Issue Category: Age-Friendly Public Health

The Number of People in the U.S. Serving as Informal Caregivers is Growing, Yet Support and Assistance for Them is Shrinking, According to New Policy Brief

Public health agencies can play vital role in supporting caregivers

(Washington, DC – September 30, 2025) – As the percentage of older adults continues to grow in the United States, so do the number of people providing informal caregiving to them. A new policy brief highlighting the role of caregivers, published by Trust for America’s Health (TFAH) today, finds that many people who provide unpaid, informal caregiving are experiencing increasing levels of economic, emotional, and physical hardships as a result. The brief highlights the many roles that public health agencies can play in supporting caregivers and that more federal and state interventions are needed to support this growing segment of the population.

The brief, Public Health’s Roles in Supporting Informal and Family Caregivers, reports that 41.8 million people served as a caregiver to an adult over the age of 50 in 2020, an increase of over 7 million people who provided unpaid care to a family member or friend in 2015.

“The prevalence of caregiving in the U.S. has grown exponentially more complex,” said Megan Wolfe, senior policy development manager at TFAH who leads its Age-Friendly Public Health Systems initiative. “As more jurisdictions work to be age-friendly communities, having a nuanced understanding of the role and challenges facing caregivers will allow public health organizations to work with community partners to advocate for and provide the support caregivers need.”

The caregiving population is a diverse one, with about 40 percent of caregivers being individuals of color (17 percent Hispanic or Latino, 14 percent non-Hispanic Black, 5 percent Asian American and Pacific Islander, and 3 percent some other race/ethnicity, including those who identified as multiracial), according to the brief.

Women that serve as caregivers and caregivers of color face greater financial stress and physical demands that can impact their health, including experiencing depressive symptoms and feeling ignored or difficulty navigating healthcare systems.

TFAH’s Age-Friendly Public Health Systems (AFPHS) provides guidance for public health practitioners on the policy and systems changes that are needed to advance healthy aging and build supportive communities. This includes programs and activities that support caregivers, including better availability and easier navigation of caregivers’ supports.

The brief provides recommendations for the roles of public health that are aligned with the AFPHS Framework, including:

  • Advocate for changes to the workplace to create supports for caregivers including leave policies and employment protections.
  • Help create cross sector initiatives that support older adult and caregiver needs.
  • Work with the healthcare sector to ensure that healthcare providers understand and can refer caregivers to non-clinical support resources in their communities.
  • Collect data on the experience of caregivers and help communities design programs that meet their needs.
  • Model the use of culturally appropriate communication strategies that recognize the diversity of the caregiving population.
  • Create programs that provide caregivers with the tools they need to care for themselves and their care recipients.

TFAH’s Age-Friendly Public Health Systems initiative is made possible with generous support from The John A. Hartford Foundation.

To learn more about the Age-Friendly Public Health Systems initiative, visit Age-Friendly Public Health Systems – Trust for America’s Health (afphs.org)

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Trust for America’s Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and works to make the prevention of illness and injury a national priority.

The John A. Hartford Foundation, based in New York City, is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The leader in the field of aging and health, the Foundation has three areas of emphasis: creating age-friendly health systems, supporting family caregivers and improving serious illness and end-of-life care. https://www.johnahartford.org/

Age-Friendly Public Health: The Podcast

July 2025

In this episode of Age-Friendly Public Health: The Podcast, host Dr. J. Nadine Gracia, President and CEO of Trust for America’s Health is joined by Alison Barkoff, Associate Professor of Health, Law, and Policy at the George Washington University Milken Institute School of Public Health, to discuss how disability and aging policy intersect and can support one another. 

The Intersections Between Aging and Disability Policy – transcript

Season Two Episode:

Season One Episodes:

You can listen on Apple Podcasts, Spotify or where ever you access your favorite podcast.

