Missouri, Kansas Laggards In Public Health Spending

Kansas spends only about $12 per person on public health, making it one of the states putting the least money into preventing chronic and infectious diseases.

According to a recent report from the Trust for America’s Health, Kansas spent about $36 million in fiscal year 2015 on public health programs for its 2.9 million people, or about $12.40 per person. That ranked the state 47th in per capita spending compared to the other 49 states and the District of Columbia.

Missouri ranked even lower, spending $5.90 per person. Only Nevada spent less.

Public health departments in Kansas provide immunizations, prepare for disease outbreaks and track illnesses considered a public health risk, such as Lyme disease, sexually transmitted infections and measles. Most also offer health education and some health care services, such as prenatal care for low-income mothers. 

Michelle Ponce, executive director of the Kansas Association of Local Health Departments, said state funding to local health departments in Kansas has been unchanged since 1995. At the same time, costs have gone up and departments have faced new threats like Zika virus, she said.

“While (funding) hasn’t been cut, it also hasn’t increased in 20 years,” she said.

Kansas has a decentralized system, so public health departments are controlled locally and vary in what they can afford to offer, Ponce said. While many receive federal public health funding, she said, those dollars typically can only be used for a narrow purpose.

“We’ve seen quite a few counties make substantial reductions in what they can provide,” she said. “It’s certainly a challenge.”

Comparisons Not Exact

Nationwide, the report said states spent a median amount of $33.50 per person, meaning half spent more and half spent less. West Virginia spent most, at $220.80 per person.

Albert Lang, spokesman for the Trust for America’s Health, said the state-to-state comparisons may not be exact because states report their spending differently, but the researchers have attempted to include a broad range of public health spending while remaining consistent in what is counted in each state. Medicaid and federally funded health programs aren’t part of the equation, he said.

“We try to include any funding that can be specifically tied to public health in a given state,” he said.

Bert Malone, vice president of the Missouri Public Health Association, said the state’s 115 public health agencies have increased their reliance on local tax dollars or other sources of fundraising. As Missouri reduced state funding, he said, some agencies have cut hours or health education.

“They lack any reliable source of state funds,” he said. “If one county doesn’t pass a mill tax increase, you don’t get those services that another county is able to offer.”

Kansas also ranked in the bottom half when it came to public health grants from federal agencies. The state received $57.8 million from the Centers for Disease Control and Prevention (CDC) in fiscal year 2015, or about $19.86 per person, and $69.5 million, or $23.88 per person, from the Health Resources and Services Administration, for a combined total of $43.74.

Missouri received slightly more, with $17.33 per person from the CDC and $27.52 per person from the HRSA, for a combined $44.85 per person.

With federal and local spending added, public health spending nationwide averaged $255 per person in 2014 — down from $281 in 2008. That accounted for about 2.4 percent of all health care spending in the United States.

Spending And Outcomes

There wasn’t a clear link between public health spending and health outcomes in the states.

West Virginia spent more per person than any other state but fared poorly on the preterm birth rate, percentage of adults who smoked or were obese, on-time vaccinations for children and adults with diabetes. On the other hand, Hawaii came in second in public health spending and its residents have relatively good outcomes.

Public health efforts affect some conditions more than others. A 2011 study in Health Affairs found that when spending by local health departments increased 10%, infant mortality fell by 6.9% and heart disease deaths dropped by 3.2%. There was less impact on deaths from diabetes and cancer, however, and deaths from influenza and Alzheimer’s disease showed almost no change.

The Trust for America’s Health report estimated every $1 spent on programs that succeed in improving nutrition, increasing physical activity or preventing tobacco use would yield about $5.60 in savings on future health care.

But Malone said Missouri policymakers haven’t recognized the value of investing in public health.

“Legislators simply don’t like people telling them how to live their lives, so chronic disease prevention has been a low priority,” he said.

Officials with the Kansas Department of Health and Environment and Missouri Department of Health and Senior Services did not respond to requests for comment on the public health spending report.

The KHI News Service is an editorially independent initiative of the Kansas Health Institute.