Issue Category: Child and School Health

California’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

In the mid-1980s, the California state legislature declared childhood lead exposure the most significant environmental health problem in the state and subsequently established the Childhood Lead Poisoning Prevention Branch within the state’s Department of Public Health (CDPH).

The program compiles information, identifies target areas, and analyzes data to design and implement ways to reduce childhood lead exposure. The statutes also determine a “standard of care” to evaluate children for lead-exposure risk; mandate reporting by laboratories of all state blood lead test results; and require public health and environmental services for children identified with elevated blood lead levels, including ordering property owners to remove hazardous lead conditions. The state requires the establishment of procedures and the adoption of regulations regarding residential lead paint, and lead-contaminated dust and soil. It also authorizes and administers a lead-based paint prevention training, certification, and accreditation program.

Funding

To help pay for the program, in 1993, California adopted an annual Childhood Lead Poisoning Prevention Fee, administered jointly by CDPH and the California Board of Equalization (BOE), on manufacturers and other entities involved with the production or sale of lead and lead-based products collected from businesses in the petroleum and architectural coatings industries and from facilities reporting releases of lead into the air. The department deploys a “historical market share attributions” concept to estimate each payer’s long-term contribution to environmental lead contamination and allocate fees. It then deploys collected funds (the fee generated $20.6 million in fiscal 2015) to support healthcare referrals, assessments of homes for hazards, and educational activities.

Banning Lead in Certain Products

California has led U.S. efforts to ban lead from a range of products beginning with a 1986 law, Proposition 65, which requires manufacturers, retailers, and other businesses to notify consumers when they are being exposed to toxic chemicals, including lead. The law has made consumers more aware of toxic chemicals in their environment, and advocates have successfully pressed for more regulations to ban or curtail the use of lead and other toxins in products. In conjunction with these efforts, California passed a number of strict laws to safeguard products and protect its citizens from lead exposure. For example:

  • In 2005, California implemented a lead-in-candy law. The state considers candies with lead levels in excess of 0.1 parts per million (ppm) to be contaminated. The Food and Drug Branch of the California Department of Public Health is required to test samples, notify the manufacturer of the adulteration, and issue a health advisory. The federal Food and Drug Administration subsequently issued national guidance in 2006 recommending that all candy likely to be consumed by children contain no more than 0.1 ppm of lead.
  • In 2006, California enacted the Metal-Containing Jewelry Law. This requires jewelry and components, such as dyes and crystal, that  are sold, shipped, or manufactured for sale in California to meet limits set by the state under a 2004 consent judgment that applied to a number of manufacturers, retailers, and distributors in response to a lawsuit filed by the Attorney General of California and two environmental groups. The law forbids the manufacture, shipping, sale, or offer for retail sale or promotional purposes jewelry in California unless it is made wholly from one or more specified materials. It also mandates lead restrictions for certain specified materials allowed in manufacturing jewelry and establishes provisions for children’s jewelry and that used for body-piercing.
  • California passed additional legislation in 2006, effective in 2010, to reduce the lead content in water distribution products. The law prohibits more than 0.25 percent lead in commercial pipes, fittings, and fixtures.  In 2010, the U.S. Congress amended the Safe Drinking Water Act, including provisions similar to the California standard, and, in 2014, the 0.25 percent standard for lead in pipes, fittings, and fixtures became national.
  • In 2009, California passed the California Lead in Wheel Weights Ban to prevent lead from wheel weights, used to balance tires in vehicles, from entering the environment.  Before the ban, lead wheel weights, which can become dislodged from the wheels and end up on roads where they are abraded into lead dust and debris, were responsible for releasing 500,000 pounds of lead annually onto California roads. Since 2009, six other states, including Washington, Maine, Illinois, New York, Vermont, and Minnesota, have followed California’s lead. Also in 2009, the U.S. Environmental Protection Agency (EPA) started the process to consider banning lead wheel weights in the United States, but it has not taken formal action. The European Union has already banned lead wheel weights, while manufacturers in Japan and Korea stopped installing them in 2005.

In 2010, both California and Washington passed legislation restricting the use of heavy metals including lead in motor vehicle brake pads. In 2014, in California, and 2015 in Washington, brake pads sold in those states could not contain more than 0.1 percent by weight. The legislation also limits the levels of asbestiform fibers, cadmium, chromium, copper, and mercury in the brake friction materials. In January 2015, brake manufacturers signed a memorandum of agreement with the Environmental Protection Agency and the Environmental Council of the States declaring that all brake pads sold in the United States will meet the California/Washington standards. The brake- pad standards were adopted immediately, while standards for copper are being phased in.

  • In 2003, California passed the Toxics in Packaging Prevention Act, which limited harmful substances in packaging and reduced the levels of toxins contaminating soil and ground water near landfills. While the original law exempted lead paint or applied ceramic decoration on glass bottles, a 2008 amendment banned such uses if the lead content exceeds 600 ppm.
  • California passed a law in 2013 that made it the first state to require the use of only lead-free ammunition be used for hunting with a firearm in California. The regulations, which began to phase in in 2015, will be fully implemented in 2019. Lead ammunition for hunting waterfowl was banned nationally in 1991, but the California law extends the ban to hunting for all wildlife. The main purpose of the law is to protect endangered wildlife, including the California condor, from lead exposure. However the legislation should have the added benefit of reducing lead exposure for the families of hunters.

Results

The number of children from 0 to under 21 years who have been identified with blood lead levels at and above 4.5 mcg/dL has been decreasing significantly. In 2013, 1.7 percent of tested children had blood lead levels in this range. In 2007, 6.5 percent tested above 4.5 mcg/dL.