Age-Friendly Public Health: The Podcast is a production of Trust for America’s Health’s (TFAH) Age-Friendly Public Health Systems Initiative. This quarterly podcast, hosted by TFAH’s President and CEO Dr. J. Nadine Gracia, will feature conversations with leaders in the age-friendly public health systems movement on challenges, opportunities, and model programs, with a focus on the role public health can play in helping older adults thrive.

 

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    New 6Cs Training and Implementation Guide will Help Communities Implement Strategies to Support Older Adults

    TFAH’s Age-Friendly Public Health Systems (AFPHS) team recently released a new toolkit, The 6Cs Training and Implementation Guide, to give public health professionals an in-depth understanding of the AFPHS “6Cs” Framework. The guide will help communities build effective public health strategies and practices to support older adults.

    Megan Wolfe, who leads AFPHS, sat down to answer a few questions about this new resource:

    TFAH: What is the 6Cs Training and Implementation Guide and how did it come about?

    Megan: The 6Cs Guide resulted from the need to provide guidance to state and local health departments seeking recognition through the Age-Friendly Public Health Systems (AFPHS) Recognition Program. The Recognition Program requires health departments to commit and complete strategies and activities and adopt policies and programs to support older adult health and well-being. These activities need to be aligned with the AFPHS 6Cs Framework. So, the Guide includes a comprehensive set of strategies that public health practitioners can learn and hopefully adopt as part of their AFPHS journey.

    As we were developing the Guide, we realized that we accumulated a great deal of valuable resources that we could use to build a truly comprehensive library, including examples of data dashboards on older adults, examples of partnerships, as well as tools to enhance the community health improvement process.

    TFAH: Who is the Guide intended for? Who should use the Guide?

    Megan: The Guide can be used by anyone who wants to build expertise in healthy aging, especially from a public health perspective. Our vision is that entire health department staffs will use it, but it’s also perfect for individuals or small teams to work through together.

    TFAH: How should an individual or community group use the Guide. Is there a proper order to best utilize the Guide?

    Megan: The Guide is aligned with the six tenets of the AFPHS framework, so we developed one module for each of the six tenets, as well as an introductory module. We suggest that users start with the introduction and then complete Module 1, because it   is focused on creating and leading change and really sets the tone for the other modules. After that, users can really jump around and complete whichever module that provides the guidance they need, or simply complete them in order, one through six.

    TFAH: Are there any features in the Guide that are a personal favorite of yours?

    Megan: So many things! My absolute favorite are the lists of resources that are included in each module. This will be a dynamic list that we’ll update regularly, based on the development of new tools and identification by our team of great examples of the 6Cs in action. I also really like the Competence Checks that are part of Modules 1-3, as they provide an opportunity for a user to reflect on the expertise they’re building and assess where they go next. Modules 4-6 have application exercises rather than Competence Checks, and these are valuable for putting the strategies into action.

    Megan Wolfe, JD is the Senior Policy Development Manager at TFAH, where she works with the Policy Development team to advance a modernized, accountable public health system through the Age-Friendly Public Health Systems initiative.

     

    2024 Year in Review and Looking Ahead to 2025

    During 2024, Trust for America’s Health (TFAH) continued its work to create a more resilient, trusted, and equitable public health system, and a healthier nation.

    TFAH continued its work in a number of critical issue areas to improve the nation’s health, including emergency preparedness, public health funding, chronic disease prevention, the role of food and nutrition policy in stemming the nation’s obesity crisis, preventing substance misuse and suicide, supporting healthy aging, and addressing the health impacts of climate change and other environmental health risks.

    Progress and Risks

    The nation’s public health system is at an inflection point; progress has been made in many areas but there are also continuing and potential new risks to the nation’s health. The following are examples of areas of progress and areas of risk.

