Medical providers — doctors, nurses, dentists, for example — help with our personal healthcare. People in the field of public health work to improve the health of all residents of a community (or state or nation) and better understand the factors influencing health. So while a medical doctor treats a patient for asthma, public health agencies probe how many people have asthma, what puts them at risk and what actions are needed to reduce exposures and risks community-wide.

We need both approaches. Unfortunately, though, public health is less well understood by the public it serves and lacks the financial resources to do its job. Of the estimated $3.6 trillion the United States spends per year on health, less than 3% goes to public health and prevention, a 2020 study from the Trust for America’s Health found.

The study said, “Health departments across the country are battling 21st century health threats with 20th century resources.” Nowhere is that more evident than in New Jersey, where public health agencies are increasingly on the front lines of addressing threats to health that were not contemplated when the laws, rules and funding of local delivery of public health services were established. Today, public health is affected by global pandemics, more intense extreme weather, the opioid addiction crisis, marijuana legalization, e-cigarettes and an increasing awareness that the places where we live, work and play have an impact on our health.

A new Rutgers University report by a team I led came to some disturbing conclusions:

• New Jersey ranks 31st nationally in state funding for public health — and when our team compared New Jersey with a set of other states, we found New Jersey has among the lowest local median public-health appropriations per capita in the nation and one of the smallest public health workforces per capita compared to the other states we studied.
• In addition to struggling with inadequate resources, local public health agencies in New Jersey face detrimental restrictions on how they can use those resources. Most public health funds are required to be spent for specific purposes, with little flexibility to shift funds when more pressing community needs emerge. For 45 years, the only state-appropriated, unrestricted funds for local health departments was the Public Health Priority Fund — and it was eliminated in the 2011 state budget.
• Experts are well aware of these weaknesses. The Rutgers team identified at least a dozen studies, reports or executive actions examining the state’s public health infrastructure over the past 30 years.

But the problems persist. One reason for the lack of action is that public health in New Jersey is “invisible” to most residents until an emergency strikes.

An Eagleton Center for Public Interest Polling statewide survey found that 30% of respondents don’t know what the top health-related issue their community is facing, besides COVID-19, and 48% said they were “not too” or “not at all” familiar with the functions of their local public health department.

Yet a large percentage (89%) of respondents said that they have been personally affected by a service provided by their local health department, and more than 75% indicated a great deal or a moderate amount of trust in state and local health officials. Approximately 88% of New Jerseyans believe that it is either “very” or “somewhat” important for the state to establish a source of stable, dedicated funding for use only on local public health services and programs, but they expressed concern about where the money would come from.

Our examination of efforts in several other states points to success in increasing unrestricted funding for local health departments to modernize their capacity to deal with today’s — and tomorrow’s — health issues.

We also found local public health leaders in New Jersey to be eager to take an active part in developing solutions to constrained public health capacity. The Rutgers project team heard a tremendous willingness on the part of the local public health community in the state to find opportunities to strengthen delivery of services while cautioning that the inadequacy of unrestricted funding is the biggest challenge to delivering a 21stcentury public health infrastructure for New Jersey.

In today’s world, we can’t afford to fight health threats with our hands tied. For New Jersey to be a truly healthy and equitable state, we need the public health infrastructure to function at full strength for everyone’s wellbeing.