Underfunded and Under Threat

Judges comments

The breadth and depth of this reporting is astounding. The series is a huge boon for other reporters in all 50 states who’d like to parse the data themselves. Bravo for KHN and AP to be generous enough to hold video conferences to demo what’s there and how to use the data. This is an excellent example of collaborative investigative work with local and national stories that led to further investigations and reporting.

About the Project

Long before the coronavirus pandemic upended the nation, the U.S. had been dismantling the public health system designed to protect it.

In the Underfunded and Under Threat series, KHN and The Associated Press joined forces to take a definitive look at how the nation systematically gutted public health departments ahead of the largest health crisis in generations.

Few people had an understanding of what public health departments do, and no comprehensive data existed that tracked public health at local, state or federal levels. But who better to take on that challenge and tell the story, particularly at a time when the country needed to hear it most? By working together, we were able to marry the health expertise of KHN and the reporting reach and resources of the AP.

The team had to pull together more than a dozen data sources to assess hundreds of state and local health departments. Reporters interviewed more than 150 people, surveyed all 50 statehouses, filed dozens of records requests and sorted through legislation across the country.

Our analysis found that at least 38,000 state and local public health jobs disappeared since 2008, and we showed that spending for local public health departments dropped by 18% per capita since 2010, while priorities such as law enforcement got more money.

Though Congress set aside trillions of dollars to ease the crisis, our investigation found that many states initially spent little of that on public health departments. For example, a Minnesota debt collection company received at least $5 million, while the state health department was forced to take money away from violence prevention and other programs to buy COVID-19 tests and pay contact tracers.

Our survey of statehouses showed that, during the pandemic, legislatures continued to undercut the system with budget cuts. Lawmakers also crafted bills in at least 24 states to further weaken public health powers.

KHN and AP showed how such politicization prompted physical threats against public health workers on the front lines. And we followed that story throughout the year, documenting how this virulent backlash led to the largest exodus of public health leaders in American history. Our reporting showed that at least 248 top state and local public health leaders in 42 states resigned, retired or were fired since April 1, 2020. That means 1 in 6 Americans lost their local public health department leader during the pandemic.

Now, though, public health officials fear the newer flood of federal money will dry up once the pandemic recedes, returning them to the boom-bust cycle of funding.

The decades of neglect revealed the underlying truth that U.S. political leaders have little respect for the role of our public health system and the expertise of its leaders. That disregard has played out vividly during the pandemic as politicians — along with their supporters — vilified public health leaders and ignored their advice, most certainly leading to more deaths than would have occurred if public health guidance had been followed.