A Blueprint for the 2021 Administration and Congress

The Promise of Good Health for All: Transforming Public Health in America  

The nation’s public health system is dangerously inadequate and needs sustained attention and investment. This report provides an action plan for the administration and Congress taking office in 2021.

The COVID-19 pandemic sharply illuminated weaknesses in the nation’s public health system and ways in which structural racism put communities of color at disproportionate risk of negative health outcomes. This report offers a blueprint for policymakers taking office in 2021 on how to strengthen the system, protect against health security threats, address the social determinants of health, and combat racism and other forms of discrimination that negatively affect community and individual health and resilience.

Americans are facing increasing environmental and weather-related threats from wildfires to hurricanes. Infectious disease outbreaks are a constant and complex risk as world travel allows small outbreaks to become worldwide threats in a matter of hours. Additionally, Americans have higher levels of chronic disease and mental health and substance misuse issues than ever before.  As a nation, we spend over $3 trillion annually on healthcare but lag behind other developed countries in practically every health metric. A key to addressing these threats to the nation’s health is a significant investment in the public health system, including programs rooted in prevention and working at the population health level. The report calls for an annual $4.5 billion investment in the nation’s public health infrastructure including in 21st century data systems and a robust public health workforce.

“Even before COVID-19, numerous health emergencies, including infectious disease outbreaks like measles, Zika and Ebola, the opioid epidemic, weather-related events and lung injuries due to vaping demonstrated the urgency of a strong public health system,” says John Auerbach, President and CEO of Trust for America’s Health.

“Each of these emergencies brought short-term attention to the importance of the public health system, but short-term attention is not enough.  Without sustained investment the nation’s public health system we will not be ready to protect Americans’ lives and livelihoods during the next health emergency,” Auerbach said.

The conditions in which people live and work are key drivers of their health. Therefore, solutions to health risks and inequities largely exist outside the healthcare sector and reinforce the importance of investing in population health and the social determinants of health. Increasing the nation’s investment in health promotion and disease prevention will not only improve the quality of life for millions of Americans, it will help decrease the nation’s exploding healthcare spending.


The report focuses on five key priority areas:

PRIORITY 1: Make substantial and sustained investments in a more effective public health system including a highly-skilled public health workforce.

PRIORITY 2: Mobilize an all-out effort to combat racism and other forms of discrimination and to advance health equity by providing the conditions that optimize health.

PRIORITY 3: Address the social determinants of health including economic, social, and environmental factors that result in preventable illness, injuries and death.

PRIORITY 4: Proactively address threats to the nation’s health security.

PRIORITY 5: Improve health, safety, and well-being for all people by providing pathways to optimal health across the life span.


Among the report's recommendations for federal policymakers are:

  • Strengthen and modernize the public health system by creating a $4.5 billion per year Public Health Infrastructure Fund to support foundational public health capabilities at the state, local, territorial, and tribal levels.
  • Build 21st century public health surveillance systems at the federal, state, and local levels to enable rapid detection and response to disease threats.
  • Create a Health Defense Operations budget designation to build sustainable funding for public health programs that prevent, detect and respond to outbreaks.
  • Make advancing health equity and eliminating health disparities a national priority with a senior-level, federal interdepartmental task force charged with adopting policies and programs in housing, employment, health, environmental justice and education that reduce health inequities and address the social determinants of health.
  • Expand grants to address health inequities and ensure funding is reaching under-resourced, marginalized, and disproportionately affected communities.
  • Prioritize increased funding for state, local, tribal, and territorial public health emergency preparedness and response programs, such as CDC’s Public Health Emergency Preparedness program and HHS’s Hospital Preparedness Program.
  • Build surge capacity across the healthcare system and develop standards for healthcare facility readiness. Policymakers should provide payment incentives and reward facilities that maintain specialized disaster care capabilities.
  • Grow the CDC’s Climate and Health Program so it can support every state, large cities, territories, and tribes to be climate-ready. Clean air and water regulations should be restored and strengthened, including the Clean Air Act and Clean Water Act.
  • Increase research and effective messaging to build vaccine confidence and ensure that no person faces barriers to receiving all necessary vaccinations.
  • Promote optimal health across the lifespan through access to health insurance, job-protected paid leave for workers, and significant investments in programs proven to support families and improve health – from babies to older adults.

The report is endorsed by the American Public Health Association, the Asian & Pacific Islander American Health Forum, the Big Cities Health Coalition, the Public Health Institute, and the National Network of Public Health Institutes.

Read the Full Report