KFF’s Kaiser Health News, AP Investigate the State of the Nation’s Public Health Infrastructure as It Confronts the Challenge of the COVID-19 Pandemic

A new investigation from KFF’s Kaiser Health News (KHN) and The Associated Press examines the troubling state of the public health infrastructure the nation is relying on to navigate the health and economic threats presented by the COVID-19 pandemic.

The multipart investigation, which launched today, finds that the public health workforce in the United States is underfunded and under threat, lacking the basic tools to confront the worst pandemic in a century. The novel coronavirus has infected at least 2.6 million people in the U.S., killed more than 12,000 people and cost tens of millions of jobs and $3 trillion in federal rescue money.

Among the key findings in the series’s first story, “Hollowed-Out Public Health System Faces More Cuts Amid Virus”:

  • Since 2010, spending on state health departments has dropped by 16% per capita, and in local health departments by 18%, in 2019 dollars after adjusting for inflation, according to the KHN and AP analysis.
  • At least 38,000 state and local public health jobs have been eliminated since the Great Recession in 2008, leaving an inadequate workforce in what was viewed in the mid-20th century as one of the world’s best public health systems.
  • At least 14 states have already cut or are actively considering cuts to health department budgets or positions. States, cities and counties, facing declining revenues amid the economic downturn, are laying off and furloughing the already limited staff.

For their first investigative collaboration, KHN and AP journalists interviewed more than 150 public health workers, policymakers and experts, analyzed state and federal financial records, and surveyed statehouses around the country. Their investigation finds that governments at every level have failed to provide the public health system with the resources — both human and financial — that are required to protect the nation from pandemics.

The reporting also shows how public health officials, who already work on an array of tasks for their communities — such as administering vaccination programs, tracking and preventing infectious diseases, screening infants, monitoring water and air quality, and conducting food and restaurant inspections — are stretched thinner than ever as they work to reduce and monitor the effects of the pandemic. Departments are having to spend already constrained budgets on adequate supplies to keep workers safe as they try to implement preparedness plans and mount effective contact tracing efforts with limited staff. And they have been targeted for criticism by frustrated elected officials and members of the public who blame them for unpopular lockdowns and safety restrictions.

“Bringing together the resources of both The Associated Press and KHN enabled us to marry hard-to-wrangle data with compelling stories from the front lines of the nation’s public health system as it grapples with this pandemic,” said KHN national editor Kytja Weir.

“We are pleased to be working with Kaiser Health News to take a deep look at what is really happening inside the U.S. public health system,” said AP investigative editor Alison Kodjak. “This is important public service journalism at a critical time.”

Through the collaboration, AP and KHN have shared data and offered guidance to news organizations that are AP members and customers to help them localize the findings of the investigation for their regions. KHN and AP expect to publish more stories in the series over the coming weeks and months.

About KFF and Kaiser Health News

Filling the need for trusted information on national health issues, KFF (Kaiser Family Foundation) is a nonprofit organization based in San Francisco, California. KHN (Kaiser Health News) is a nonprofit news service covering health issues. KHN is an editorially independent program of KFF and, along with Policy Analysis and Polling, is one of the three major operating programs of KFF. KFF is not affiliated with Kaiser Permanente.

About AP

The Associated Press is an independent global news organization dedicated to factual reporting. Founded in 1846, AP today remains the most trusted source of fast, accurate, unbiased news in all formats and the essential provider of the technology and services vital to the news business. More than half the world’s population sees AP journalism every day. Online: www.ap.org


Chris Lee | KFF | (202) 654-1403 | chrisl@kff.org
Patrick Maks | The Associated Press | (212) 621-7536 | pmaks@ap.org