20% in 2022. Health is valuable, and if we actually got healthier after spending that much money, the price might be worth it. However, 20% is a lot of money for treatments that may do more harm than good.
The problem with our public health system isn’t just bad for our wallets. A third way the cost of our healthcare system impacts us is that it dictates and limits our treatment options. For instance, doctors often choose your treatment based on what your insurance will cover. This treatment isn’t always the safest, most effective, or most efficient one available.
Finally, the system doesn’t cover everyone. Even though we’re spending all this money, tens of millions of people don’t have insurance or access to basic care.
Our health system is supposed to heal us, but too often, it’s hurting us.
TITLE: The China Study
AUTHOR: T. Colin Campbell and Thomas M. Campbell
What We Can Do
Experts agree that the two major problems in U.S. public health spending are data infrastructure and preventive measures. Truly fixing these issues will require major changes in policy and spending practices—updating government computer systems alone will cost billions (though having a healthier population is projected to save money in the long run). In other words, these are problems that must be solved at the government level, driven by voting and political pressure from citizens.
Why Is American Health Care Moving Toward Value-Based Care?
The American health care system is notoriously dysfunctional, and patients are increasingly worse off for it. Despite having the world’s largest economy and a spending bigger slice of it on health care than any other developed country, the U.S. has lower life expectancy, higher infant mortality, and higher rates of unmanaged diabetes.
Comparatively low salaries for primary-care doctors pushes many medical students toward becoming well-paid specialists, creating a shortage of family physicians and leading to long wait times and shorter appointments. As a result, patient-doctor relationships have deteriorated, meaning less preventive care and worse health outcomes.
Additionally, access is shrinking for many Americans: Independent practices are giving way to large hospital systems and rural hospitals are shuttering. Health care costs are rising as the pay-per-service model means doctors make more money by racking up patients’ bills with tests and treatments. To combat these problems with the U.S. public health system, value-based care is structured so that providers benefit from keeping costs low, incentivizing preventive care. A move to value-based care shifts value back to primary-care physicians, patient-doctor relationships, and maintaining good health—rather than diagnosing and treating ailments.
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