From Ebola to SARS to COVID-19, public health funding in the United States has long followed a short-sighted, cyclical pattern: Emergency resources surge to meet a pressing crises, then quickly recede as the disease outbreak is addressed and the attention of the public and policy makers moves on. But now, according to new research from the University of Minnesota School of Public Health (SPH), proposed federal spending cuts could exacerbate this already flawed funding system and leave many U.S. communities—especially rural ones—without the resources to sustain even basic public health protections.

The study, published in the Journal of Health Politics, Policy and Law, examines what would happen if federal funding was rolled back to pre-COVID-19 levels. Drawing on national datasets from the U.S. Census Bureau, the Centers for Medicare and Medicaid Services, and national public health associations, the researchers modeled multiple funding scenarios to test whether local governments would be able to replace lost federal dollars and maintain services.

“Over the past 40 years—and especially in the last 15—the federal government’s role in funding our state and local public health agencies has grown substantially, meaning that rollbacks in federal support are more consequential than ever before,” said JP Leider, SPH associate professor, director of the Center for Public Health Systems (CPHS), and lead author of the study. “While some local jurisdictions would be able to weather proposed federal cuts through other revenue sources, many counties—especially smaller, poorer, more rural ones—would be unable to replace lost federal funding. This would create a tiered system of public health, where people in wealthier, urban and suburban areas would be protected, and people in rural counties would be more exposed to public health threats.”

The paper includes a number of findings about the impact proposed federal public health cuts would have on local communities across the U.S., including:

• Massive potential reductions in overall public health spending. A rollback to 2019 federal funding levels would cut local public health spending by an estimated $13.5 billion nationwide, or about $4.3 million per county.
• Disproportionate impact on rural and low-resource communities. Jurisdictions most dependent on federal aid—often smaller, poorer, or rural counties—would face the deepest losses, threatening essential services such as disease surveillance, emergency preparedness, and maternal and child health programs.
• Limited local capacity to backfill cuts. For every 1% reduction in federal funds, local governments would need to raise their own revenues by 0.6% to maintain services—an increase most counties have never achieved.

“Without sustained federal investment, the essential services that protect Americans—like disease tracking, food safety, and emergency preparedness—are at risk,” said Jason Orr, a co-author and researcher at CPHS. “These cuts won’t just affect budgets; they’ll weaken vaccine programs, reduce behavioral health and overdose prevention efforts, and leave rural and low-income communities especially vulnerable. The public health system is only as strong as its weakest link—if federal funding is reduced, the entire country becomes more vulnerable.”

The study recommends maintaining stable federal funding for Foundational Public Health Services, and also suggests that further research be conducted on how disinvestment affects health outcomes, especially in rural and under-resourced communities.

The article appears in a special issue of the Journal of Health Politics, Policy and Law called “Public Health Under Siege” which chronicles the damage to public health from recent federal actions and explores the future of public health. SPH Professor Sarah Gollust is one of the special issue editors, and is also the editor of the journal. To read the opening essay in the special edition, go here.