    Areas of progress:

    • Drug overdose deaths, including from fentanyl, are down. The reduction can be credited in part to the increased availability of treatment options and the adoption of harm reduction strategies such as readily available naloxone, the overdose reversal drug, in many communities. However, disparities persist, with overdose rates increasing in many Black and Native American communities.
    • COVID-19 infection rates are currently low across the country, a testament to what can be achieved when the public health community rallies and has the funding and resources necessary to meet an immediate challenge.
    • Investments in public health data modernization, wastewater surveillance, and the Centers for Disease Control and Prevention’s (CDC) Center for Forecasting and Outbreak Analytics have improved the nation’s ability to identify and track emerging health threats. The Center has awarded more than $100 million to partners who are technologically advancing the use of outbreak data to control infectious disease spread.
    • Fifty-nine state and local health departments have earned Age-Friendly Public Health Systems Recognition Status through TFAH’s Age-Friendly Public Health Systems initiative by making healthy aging a core function of the department. In addition, four public health organizations and 154 individual public health practitioners have been recognized as public health champions.
    • Fifteen states and D.C. have adopted paid sick leave laws which require private employers to provide paid sick leave to employees attending to their own or a family member’s health. Alaska, Missouri, and Nebraska will require employers to provide paid sick leave beginning in 2025. Paid sick leave has been a long-standing TFAH policy recommendation.

    Areas of risk:

    • Public health faces a serious funding cliff as monies infused into the public health system as part of the pandemic response are expiring or in some cases rescinded. The loss of such funding returns the public health system to the state of underfunding it experienced for decades prior to the global pandemic. TFAH’s annual report, The Impact of Chronic Underfunding on America’s Public Health System 2024: Trends, Risks, and Recommendations called attention to the critical need to increase investment in public health on a sustained basis.
    • The COVID-19 pandemic exposed serious gaps in the nation’s emergency infrastructure that have not been fully addressed. Furthermore, misinformation about the pandemic, particularly about lifesaving COVID-19 vaccines, contributed to an uptick in mistrust of public health officials that could lead to more vaccine hesitancy and challenges to important public health authorities, all of which could make containing future disease outbreaks more difficult.
    • New disease outbreaks such as the H5N1 Bird Flu could grow.
    • Rates of recommended childhood vaccinations are down.
    • Health disparities continue to impact the nation. Rates of chronic disease are on the rise in every community but are higher, for example, among many communities of color and in rural communities, due to structural barriers to health like access to healthy and affordable food, secure housing, and opportunities for physical activity in those communities.
    • Health risks are also increasing due to an increase in the number and severity of weather-related incidents including extended periods of extreme heat and extreme heat in regions of the country unaccustomed to such weather.

    Working With Partners and Providing Leadership to Strengthen the Nation’s Public Health Ecosystem

    TFAH released its Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress in October, after consultation with more than 45 experts, practitioners, organizations, and community members. The Blueprint provides the incoming Administration and Congress a policy roadmap for improving the nation’s health, economy, and national security within six priority areas: 1) invest in public health infrastructure and workforce, 2) strengthen prevention, readiness, and response to health security threats, 3) promote the health and well-being of individuals, families, and communities across the lifespan, 4) advance health equity by addressing structural discrimination, 5) address the non-medical drivers of health to improve the nation’s health outcomes, and 6) enhance and protect the scientific integrity, effectiveness, and accountability of agencies charged with protecting the health of all Americans.

    Working with partners across multiple sectors is central to TFAH’s work. TFAH staff led or participated in a number of coalitions during 2024, including the Coalition for Health Funding, the CDC Coalition, the Common Health Coalition, the Well-Being Working Group, the Injury and Violence Prevention Network, National Alliance for Nutrition and Activity, the Coalition to Stop Flu, the Adult Vaccine Access Coalition, the Age-Friendly Ecosystem Collaborative, the National Alliance to Impact the Social Determinants of Health, the National Commission on Climate and Workforce Health, and the National Council on Environmental Health & Equity.

    Advocating for Evidence-Based Solutions

    A healthy community supports the health of individuals and families by creating access to non-medical drivers of health such as secure housing, transportation, quality healthcare, high-quality childcare and educational opportunities, and jobs that pay a living wage. Such health security supports individuals, families, communities, and the nation’s economy.

