Biden’s public health budget goes well beyond emergency COVID-19 investments

President Biden’s proposed $9.6 billion budget for public health programs at the Centers for Disease Control and Prevention takes to heart the critical lessons of the COVID-19 pandemic and finally begins to modernize the nation’s long-battered public health system.

America has long faced challenges with public health preparedness, with the COVID-19 pandemic underscoring shortcomings and highlighting opportunities to create lasting change. For decades, public health at all levels has been chronically underfunded and unable to maintain core capacity because of inconsistent funding over time.

The government typically ramps up public health funding in the middle of a crisis, expecting the kind of sudden surge in capacity that often takes years to develop, before suddenly slashing investments after the crisis ends. This boom-and-bust approach, which we’ve seen following Hurricane Katrina, the Ebola pandemic and other disasters, guarantees a weakened response to every crisis we face.

To date, investments to build the foundational capabilities of state and local public health agencies have been limited to categorical, usually disease-specific programs. As a recent National Academy of Medicine assessment noted, “While health departments have faced numerous challenges during COVID-19, the roots of these problems — institutional siloes, rigid funding streams, ambiguities over authority, and neglected infrastructure and workforce development — long predate the pandemic.”

Perhaps the most critical lesson is that the underlying inequities in American society mean that some communities were disproportionately and adversely affected by the pandemic, especially racial and ethnic communities. Research shows Black individuals are twice as likely to die and three times as likely to be hospitalized from COVID-19 as their white counterparts. Addressing the social and structural determinants of health that lead to these disparities, including systemic racism and income, housing and food insecurity, must become public health imperatives.

With a historic $1.6 billion increase and specific proposals, Biden’s CDC budget goes well beyond the emergency investments seen in the American Rescue Plan Act and similar legislation to address these issues with resilience, sustainability and equity at the center. Two major new investments in CDC’s budget reflect that the Biden administration is taking to heart the need to build into the ongoing work of the CDC the responsibility for supporting foundational public health capabilities and addressing social determinants as a public health issue.  

The president proposes $400 million to invest in core public health infrastructure and capacity at all levels by improving public health assessment and action, training experts who can implement public health efforts and building capacity to detect and respond to emerging threats. 

This kind of investment in building foundational capabilities outside traditional programmatic or categorical lines has been called for by public health leaders for some time. While experts say closer to $4.5 billion is needed to meet foundational capabilities, this initial $400 million will be a major start. Indeed, the proposed Public Health Infrastructure Saves Lives Act would guarantee (through mandatory spending) the availability of these funds so health departments across the country can move toward rebuilding and becoming accredited to assure that all Americans will be served by health departments meeting minimum standards.

A proposed $150 million increase (from $3 million) is invested in a CDC program to address social determinants of health, funding local multi-sector partnerships and developing plans to accelerate action on social determinants of health. The result could be improved health and resilience among populations adversely affected by the built environment, food security, social connectedness and other social determinants of health domains. This new investment should build on many lessons that have been learned about how aligning across sectors can improve population health and reduce health inequities.

We know that backbone entities like community foundations can help bring together multiple sectors that address the determinants of health, which enables local public health agencies to more quickly and effectively set priorities and leverage resources. When these kinds of partnerships include and empower community residents, it becomes a platform to rebuild trust in the public health system that took a large hit during the pandemic. 

We all know that “a president proposes and Congress disposes.” In this case, let’s hope that Congress builds from the president’s budget to guarantee long-term funding for key investments in public health infrastructure and community partnerships. It’s a critical step toward modernization.

Jeffrey Levi, Ph.D., is a professor of health policy and management at the George Washington University’s Milken Institute School of Public Health.