Though it be but little, it is fierce!
How the Preventive Health and Health Services Block Grant Bridges Gaps for Innovative, Community-Informed Public Health Interventions:
A Click-Through Story
The US Public Health System has a long-standing history of underinvestment, leading to a reduction in quality of life for individuals and communities. 1
An ill-equipped, under-resourced health department cannot function effectively.
This leads to slow disease tracking allowing disease like foodborne illness to spread faster; and costly chronic disease management that could have been prevented.
Agencies require flexibility to tackle unique and emerging public health problems including investment in public health infrastructure and capacity.
These investments enable health departments to provide essential public health services and to respond to emergencies so that communities can thrive.
However, categorical grants make up the majority of federal funds distributed to state and local government.2
For more than 40 years, the Preventive Health and Health Services Block Grant has served as an essential funding source for state, tribal, territorial, and freely associated state health agencies.
The consistency and sustainability of this grant funding allow recipients to initiate, expand, maintain, and sustain progress on initiatives that complement categorical funding and build a more robust public health infrastructure.
All 50 States +
District of Columbia
2 American Indian Tribes
5 US territories
3 Freely associated states
—PHHS Block Grant Coordinator, 2022
—PHHS Block Grant Coordinator, 2022
Recipients, in collaboration with their advisory committees, use the PHHS Block Grant to address unfunded or underfunded programs that focus on the leading causes of death and disability.
The PHHS Block Grant allows recipients to identify and fund initiatives aligned with national Healthy People objectives that address vital community public health needs in a way that categorical funding may not be equipped to support.
“[T]he block grant gave us some stability… to fully – or more fully – address the needs of families [in our jurisdiction]”
— PHHS Block Grant Coordinator, 2023
“By definition, the block grant fund gives the recipient ability to address [and] prioritize public health needs in their jurisdiction. [We are able to] set our own goals and … implement the local strategy to address national health priorities, [such as] the response to COVID-19 pandemic.”
— PHHS Block Grant Coordinator, 2022
In FY 21 - 22, recipients (58%) used PHHS Block Grant funds to address emerging public health needs.4
Emerging needs over the past few years have included immunization and infectious diseases and social determinants of health.
118 emerging public health needs were addressed with the PHHS Block Grant in FY 21 – 22.5
How Emerging Public Health Needs were Addressed in FY 21 - 22 | n = 118 6
Nearly all recipients (94%) used grant funds to implement public health programs, services, or policies, most of which were evidence based (moderate, strong, or rigorous).7
Of the 947 public health interventions that recipients implemented in FY 21 – 22,
776 (82%) were evidence based.8
The top 5 health topic areas made up 58% of the 776 total evidence based interventions.9
In some cases, this grant serves as “seed funding” for innovative projects that a state, tribal, territorial, or freely associated state health agency provides to meet otherwise-unfunded community health goals.
It allows recipients to try intentional, innovative ideas, while remaining good stewards of federal funds.
The creation and implementation of a novel process, policy, product, program, or system leading to improvements that impact health and equity. It is a new or adapted solution that may be creative, untested and based on context.
Successful innovation results in improved effectiveness, efficiency, or quality.
The process of innovating, through successes and failures, will produce new learning and understanding for informed decision-making and program improvement.10
Within FY 21 – 22 some recipients leveraged PHHS Block Grant funding to implement untested, innovative and/or new public health interventions.
Of the 43 interventions with a weak or no evidence base, 63% were untested, innovative, and/or new.11
Depending on the need, evidence-based interventions may not exist.
Innovation allows for jurisdictions to balance the current evidence-base with what they hear from their communities.
Often this form of customization isn’t feasible within the structure of categorical funding.
The flexibility of the PHHS Block Grant Funds to meeting emerging needs allows recipients to build the evidence-base. In FY 21 - 22, 65% of the 43 interventions with a limited evidence base collected new data as a result.12
“[Block grant funding] really helped us … increase our statistical power and our ability to represent diverse populations on that first as well as all of our subsequent surveys heading into the three years of data collection.”
—PHHS Block Grant Coordinator, 2022
—PHHS Block Grant Coordinator, 2023
—PHHS Block Grant Coordinator, 2023
Expand existing programs that are effective and have the biggest impact within the jurisdiction.
Implement programs that are needed for new, unexpected crises.
Achieve state, territorial, and tribal health goals and objectives.
Implement evidence-based programs for the categories that aren’t discretely funded elsewhere.
Try innovative programs that lack categorical funding because they don’t exist yet or because they aren’t “evidence-based/informed” within the public health sector.
Thanks for reading!
Source: American Progress. “How Investing in Public Health Will Strengthen America’s Health.” https://www.americanprogress.org/article/how-investing-in-public-health-will-strengthen-americas-health/.
Congressional Research Service. “Federal Grants to State and Local Governments: A Historical Perspective on Contemporary Issues.” https://sgp.fas.org/crs/misc/R40638.pdf.
CDC. “About the PHHS Block Grant Program.” Preventive Health and Health Services (PHHS) Block Grant, May 16, 2024. https://www.cdc.gov/phhs-block-grant/about/index.html.
CDC. “PHHS Block Grant Measures Assessment 2022: Key Findings Report.” https://www.cdc.gov/phhs-block-grant/media/PHHS-Block-Grant-Measures-Assessment-2022-Key-Findings-Report.pdf. Measure 2.1.
CDC. “PHHS Block Grant Measures Assessment 2022: Key Findings Report.” https://www.cdc.gov/phhs-block-grant/media/PHHS-Block-Grant-Measures-Assessment-2022-Key-Findings-Report.pdf. Appendix Table 8.
CDC. “PHHS Block Grant Measures Assessment 2022: Key Findings Report.” https://www.cdc.gov/phhs-block-grant/media/PHHS-Block-Grant-Measures-Assessment-2022-Key-Findings-Report.pdf. Appendix Table 11.
CDC. “PHHS Block Grant Measures Assessment 2022: Key Findings Report.” https://www.cdc.gov/phhs-block-grant/media/PHHS-Block-Grant-Measures-Assessment-2022-Key-Findings-Report.pdf. Measure 3.1.
CDC. “PHHS Block Grant Measures Assessment 2022: Key Findings Report.” https://www.cdc.gov/phhs-block-grant/media/PHHS-Block-Grant-Measures-Assessment-2022-Key-Findings-Report.pdf. Appendix Table 12.
CDC. “PHHS Block Grant Measures Assessment 2022: Key Findings Report.” https://www.cdc.gov/phhs-block-grant/media/PHHS-Block-Grant-Measures-Assessment-2022-Key-Findings-Report.pdf. Appendix Table 15.
Note: This definition is adapted from the Public Health National Center for Innovations and additional input from the environmental scan.
Source: ASTHO. “Flexible Funding to Support Public Health Innovation.” https://www.astho.org/topic/report/flexible-funding-to-support-public-health-innovation/.
CDC. “PHHS Block Grant Measures Assessment 2022: Key Findings Report.” https://www.cdc.gov/phhs-block-grant/media/PHHS-Block-Grant-Measures-Assessment-2022-Key-Findings-Report.pdf. Appendix Table 13.
CDC. “PHHS Block Grant Measures Assessment 2022: Key Findings Report.” https://www.cdc.gov/phhs-block-grant/media/PHHS-Block-Grant-Measures-Assessment-2022-Key-Findings-Report.pdf. Appendix Table 14.
CDC. “Funding by Topic Area.” Preventive Health and Health Services (PHHS) Block Grant, May 15, 2024. https://www.cdc.gov/phhs-block-grant/php/data-research/funding-by-topic/index.html.