    Throughout the year, TFAH convened partners to strategize ways to effectively advance health promoting policies and programs at the federal and state levels. In addition, TFAH staff worked with numerous federal agencies and offices, like CDC, FDA, and SAMHSA, as well as public health organizations such as the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), Big Cities Health Coalition, and the National Governors Association to advance policies and garner support for programs that will improve Americans’ health. Among TFAH’s legislative goals for 2024 and moving into 2025 are increased and sustained investment in public health agencies, infrastructure, and programs; passage of a new Farm bill that provides access to nutrition support programs; reauthorization of the Pandemic and All Hazards Preparedness Act and the Older Americans Act; and passage of the Public Health Infrastructure Saves Lives Act and the Social Determinants of Health Act.

    These advocacy efforts earned numerous policy wins, including the U.S. Department of Agriculture’s (USDA) updates to school meals formulas and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefit food packages that aligns with TFAH recommendations.

    TFAH’s core annual reports, which track data and recommend policy solutions in the areas of emergency preparedness, public health funding, preventing substance misuse and suicide, and addressing the nation’s obesity crisis, continue to be a critical source for data trends and evidence-based policy and program solutions for health officials, policymakers, other decision-makers, and advocates across the country.

    Making Healthy Aging a Core Function of Local Health Departments

    Through its Age-Friendly Public Health Systems Initiative (AFPHS), TFAH continues to provide guidance and resources to state and local health departments to help them promote healthy aging in their communities. During 2024, AFPHS co-hosted the 2024 National Healthy Aging Symposium with the U.S. Department of Health and Human Services’ (HHS) Office of Disease Prevention and Health Promotion. The symposium brought together speakers from sectors across all levels of government, philanthropy, academia, nonprofits, community-based organizations, tribal representatives, and others who shared their perspectives on important topics related to healthy aging including caregiving, brain health, the caregiving workforce, transportation, housing, and social engagement. TFAH also launched the Age-Friendly Ecosystem Collaborative to continuously engage organizations and sectors central to healthy aging.

    Supporting Public Health Communicators

    TFAH continues to be a managing partner of the Public Health Communications Collaborative (PHCC). PHCC provides no-cost messaging resources and communications training to state and local health departments to help the field effectively address the public’s information needs on public health issues. The Collaborative was first established during the COVID-19 pandemic and now works across the public health sector on such issues as H5N1 Bird Flu, Mpox, protecting health during periods of extreme heat, and vaccine confidence. Its training materials include resources on strengthening public health through community engagement, responding to misinformation, and using social media in health communications. The PHCC newsletter is shared with over 38,000 opted-in subscribers, and its website has earned over 1.2 million page views since its launch in 2020.

    Looking Ahead

    The 2025 calendar year promises to be pivotal for the nation’s health. TFAH looks forward to bringing evidence-based policy recommendations to the new Administration and Congress, particularly on issues such as emergency preparedness, chronic disease prevention, mental health, veterans’ and rural health, and investing in prevention to reverse the pattern of increasing healthcare spending without better health outcomes. We are committed to making the case for policies and programs that address the non-medical drivers of health in order to promote the nation’s health and economic security.

    How Healthy People 2030 Has Led to Success Changing the Narrative on Healthy Aging

    September is National Healthy Aging Month, and Trust for America’s Health (TFAH) is proud that its Age-Friendly Public Health Systems initiative (AFPHS) has led to state, local, and tribal efforts to help older adults remain active and independent and reframe the narrative around aging.

    The AFPHS initiative aligns with National Healthy Aging Month and Healthy People 2030, a federal initiative that identifies public health priorities to help individuals, organizations, and communities across the United States improve health and well-being. The Office of Disease Prevention and Health Promotion (ODPHP) at the U.S. Department of Health and Human Services, in collaboration with a diverse group of partners and organizations, leads and manages the Healthy People initiative, which sets national objectives every 10 years. TFAH is honored to be officially recognized as a Healthy People 2030 Champion. The current iteration of the Healthy People initiative incorporates a variety of new objectives and targets for improving conditions for older adults. (See full list here).

