Public health girding for funding challenges in 2024 ==================================================== * Kim Krisberg ![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/54/1/1.1/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/54/1/1.1/F1) A microbiologist processes tests in Nashville, Tennessee, in 2022. Emergency pandemic funding boosted data modernization at public health labs, but more work is needed. Advocates are pushing for at-least level funding across public health this fiscal year. Photo by Nathan Posner, courtesy Anadolu Agency/Getty Images Barely a year after the official end to the U.S. COVID-19 pandemic emergency — and the increased attention to public health that came with it — public health advocates are bracing for cuts. Beginning in 2020, health departments experienced an influx of federal emergency dollars to respond to the deadly pandemic and address the gaps it exposed, such as serious workforce shortages and outdated information technology. Even as advocates urge policymakers to allocate sustained, adequate funding, many see a funding cliff on the horizon and waning appetites among lawmakers to prioritize public health. “Right now, I think we’re still experiencing a boom (in funding),” said Chrissie Juliano, MPP, executive director of the Big Cities Health Coalition, a forum for the country’s biggest metropolitan health departments. “But we know another bust is coming.” The combination casts a shadow on hopes that the lessons of COVID-19 will stop a cycle of boom-and-bust crisis funding in the field. Don Hoppert, director of government relations at APHA, said there will be opportunities to advance public health issues in 2024, both in Congress and at the regulatory level. A top priority for APHA will be keeping current federal budget levels intact. Those dollars are the primary source of funding for state, local, tribal and territorial health departments. “Right now, APHA is keenly aware of the difficulty that the nation’s public health departments face when the attention from a disaster wears off,” he said. Congress ended its 118th session in December without finalizing a federal budget for fiscal year 2024. In January, legislators in the new session passed a short-term funding resolution to avoid the latest threat of a government shutdown. Hanging over budget negotiations is the possibility of across-the-board sequestration cuts to nondefense discretionary funding, including public health, if Congress cannot pass a full budget by late spring. The potential cuts — which would slash the spending by up to 9% — were part of a deal made last year to raise the U.S. debt ceiling. In a January letter to congressional leaders, APHA, along with 850 other organizations, implored policymakers not to trigger the “disastrous” sequestration cuts. Last year’s debt ceiling deal also already rescinded billions in unspent emergency pandemic funds, some of which would have gone to public health programs and departments. According to a 2023 report from Trust for America’s Health, state and local health departments are still facing an annual shortfall of $4.5 billion to be able to provide comprehensive services in their jurisdictions. When COVID-19 arrived, they had been operating under decades of chronic underfunding. “The next piece for public health is how do we turn lessons learned and investments during these very challenging times into progress moving forward when federal resources seem to be drying up again?” Juliano told *The Nation’s Health.* As of December, for example, the Centers for Disease Control and Prevention had awarded more than $4 billion — authorized via the 2021 American Rescue Plan — to help health departments fill longtime workforce gaps. Juliano said in the immediate term, the money has been a “game changer” for health departments that received a slice. But the funding pot only lasts a handful more years, complicating recruitment and retention efforts. Adriane Casalotti, MPH, MSW, chief of public and government affairs at the National Association of County and City Health Officials, said Congress could take a number of steps in 2024 — in addition to protecting federal funding levels — that would benefit public health. ![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/54/1/1.1/F2.medium.gif) [Figure2](http://www.thenationshealth.org/content/54/1/1.1/F2) Liliana Ramos receives a vaccine in Pasadena, California, in October. If funded, the Vaccines for Adults program would help health departments sustain and expand vaccination programs. Photo y Francine Orr, courtesy The Los Angeles Times/Getty Images One is reauthorizing the 2006 Pandemic and All-Hazards Preparedness Act, which expired in September and supports emergency public health and medical response. Technically, the policies in the act still stand, Casalotti said, but the lack of reauthorization means a missed opportunity to incorporate the insights gained from COVID-19 and be better prepared for the next pandemic. Another priority for NACCHO is approval of the Vaccines for Adults program, for which President Joe Biden has proposed funding in both of the last two budget cycles. Casalotti said such a program, which would serve uninsured and underinsured adults, could help local health departments sustain and expand the vaccine programs they scaled up during the pandemic. “We saw vaccination campaigns that not only ensured everyone who wanted a vaccine could get one, but that reduced disparities (in access),” she said. Staffing will continue to be a problem and priority in 2024, said Casalotti, who noted that not all of the nation’s 3,000 local health departments shared in CDC’s recent workforce funding awards. However, one way Congress could help this year, she said, is to fund the new Public Health Workforce Loan Repayment Program, which was signed into law in 2022. “This program won’t help anybody if it’s just on paper,” she said. Emergency pandemic money also supercharged much-needed data modernization efforts at CDC and state and local health departments. Peter Kyriacopoulos, chief policy officer at the Association of Public Health Laboratories, said a goal this year is to maintain level funding for such work in fiscal year 2024 appropriations — at least $175 million — even though more is needed. “In the process of fixing the problem, we discovered just how big it is,” said Kyriacopoulos, an APHA member. For example, a 2022 report from the Healthcare Information and Management Systems Society estimated that more than $36 billion is needed over 10 years for public health data infrastructure, interoperability and sustainability. “We’ve seen big improvements from the funding that’s already gone out the door, but a significant portion is still needed to get public health where it ought to be when it comes to data,” Kyriacopoulos told *The Nation’s Health.* Also threatened by budget cuts is AmeriCorps, the federal agency that connects Americans to a year of community service. The House has recommended slashing AmeriCorps’ budget by half, to its lowest level of funding in more than 25 years. If it comes to fruition, the cut could impact its Public Health AmeriCorps initiative, which started in 2021. A partnership of CDC and AmeriCorps, Public Health AmeriCorps has boosted the public health workforce by connecting organizations and agencies in need of staff with those eager to receive training and help communities. Program members have worked on community vaccinations, food and nutrition, HIV/AIDS and more. “There are thousands of people supporting public health in communities around the country right now through this initiative,” said Angela McGowan, MPH, senior director of the Alliance for Disease Prevention and Response. “It’s vital work. And the hope is they will stay in the field and build support for public health.” Beyond Congress, Hoppert said APHA will be pushing the Biden administration to finalize key public health and climate change regulations in 2024. Among them is a U.S. Food and Drug Administration’s proposal to ban menthol-flavored cigarettes that was supposed to be finalized by last year. Estimates show the rule could each year save the lives of up to 45,000 Black Americans, who are more likely to smoke menthol cigarettes and less likely to be diagnosed at the early stages of lung cancer. Another regulatory priority is to quickly finalize proposed rules at the U.S. Environmental Protection Agency on air pollution and climate change, including stronger greenhouse gas emission standards for vehicles and limits on carbon and mercury pollution from power plants. Hoppert said given the gridlock in Congress this year and campaigning for the fall presidential election, advocates’ voices will be key in keeping public health at the forefront of policy discussions. “If we invested consistently in public health, we wouldn’t need to have billions of dollars pumped into the system at the last minute,” he told *The Nation’s Health.* “We could build a system that is fully operational and ready for any emergency.” For public health advocacy tips, visit [www.apha.org/advocacy](http://www.apha.org/advocacy). * Copyright The Nation’s Health, American Public Health Association