How much do state health agencies spend on non-public health activities?

State health agencies are central to the public health enterprise. They are guarantors of communicable disease control, enforcers of laws and regulations, and are responsible for the current and future health of the residents of their state. However, many state health agencies provided programs and services that are beyond the scope of traditional public health. Current measures of state spending on public health, namely through the endeavors of the Association of State and Territorial Health Officials, tend to exclude non-public health spending. As such, these estimates have not previously been available to practitioners or researchers. To better understand the current state of state health agencies, we have analyzed administrative budget data available through the Census' State Finance division, and have parsed public health spending from total spending in the designated state health agencies. For FY11, over 186,000 budget line items constituted the spending dataset for designated state health agencies. Preliminary analysis suggests that 62% of the $16.7 billion spent by free-standing agencies went toward public health and behavioral health provision, while 26% went to payments to vendors for clinical care, and 5% went toward transfer to local government. Among umbrella agencies (where public health may be one division among several), approximately $77.4 billion was spent in FY11, 70% went to payments to vendors for clinical care, 10.6% went for public health and behavioral health, 4.7% went toward welfare, and 9% went toward local transfers of any kind. The data show that state health agencies are responsible for several facets affecting population health and well-being, beyond public health. This suggests a greater need to understand how public health relates to other governmental agencies, bureaus, and departments when running financial analyses and when conducting public health planning.