Years of lean state budgets may be threatening Minnesota's national reputation for a sterling public health system, according to a report released Monday by two leading health organizations.

Minnesota ranked 43rd nationally in state funding for public health, with per capita spending of $14.62, about half the national average, according to the analysis conducted by the Trust for America's Health, a nonprofit health advocacy group.

The report came as no surprise to county public health leaders, who described recent austerity measures ranging from layoffs to reassigning restaurant inspectors to help with flu shots.

Between 2008 and 2009 public health spending in the state dropped by $6.5 million to $77 million, the report said.

"That is significant," said Jeffrey Levi, executive director of the group and an associate professor at George Washington University. "That translates into real jobs lost and real services not being delivered."

Minnesota is nationally known for its public health system and for the work of the Minnesota Department of Health. The department has received national recognition for its disease investigations, and the state is known for its high vaccination rates and generally healthy population.

But Levi warned that those could slip as funding slips. "To a lot of folks, the Minnesota public health is a model of how things should be done," he said. "But you can't maintain that if you are cutting budgets."

He also said Minnesotans' robust health is in part due to the state's low rates of uninsurance and good access to health care. But these, too, have been slipping in recent years.

Local public health officials said funding for public health has been eroding for years, and they are feeling the pain. The St. Paul-Ramsey County Public Health Department has cut 15 out of 325 positions, leaving some of its programs understaffed, said Rob Fulton, department director.

As a result, it pulled restaurant inspectors from their jobs to help with H1N1 flu vaccination clinics, he said. The county also has stopped health screenings for new refugees, relying instead on another community agency to do the work. It can't handle more than 125 clients at a time in its visiting nurse program for first-time pregnant women.

The same is true in Anoka County, said Rina McManus, director of Community Health and Environmental Services.

"We've tried to spread our work to other community entities like hospitals and schools," she said.

State and local officials agreed Monday that, in general, the amount of money for public health is decreasing, and almost certainly will shrink more given the state's budget crunch.

But, they said, the report measures only public health spending from the state's general fund, which does not include all sources of money for public health in Minnesota or in other states.

That more complete analysis, which would include everything from fees to property taxes, has never been done, they said.

Minnesota also compared poorly to other states in federal funding from the Centers for Disease Control and Prevention (CDC). According to that measurement, Minnesota ranked 41st nationally.

Levi said the report, which was co-sponsored by the Robert Wood Johnson Foundation, is aimed at Congress and the Obama administration.

Senate addresses public health

"Our hope is that this will strengthen congressional resolve to maintain the public health provision in health care reform," he said, which in the Senate version of the stalled bill would be about $15 billion.

The nation's public health system is woefully underfunded as it is, the report said. Federal funding for public health has been "virtually flat'' for five years and has not kept pace with inflation.

"Millions of Americans are needlessly suffering from preventable diseases, health care costs have skyrocketed and our workforce is not as healthy as it needs to be to compete with the rest of the world," it said.

In 2008 Minnesota public health got a major boost from a one-time $47 million allocation from the Legislature to fight smoking and obesity. About $20 million of it will be spent this year and $27 million next year in communities across the state. Anoka County, for example, will get $2.3 million to reduce smoking and improve the quality of food in school lunch programs, among other programs.

"That was a major investment," McManus said. "We haven't seen it at that level in some time," she said.

That money, however, did not come from the state's general fund. It's allocated from the Health Care Access Fund, a levy on health care providers that also funds MinnesotaCare, a health insurance program for low-income working people.

That's an example of public health funding in Minnesota that is not reflected in the report, and which may be unique to Minnesota, officials said.

Another $100 million is provided to local public health agencies by county property taxes, said Craig Acomb, assistant commissioner at the Health Department. The Minnesota Department of Health also receives millions in federal funding from other agencies in addition to the CDC. He said that the $77 million that comes from the state's general fund is only a small portion of its half-billion-dollar total budget.

He also pointed out that the $20 million for obesity and smoking prevention that's been allocated this year amounts to about $3.86 per Minnesotan. If that were figured into the state rankings it would push Minnesota up to 38th place -- right next to Georgia.

Josephine Marcotty • 612-673-7394