Public Health Highlights of President’s FY22 Budget Proposal

June 09, 2021 | Jeffrey Ekoma

Last month, President Biden released full details of the fiscal year (FY) 2022 budget. Overall, the budget request combines the president’s American Jobs Plan, his American Families Plan, and funding priorities for the Pentagon and domestic agencies, for a projected total of $6 trillion.

It’s always important to note that the budget from the president is a proposal and Congress has the authority to approve, reject, or modify recommendations from the Administration. However, there is much to be excited about if you are a public health advocate.

Read more about what President Biden is proposing below.

Public Health Infrastructure

Following the historic announcement to invest $7.4 billion to hire and train public health workers in response to the COVID-19 pandemic, the budget proposes increased funding ($50 million) for Public Health Workforce at CDC to support their fellowship and training programs.

The budget also proposes new funding to invest in core public health infrastructure and capacity across the country by directly supporting state, territorial, and local health departments. This funding would help in attracting and retaining diverse leadership, as well as improving the nation’s ability to respond to emerging and new infections.

Both investments represent the critical nature of our public health infrastructure after recent significant public health emergencies (COVID-19, Zika, Ebola, and the H1N1 influenza pandemic) and the needed urgency to address them.

This new investment sends an important signal from the White House. It shows their interest in supporting long-term investment in public health infrastructure beyond emergency supplemental funding, and provides the necessary flexibility for public health jurisdictions to utilize funding efficiently.

Data Modernization

It's been well documented that data collection and surveillance systems are antiquated and in need of modernization. The budget proposes increased funding ($100 million) for the CDC’s Public Health Data Modernization Initiative to implement its Roadmap of Activities and Expected Outcomes focused on three priority areas: coordinating people and systems, accelerating data for action, and supporting strategic innovation.

Preparing for Future Pandemics

One of the many lessons learned from the COVID-19 pandemic was the importance of adequately preparing our nation to handle future and emerging public health emergencies. The budget recognizes this and prioritizes increased investments for the Strategic National Stockpile. It allows the Assistant Secretary for Preparedness and Response to deploy personal protective equipment from the stockpile to state, territories, and cities, and supports the development of medical countermeasures-from the Biomedical Advanced Research and Development Authority.

Considering that these investments are discretionary, the proposal also seeks a new mandatory $30 billion funding allocation, over four years, to support this effort led by HHS ($24 billion), Department of Defense ($5 billion), and the Department of Energy ($1 billion). In addition, there is also the creation of a new mandatory program to fund health emergency preparedness at $250 million through FY 2026.

Utilizing a mix of both discretionary and mandatory investments represents the Biden Administration’s interest to ensure that this priority is resourced proactively and also adequately funded at least through the President’s current term in office.

Climate Change

The climate crisis and its impact on the public have been profound. Protecting the public’s health from these impacts has been a top priority for state and territorial public health jurisdictions engaged in improving environmental health.

In recognition of this, the budget proposes a $100 million increase to the CDC Climate and Health Program, which directly supports state, territorial, local, and tribal health agencies to prepare for health impacts of a changing climate, to expand the program to assist in the identification of health effects associated with climate change, and the implementation of health adaptation plans.

This investment also addresses a key summary recommendation of ASTHO’s Climate and Extreme Weather Events Health Policy Statement to “support efforts to conduct climate adaptation and vulnerability assessments and planning activities.”

There is also the creation of a new mandatory program to build climate resilience for $250 million through FY 2025.

Social Determinants of Health Program

In FY 2021, Congress provided $3 million to establish a Social Determinants of Health (SDOH) Program within CDC’s National Center for Chronic Disease Prevention and Health Promotion.

To accelerate this initial investment, the budget proposes to increase funding for the program by $150 million. This will expand funding to all states and territories to implement accelerator plans, initiate a SDOH implementation program, and many more activities. This represents a significant effort to not only improve health outcomes but also address health inequalities by allowing jurisdictions to address SDOH within their communities.

Opioid Epidemic

The COVID-19 pandemic has exacerbated the nation’s opioid epidemic and, according to an estimate from the Well Being Trust and the American Academy of Family Physicians, there may be a large increase in deaths from drug overdoses as a result of economic challenges brought on by the pandemic.

Overall, the budget proposes a $3.9 billion increase to address this epidemic by building on investments such as the Substance Abuse Prevention and Treatment Block Grant, Community Mental Health Services Block Grant, and Certified Community Behavioral Health Clinics, to name a few. These resources will also be used to increase to track and prevent overdose deaths at state, territorial, and local health departments, as well as prioritizing support for the Overdose Data to Action program.

Injury and Violence Prevention

The budget affirms a commitment to addressing injury and violence in communities across the country by increasing funding ($12.5 million) for research to prevent firearm-related injuries and deaths at the CDC, as well as expanding the number of jurisdictions participating in the Firearm Injury Surveillance Through Emergency Rooms (FASTER) initiative.

There is also a proposal to create a new evidence-based community violence intervention initiative for $2.23 billion, through FY 2031, to prevent intentional violence in cities with the highest overall number of homicides, enhance support to state and territorial health departments to initiate, expand, or enhance rape prevention activities, and providing additional support to recipients who report data to the National Violent Death Reporting System.

Looking Ahead

Congress has the final say when deciding how to spend federal funds and considering the size and scope of the President’s budget proposal, many critical public health funding priorities will need to be addressed before the expiration of FY 2021 on September 30, 2021.

One important decision before Congress is the deliberation of mandatory vs. discretionary funding for certain programs and initiatives considering the apprehension of congressional appropriators to implement additional mandatory funding.

Furthermore, the recent influx of funding to public health jurisdictions to respond to the COVID-19 pandemic is likely to impact the interest of some lawmakers to increase public health spending for the upcoming fiscal year.

A detailed summary and analysis ASTHO developed for the CDC, HRSA, ASPR, SAMHSA, and other agencies is available for download. ASTHO will continue to engage in and monitor developments of activities related to the fiscal year 2022 appropriations cycle.