INTERNATIONAL JOURNAL OF CLINICAL AND MEDICAL CASES (ISSN:2517-7346)

The world is facing a pandemic crisis of unknown proportions. The COVID-19 pandemic has been an eye-opener for many countries like the United States (U.S.) which have not prioritized their public health and prevention policies and practices. The U.S. public health agencies have been critically underfunded. The U.S. has historically been underfunding public health initiatives for years. U.S. funding priorities have been toward the U.S. military complex. Perhaps this is the time for the U.S. and other large countries to reassess the importance of public health in their respective countries. The study is secondary research and aims to critically analyze how the U.S. government has invested resources in defense and the armed forces instead of investing in public health prevention and practices. 

Public health; Preventive health services; Pandemics; Coronavirus; Healthcare financing

With each passing day, the world population anxiously awaits more details about the mounting cases and fatalities from the mysterious coronavirus COVID-19. There have been more than 3.175 million cases worldwide and 224,172 known deaths, according to the World Health Organization (WHO) [1]. The U.S. has more cases than any other country, and the COVID-19 has dramatically exposed the U.S. for not being sufficiently prepared to handle pandemics. Why was the U.S. not prepared? Billions of dollars have been put toward defense and the military. Why so little to public health prevention? Why is the U.S. in short supply of Personal Protective Equipment (PPE) such as masks, gowns, and face guards? If it was a war, would the country send the soldiers into battle without weapons, protective clothing, and training? Absolutely not. It is a time that the U.S. and other countries understand the importance of public health prevention and preparedness and invest resources in preventing for the next pandemic.

The U.S. has seen some significant cuts in the budgets for public health funding in recent years. The Trust for America’s Health, a public health and research and advocacy organization estimates $4.5 billion underfunding for health services. The President’s proposed Fiscal Year 2018 budget included a nearly 18 percent cut to the U.S. Department of Health and Human Services (HHS) that jeopardize the U.S. core public health capabilities and services. Over the years, public health spending has declined, which has affected the U.S. ability to fund preventive services [2].

Public health funding represented 3% of the roughly 3.36 trillion spent on health care in 2017, which totaled an average of $255 per person [3]. In the fiscal year 2018, state spending on public health increased by 2% to a total of $11.8 billion. Seventeen states and the District of Columbia cut their budgets that year, with some, including Alaska, Maine, and Texas, decreasing their funding by more than 10% over the prior year. A quarter of health departments that serve populations of less than 50,000 reported budget cuts in both 2016 and 2017 [4]. The Centers for Disease Control and Prevention (CDC) has received less funding than needed for core public health activities in recent years, which has impacted directly on preventive actions locally and internationally.

The current problem has been made worse by the reluctance of the U.S. to fund the prevention of epidemics internationally. In 2018, the U.S. administration dismantled the office of the national security council and severely cut the resources of the CDC epidemic control teams that work globally. The U.S. administration fired the government’s entire pandemic response chain of command. The government also cut $15 billion in national health spending. It reduced the global disease-fighting finances of the CDC, the National Security Council (NSC), and the United States Department of Homeland Security (DHS). Additionally, the federal government’s $30 million Complex Crises Fund was also eliminated [5]. The severe financial cut led many health departments across the country very unprepared to control public health emergencies such as infectious disease outbreaks [4]. 

While the United States contribute only 5% of the discretionary budget on health spending, it spends 52% of its budget on defense. The government has prioritized military and defense over public health funding. The government spends more than $700 billion on the military, including tens of billions of dollars for the wars against Afghanistan, Iraq, and Syria. Also, the government does not shy away from cutting public health funding plans and strip the public of health insurance [6]. The impact of major reductions in the budgets for public health funding was made visible by the COVID-19 crisis [7]. A rebalancing of U.S. military and health care spending would allow funding for proven community prevention strategies to address a wide range of health outcomes and establish better infrastructure in the communities that need them most [3]. The U.S. government had allocated $890 billion for defense-related funding in the year 2018, which is the highest among all the countries. The Prevention And Public Health Fund (PPHF), however, was only $900 million for the year 2018 [8]. This demonstrates alarming underfunding for public health prevention programs. Shifting only a 1% of the $890 billion-dollar defense budget would provide an additional $8.9 billion for preventive services, which would have equipped U.S. government response to fight against many infectious diseases promptly. The additional funding could be used to train medical personnel who can handle COVID-19 patients, purchasing crucial medical equipment such as ventilators, ICU beds, face masks, hand Sanitizers, mass testing equipment, and construction of isolation centers. More investment in health professionals, researchers, and public health infrastructure would have prevented the current surge and spread of pandemics as well as addressed the shortage of health professionals, equipment and facilities. Additionally, the surplus funding would provide funds for research on emerging diseases and have emergency funds set aside for any pandemics that might come up.

According to the Institute of Medicine’s (IOM) report, the U.S. wastes approximately $750 billion annually on unnecessary health care services, administrative costs, and medical fraud [9]. In 2016, the Public Health Emergency Preparedness program funding was $660 million, which had decreased from $1.03 billion [10]. Underfunding creates a massive threat to public health when the disease spread globally such as COVID-19. While defense funding is needed, there is a broad general consensus that public health should be the priority of a democratic government. Reform is required to modernize public health infrastructure and increase public health funding for public health prevention. In this scenario, spending, revenue on weapons, ammunition, and foreign military defense will be considered unwise and harmful to the entire country. Moving forward, to protect citizens from such threats of a pandemic, the U.S. government should turn its attention to health services. 

COVID-19 has been an eye-opener for countries like the U.S., who have not prioritized health care and prevention policy. The U.S., as well as other countries and its leaders, had been unprepared for this pandemic. What can the U.S. learn from this pandemic that has affected so many lives internationally? Prevention is just as important as the treatment of disease. Is this not the time for the world leaders to reconsider the allocation of funds for prevention? Clearly, it is time for the leaders of each and every country to consider allocating more resources to the prevention of disease and public health preparedness programs.

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