Hawaii continues to spend more money on public health per person than any other state — an average of $172.21 for a total of $221,008,69 in 2008, according to a new report by Trust for America's Health.

The figures have increased since 2007, when Hawaii led the nation with total spending of nearly $196 million — an average of about $152.66 per person.

However, Hawaii's public health is better than many states, with key indicators showing, for example, low rates of adult obesity, adult smoking and new cases of cancer.

State health officials weren't clear where the trust obtained its information on state health spending. The total general fund budget for Hawaii's Health Department this fiscal year is $454.5 million, including state, federal and special funds for all services, said Susan Jackson, deputy director for health.

It may appear to be a fat budget for a small population but “;certain infrastructure is needed to run health services throughout the islands”; and there are no county health departments here as in other states, she pointed out. Also, the budget doesn't cover all needs for public health services, she added.

The U.S. Centers for Disease Control and Prevention averaged $17.60 per person last year with public health spending nationally. State spending averaged $33.71 per person, with a low of $3.37 per person in Nevada.

The nonprofit trust's 2009 report, “;Shortchanging America's Health,”; shows Hawaii rose from 13th place in 2007 for federal funding for disease prevention to eighth place last year.

The “;State-by-State Look at How Federal Public Health Dollars Are Spent”; examines how the recession could result in critical cuts to disease prevention and emergency preparedness programs.

The CDC provides the bulk of federal public health dollars, distributing about 75 percent of its budget to states and other public and private partners to support health programs. The Health Resources and Services Administration and Office of the Assistant Secretary of Preparedness and Response also provide public health money.

Laura Segal, Trust for America spokeswoman, said by telephone that there is “;no clear logic or explanation”; for CDC's state health funding, distributed in competitive grants or cooperative agreements.

“;It's not based on health statistics or outcomes. It's luck of the draw,”; she said.

Hawaii received a total of almost $33 million last year from CDC, averaging $25.55 per capita. Alaska received the most state funding — about $36.22 million for an average of $52.78 per person.

Indiana received $81,208,839, which amounted to $12.74 per person — the least in the country — and it had the worst health outcomes, Segal pointed out.

“;We're trying to show that spending in this country is not in alignment with what the health problems are,”; she said. Only “;a tiny fraction”; is being spent on prevention, compared to high health care costs, she said.

Risa Lavizzo-Mourey, Robert Wood Johnson Foundation president and chief executive officer, said in a news release, “;Even in these troubled times, prevention is an investment we can count on to deliver a big payoff — sparing millions of people from developing preventable diseases while saving billions in health care costs.”;

All but four states face budget shortfalls for 2009, 2010 and 2011 that could total more than $350 billion, the Center on Budget and Policy Priorities estimates.