Health care has become one of Alabamians’ top priorities for state government, according to a new report from the Public Affairs Research Council of Alabama.
PARCA’s report, published as part of its “Issues and Agencies” series, comes as rising health care costs and uncertainty surrounding federal support for health insurance coverage have increased concerns about access to care. In its 2026 public opinion survey, PARCA found that health care was tied with education as the issue Alabamians most want state government to address.
The report focuses on the Alabama Department of Public Health, its responsibilities, funding and governance, while examining the health outcomes and access issues.
Alabama ranked 47th among the 50 states in America’s Health Rankings’ 2025 annual report. The state faces high rates of chronic disease, poverty and limited access to health care, with life expectancy and infant health among the areas where Alabama continues to lag national figures.
The state’s health challenges differ across communities. Rural areas face particular difficulties maintaining hospitals and providing specialized services, including maternity care.
Of Alabama’s 67 counties, 58 are classified as rural, and more than 40 percent of the state’s population lives in rural areas. At least seven rural hospitals have closed since 2010. As of July 2026, 37 percent of the state’s remaining rural hospitals were considered at immediate risk of closure, according to PARCA.
Access to maternity services is also limited. Nearly 90 percent of women in rural Alabama live more than 30 minutes from a hospital with birthing services, compared with 26 percent of women in urban areas. Only 15 of the state’s 58 rural counties have labor and delivery units.
Alabama received $203.4 million in 2026 through the federal Rural Health Transformation Program, which the Alabama Department of Economic and Community Affairs administers. The first major round of funding supported initiatives involving rural health services, workforce development, mental health, medical practices and health records and cybersecurity.
The program is intended to support rural communities across all 67 counties, but the funding is temporary. The program ends in fiscal year 2030, leaving questions about how the state will sustain those efforts after federal support expires.
The Alabama Department of Public Health has a broad mandate that includes monitoring disease, enforcing public health laws, inspecting facilities and overseeing programs designed to prevent illness.
The department operates roughly 75 offices and employs more than 2,600 people. In 2025, it screened approximately 120,000 newborn specimens for genetic and metabolic disorders, conducted 47,000 inspections of food service, lodging, tattoo and seafood facilities, and investigated 685 disease outbreaks and clusters.
The agency’s funding comes from a combination of state, federal and local sources, as well as fees, permits and clinical billing.
For fiscal year 2026, the department was appropriated $1.41 billion in total funding, including $159.4 million from the state General Fund. That General Fund appropriation represented about 4 percent of the fund’s total spending.
Alabama spent $137 per person on public health in fiscal years 2022 and 2023, above the national figure of $124, according to the report. That spending ranked 18th nationally and first in the Southeast.
The federal Rural Health Transformation Program is scheduled to end in fiscal year 2030, leaving the state to ask how to sustain its investments in rural health care. Meanwhile, changes to the Alabama Department of Public Health’s budget and governance will shape how the agency carries out its responsibilities in the coming years.
