A new report from ASPPH’s partner, Trust for America’s Health (TFAH), Underfunded and Under Strain: The State of America’s Public Health System, examines how longstanding underinvestment, workforce reductions, funding disruptions, and institutional uncertainty have weakened the nation’s public health infrastructure. The report calls for restoring federal operating capacity and establishing more predictable, sustainable funding to protect communities and prepare for future health threats.

TFAH finds that the public health system entered 2025 with significant funding, workforce, and infrastructure vulnerabilities. In 2024, just 3 percent of the nation’s $5.3 trillion in health expenditures supported governmental public health activities. While Congress maintained Centers for Disease Control and Prevention (CDC) program-level funding at approximately $9.1 billion for fiscal year (FY) 2026, CDC’s workforce had declined by approximately 3,600 employees, or 28 percent, from the end of FY 2024 by May 2026.

The report also raises concerns about the FY 2027 President’s Budget Request, including proposed reductions to CDC resources, elimination of the Prevention and Public Health Fund, and consolidation of major federal health programs. TFAH emphasizes that maintaining appropriations alone is not enough to ensure programs can operate effectively when staffing, expertise, grant administration, and timely funding are disrupted.

Among its recommendations, TFAH calls for rebuilding federal health agency capacity, strengthening CDC with at least $11.58 billion in FY 2027, ensuring appropriated funds are released promptly, and providing durable and predictable public health financing. The organization also launched a new Public Health Programs Monitor to track federal funding, staffing, and operational changes across the Department of Health and Human Services.