    Both Healthy People 2030 and TFAH’s AFPHS 6C’s Framework emphasize community partnerships and effective communication to meet the needs of older adults. Through the AFPHS initiative, TFAH has worked closely with federal partners to encourage and support  collaboration between state, local, tribal, and territorial public health and aging agencies. Highlights from these collaborations include:

    • A partnership in Hawai’i — the Kūpuna Collective — that supports age-inclusive ways to maximize health, independence, and engagement among older adults. Network members include foundations, nonprofit and community-based organizations, healthcare organizations, and academic institutions.
    • Implementation of the Counseling on Access to Lethal Means (CALM) program by the Georgia Departments of Health and Aging Services to promote mental health among older adults and limit access to lethal means of suicide.
    • A joint effort among tribal nations in Region 6 to provide training, resources, services, and funding for improving nutrition education and supplying meals.

    Building an age-friendly ecosystem that holistically supports healthy aging should be a priority in communities across the country since nearly a quarter of the U.S. population is expected to be 65 years or older by 2060.

    TFAH co-hosted the National Healthy Aging Symposium with ODPHP on September 26, 2024 to elevate successful innovations that improve older adult health and well-being and provide a forum to learn from experts in fields like brain health, caregiving, and social determinants of health.

    The National Healthy Aging Symposium

    The Association for State and Territorial Health Officials Achieves Age-Friendly Public Health Systems Recognition

    First National Organization to Achieve Age-Friendly Public Health Systems Recognition

    (Washington, DC – June 12, 2024) – Trust for America’s Health (TFAH) is pleased to announce that the Association of State and Territorial Health Officials (ASTHO) has earned Advanced Recognition through TFAH’s Age-Friendly Public Health Systems (AFPHS) Recognition Program.

    The AFPHS Recognition Program highlights the efforts of departments of health and public health organizations designed to improve the health and well-being of older people. ASTHO is the first national-level organization to achieve AFPHS recognition.

    TFAH is a long-time partner of ASTHO in supporting state and territorial health departments to advance health equity and optimal health for all. ASTHO and TFAH have partnered on healthy aging activities since the inception of TFAH’s Age-Friendly Public Health System initiative in 2017, including participating in AFPHS programs and contributing to the development of AFPHS resources.

    “ASTHO continues to be forward-thinking in the guidance it provides to its members and partners, including information and resources that enable communities to be better prepared to help their older adult population thrive, said J. Nadine Gracia, M.D., MSCE, TFAH President and CEO. “TFAH applauds ASTHO’s commitment to health equity and the many ways that this commitment enhances efforts to improve older adult health.”

    “ASTHO is honored to be recognized by TFAH,” said Dr. Joseph Kanter, M.D., MPH, ASTHO Chief Executive Officer. “Our team is motivated to continue supporting public health departments in elevating their work on healthy aging and older adult health.”

    Action steps for recognition are based on the AFPHS 6Cs Framework: creating and leading; connecting and convening; coordinating; collecting, analyzing and translating data; communicating; and complementing.

    ASTHO achieved AFPHS Advanced Recognition based on multiple activities that are specifically aligned with the AFPHS 6Cs Framework. These include:

    • Creating and leading – ASTHO develops and maintains resources on improving older adult health and well-being, including technical packages and webinars.
    • Connecting and convening – ASTHO hosts a learning community to coordinate community-clinical linkages to prevent falls among older adults.
    • Collecting relevant data – ASTHO provides technical assistance to states in the analysis of their Behavioral Risk Factor Surveillance System data on several areas including subjective cognitive decline and caregiving.
    • Communicating – ASTHO developed an e-Learning module to support public health agencies in gaining a foundation in healthy aging as a public health issue.
    • Complementing – ASTHO developed a guide with examples to help states expand their fall prevention strategies.

