National Academies Press: OpenBook

For the Public's Health: Investing in a Healthier Future (2012)

Chapter: Appendix E: Funding Diagram for Public Health

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Suggested Citation:"Appendix E: Funding Diagram for Public Health." Institute of Medicine. 2012. For the Public's Health: Investing in a Healthier Future. Washington, DC: The National Academies Press. doi: 10.17226/13268.
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Suggested Citation:"Appendix E: Funding Diagram for Public Health." Institute of Medicine. 2012. For the Public's Health: Investing in a Healthier Future. Washington, DC: The National Academies Press. doi: 10.17226/13268.
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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.

Suggested Citation:"Appendix E: Funding Diagram for Public Health." Institute of Medicine. 2012. For the Public's Health: Investing in a Healthier Future. Washington, DC: The National Academies Press. doi: 10.17226/13268.
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image

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).

Suggested Citation:"Appendix E: Funding Diagram for Public Health." Institute of Medicine. 2012. For the Public's Health: Investing in a Healthier Future. Washington, DC: The National Academies Press. doi: 10.17226/13268.
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Suggested Citation:"Appendix E: Funding Diagram for Public Health." Institute of Medicine. 2012. For the Public's Health: Investing in a Healthier Future. Washington, DC: The National Academies Press. doi: 10.17226/13268.
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Page 253
Suggested Citation:"Appendix E: Funding Diagram for Public Health." Institute of Medicine. 2012. For the Public's Health: Investing in a Healthier Future. Washington, DC: The National Academies Press. doi: 10.17226/13268.
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Page 254
Suggested Citation:"Appendix E: Funding Diagram for Public Health." Institute of Medicine. 2012. For the Public's Health: Investing in a Healthier Future. Washington, DC: The National Academies Press. doi: 10.17226/13268.
×
Page 255
Suggested Citation:"Appendix E: Funding Diagram for Public Health." Institute of Medicine. 2012. For the Public's Health: Investing in a Healthier Future. Washington, DC: The National Academies Press. doi: 10.17226/13268.
×
Page 256
Next: Appendix F: For the Public's Health: The Role of Measurement in Action and Accountability: Report Summary »
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The Robert Wood Johnson Foundation asked the Institute of Medicine (IOM) to examine three topics in relation to public health: measurement, the law, and funding. IOM prepared a three report series—one report on each topic—that contains actionable recommendations for public health agencies and other stakeholders with roles in the health of the U.S. population.

For the Public's Health: Investing in a Healthier Future, the final book inthe series, assesses the financial challenges facing the governmental public health infrastructure. The book provides recommendations about what is needed for stable and sustainable funding, and for its optimal use by public health agencies.

Building on the other two volumes in the series, this book makes the argument that adequate and sustainable funding for public health is necessary to enable public health departments across the country to inform and mobilize action on the determinants of health, to play other key roles in protecting and promoting health, and to prepare for a range of potential threats to population health.

The final book in the For the Public's Health series will be useful to federal, state, and local governments; public health agencies; clinical care organizations; and community-based organizations.

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