How Much Do We Spend? Creating Historical Estimates of Public Health Expenditures in the United States at the Federal, State, and Local Levels

Jonathon P. Leider, Beth Resnick, David M Bishai, F. Douglas Scutchfield

Research output: Contribution to journalReview article


The United States has a complex governmental public health system. Agencies at the federal, state, and local levels all contribute to the protection and promotion of the population's health. Whether the modern public health system is well situated to deliver essential public health services, however, is an open question. In some part, its readiness relates to how agencies are funded and to what ends. A mix of Federalism, home rule, and happenstance has contributed to a siloed funding system in the United States, whereby health agencies are given particular dollars for particular tasks. Little discretionary funding remains. Furthermore, tracking how much is spent, by whom, and on what is notoriously challenging. This review both outlines the challenges associated with estimating public health spending and explains the known sources of funding that are used to estimate and demonstrate the value of public health spending.

Original languageEnglish (US)
Pages (from-to)471-487
Number of pages17
JournalAnnual Review of Public Health
StatePublished - Apr 1 2018



  • public health finance
  • public health spending
  • public health systems
  • public health systems research

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this