    TFAH’s Age-Friendly Public Health Systems initiative is made possible with generous support from The John A. Hartford Foundation.

    To learn more about the Age-Friendly Public Health Systems initiative, visit Age-Friendly Public Health Systems – Trust for America’s Health (afphs.org)

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    Trust for America’s Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and works to make the prevention of illness and injury a national priority.  www.tfah.org

    The Association of State and Territorial Health Officials (ASTHO) supports the work of state and territorial public health officials and furthers the development and excellence of public health policy nationwide. About Us | ASTHO

     

    The John A. Hartford Foundation, based in New York City, is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The leader in the field of aging and health, the Foundation has three areas of emphasis: creating age-friendly health systems, supporting family caregivers and improving serious illness and end-of-life care. https://www.johnahartford.org/

     

    TFAH Celebrates Older Americans Month: Powered by Connection

    In his presidential proclamation designating May as Older Americans’ Month, President Joe Biden said “Older Americans are the backbone of our Nation. They have built the foundation that we all stand upon today”.

    This annual celebration, first declared in 1963, provides the opportunity to not only recognize older Americans’ contributions to our society, but also to highlight challenges and reaffirm our commitment to serving older adults across the country.

    This year’s theme, “Powered by Connection,” helps us focus on the profound impact that meaningful connections have on everyone’s well-being and health, including older adults. The  U.S. Surgeon General’s 2023 Advisory on the Healing Effects of Social Connection and Community underscores the importance of this engagement. While social isolation can have the same effect as smoking 15 cigarettes a day, a study in Scientific American found that strong social connections can boost a person’s lifespan by 50 percent!

    The public health sector is leading in many states and communities to enhance connectedness among older adults, recognizing the value of engagement for people’s health and well-being. Many organizations are leading efforts to build inclusive neighborhoods and to include policies for mitigating social isolation into state and community health improvement plans. Public health agencies are partnering with area agencies on aging, YMCAs, or other community-based organizations to improve access to facilities and programs that provide services to older adults, particularly those in underserved communities. Some are leading efforts to pilot and expand intergenerational programs, connecting older people with younger individuals who provide training on technology, for example. Local health departments are partnering with parks and recreation, transportation, and housing colleagues to build inclusive public spaces and ensure they have adequate lighting, space, and other features to bolster safety for older adults and their families.

    Trust for America’s Health’s Age-Friendly Public Health Systems 6Cs Framework offers a practical guide for public health actions to improve social connectedness:

    • Creating and leading changes in social isolation and loneliness among older adults by improving awareness of the health implications and motivating existing older adult systems and infrastructures to address social isolation.
    • Connecting multi-sector partners to strengthen ties between healthcare systems and community-based networks and resources addressing older adult social isolation and loneliness.
    • Collecting data and developing a more robust evidence base on the implications and importance of addressing social isolation.
    • Coordinating existing programs for older adults to improve screening, access and service delivery to older adults and strengthen ongoing education and training on social isolation.
    • Communicating how to translate current research into healthcare practices to support the reduction of social isolation among older adults.
    • Complementing existing aging services to reach older adults where they are to reduce social isolation.

    Social engagement is not just about having someone to chat with. It’s about the transformative potential of community engagement in enhancing mental, physical, and emotional well-being. By recognizing and nurturing the role that connectedness plays, we can mitigate issues like loneliness, ultimately promoting health across the life span for all Americans.

    Ready or Not 2024: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism

    The Ready or Not 2024: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report identifies gaps in national and state preparedness to protect residents’ health during emergencies and makes recommendations to strengthen the nation’s public health system and improve emergency readiness. As the nation experiences an increasing number of infectious disease outbreaks and extreme weather events, the report found that while emergency preparedness has improved in some areas, policymakers not heeding the lessons of past emergencies, funding cuts, and health misinformation put decades of progress at risk.

     

    Resource:

    Ready or Not 2024: State-by-State Factsheets