Real, inflation-adjusted public health expenditures surged from $39 per capita in 1960 to $281 per capita in 2008, then fell 9.3 percent to $255 per capita in 2014, according to the analysis published in the American Journal of Public Health.

Public health’s share of total U.S. health expenditures rose from 1.36 percent in 1960 to 3.18 percent in 2002, then fell to 2.65 percent in 2014, the analysis found.

By 2023, public health’s share of total health expenditures is projected to fall to 2.40 percent, the researchers estimate.

Cuts in public health spending impact not just individual patients, but all residents, noted Patrick Bernet, a health finance researcher at Florida Atlantic University in Boca Raton who wasn’t involved in the study.

“Public health activities offer a broad range of health and financial benefits: a longer, healthier life, more productive workers for industry, lower anticipated Medicare and Medicaid spending, lower insurance premiums for everyone else, and children better able to focus on their education and grow into healthy adults,” Bernet said by email.

The 2010 Affordable Care Act (ACA), commonly called Obamacare, promised a $15 billion boost in public health funding, note study co-authors Dr. David Himmelstein and Dr. Steffie Woolhandler of the City University of New York School of Public Health at Hunter College.

But a 2012 law cut funding for the ACA’s prevention and public health fund by $6.25 billion and subsequent legislative efforts reduced it even more, the researchers note.

Public health appropriations for the 2015 fiscal year are less than half of the $2 billion originally budgeted, they report.

“More resources need to go to public health programs that prevent illness, rather than just waiting for people to get sick,” Woolhandler said by email.

That’s because public health departments play a key part in preventing serious and expensive diseases, Woolhandler noted.

For example, distributing clean needles and urging drug users to get addiction treatment can help stop the spread of HIV and hepatitis C, diseases that can be devastating and expensive to treat.

Similarly, public health departments help find patients with communicable diseases like tuberculosis or Ebola, getting them early treatment and stopping epidemics, Woolhandler noted.

“It is hard to get people to agree to tax themselves to pay for a `public good’ which improves everyone’s health, but where attribution between cause and effect is less obvious,” said Arleen Leibowitz, a public policy researcher at the University of California Los Angeles who wasn’t involved in the study.

At the same time, the ACA requires insurance to cover some services such as vaccinations that might have previously been provided by public health departments, Leibowitz added.

“We can expect public health spending to account for a smaller share of total health expenditure in the future because the ACA will increase private health spending,” Leibowitz said.

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