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Appendix E
Funding Diagram for Public Health
253
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254 FOR THE PUBLIC’S HEALTH: INVESTING IN A HEALTHIER FUTURE
This figure illustrates the complexity of the current systems of funding of public health.
The left diagram represents a traditional, relatively parsimonious view of funding.
In it, the federal government gives block and categorical grants (often originating
in Congress) to state health departments and gives direct support to local health
departments. The state government gives the state health departments discretionary
funds, categorical or programmatic funds, and dedicated revenue. Some of the
funding is passed on to local health departments, which also receive funding from
city and county government. Both the state and local health departments receive some
funding from private groups and receive fees, fines, and, in some cases, Medicaid and
Medicare dollars. The left diagram does not communicate the expansive, complicated,
and intertwining nature of the delivery of public health, as the right diagram begins
to illustrate.
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255
APPENDIX E
In addition to the main organizations identified in the left diagram, other groups—
such as other state agencies, local agencies, and local organizations—create policies
and deliver programs and services that affect the public’s health. Consider Medicaid,
behavioral health, and environmental health and protection as examples. These
other organizations pay local health departments, other local government agencies,
and other local organizations (nongovernment organizations and community-based
organizations) to provide valuable public health services. Those interrelationships
greatly affect the public’s health but are difficult to track and quantify. Even among
traditional government public health, tracking revenue and expenditures is extremely
difficult, given the variety of funders, services, and billing systems involved (discussed
in more detail in Chapter 3).
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