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives. 

The case study does not attempt to to capture everything a location is doing on lead, but aims to highlight some of the important work.

National Youth Obesity Rate Holds Steady, New Data Show

Three out of 10 youth ages 10 to 17 are overweight or obese

Princeton, N.J., September 19, 2017—Roughly three out of 10 young people in the United States, 31.2 percent, are overweight or obese, according to the newest available data. Seven states—Alabama, Florida, Mississippi, North Dakota, Rhode Island, Tennessee, and West Virginia—have rates of overweight and obesity that exceed 35 percent. Only one state, Utah, has a rate under 20 percent.

The 2016 state-by-state rates for children and adolescents ages 10 to 17 were recently released on the Data Resource Center for Child and Adolescent Health (DRC) website (www.childhealthdata.org) and are reported at stateofobesity.org/children1017. This is the first update to this national data set since 2011-12.

The release of these new youth data follow the recent publication of the annual State of Obesity report by the Robert Wood Johnson Foundation (RWJF) and Trust for America’s Health (TFAH), which includes state-by-state adult obesity rates. Together, the two data sets show that obesity rates may be levelling off, but that progress could be eroded if policies are weakened or programs are cut.

At the time of the State of Obesity release in August, the leaders of RWJF and TFAH shared their perspectives:

Richard Besser, president and CEO of RWJF:

“Obesity rates are still far too high, but the progress we’ve seen in recent years is real and it’s encouraging. That progress could be easily undermined if leaders and policymakers at all levels don’t continue to prioritize efforts that help all Americans lead healthier lives.”

John Auerbach, president and CEO of TFAH:

“It’s clear that the progress we’ve made in fighting obesity is fragile—and that we’re at a critical juncture where continuation of the policies that show promise and increased support and resources could truly help bend the rising tide of obesity rates. We’re far from out of the woods when it comes to obesity. But we have many reasons to be optimistic thanks to parents, educators, business owners, health officials, and other local leaders. Our nation’s policymakers must follow their example to build a culture of health.”

To accelerate progress in addressing obesity, RWJF and TFAH urge policymakers to:

  • Invest in prevention at the federal, state and local levels, including full funding for the Centers for Disease Control and Prevention and the Prevention and Public Health Fund.
  • Prioritize early childhood policies and programs, including support for Head Start and the Child and Adult Care Food Program.
  • Maintain progress on school-based policies and programs, including full implementation of current nutrition standards for school foods.
  • Invest in community-based policies and programs, including nutrition assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), and transportation, housing, and community development policies and programs that support physical activity.
  • Fully implement menu labeling rules and the updated Nutrition Facts label.
  • Expand healthcare coverage and care, including continued Medicare and Medicaid coverage of the full range of obesity prevention, treatment, and management services.

The stateofobesity.org site provides a new feature examining relevant policies at the state level and an interactive feature reporting on the latest obesity rates by state. The DRC website, www.childhealthdata.org, enables visitors to examine youth obesity rates by race/ethnicity, household income, and other demographic factors, as well as other relevant variables, such as physical activity rates.

About the new youth data

The new overweight and obesity rates among 10- to 17-year-olds are from the 2016 edition of the National Survey of Children’s Health (NSCH). The Maternal and Child Health Bureau (MCHB) funds and directs the NSCH, and develops survey content in collaboration with a national technical expert panel and the U.S. Census Bureau, which then conducts the survey. The NSCH uses parent reports of a child’s or adolescent’s height and weight to calculate body mass index.

The NSCH methods and sample size changed between 2011-12 and 2016, meaning it is not advisable to directly compare results across years. But the data do indicate a consistent stabilization in national and state rates of childhood overweight and obesity over the last decade. The NSCH is planned as an annual survey going forward, so these and other trends can be evaluated.

The Child and Adolescent Health Measurement Initiative (CAHMI) at the Johns Hopkins Bloomberg School of Public Health partners with MCHB in the design of the NSCH and analyzes and publishes state by state findings on its Data Resource Center for Child and Adolescent Health website, which is where the data reported here were obtained. RWJF and TFAH worked with CAHMI to announce the latest obesity rate data.

Overweight and Obesity Rate Among Youth Ages 10-17 by State, 2016

1.       Tennessee

37.7

18.          Georgia

32.2

35.      Minnesota

27.7

2.       North Dakota

37.1

19.          Michigan

32

36.      Colorado

27.2

3.       Mississippi

37

20.          New York

31.8

37.      Virginia

27.2

4.       Florida

36.6

21.          New Jersey

31.7

38.      Wyoming

27.1

5.       Rhode Island

36.3

22.          Pennsylvania

31.7

39.      Illinois

27

6.       Alabama

35.5

23.          South Dakota

31.4

40.      Arizona

26.9

7.       West Virginia

35.1

24.          California

31.2

41.      Massachusetts

26.6

8.       Louisiana

34

25.          Delaware

30.9

42.      Alaska

26.3

9.       Arkansas

33.9

26.          Kansas

30.9

43.      Idaho

26

10.   Indiana

33.9

27.       North Carolina

30.9

44.      Hawaii

25.5

11.   District of Columbia

33.8

28.          Nevada

30.5

45.      Washington

25.5

12.   Oklahoma

33.8

29.          Connecticut

30.2

46.      New Mexico

24.9

13.   Maryland

33.6

30.          Iowa

29.9

47.      New Hampshire

23.8

14.   Kentucky

33.5

31.          Wisconsin

29.5

48.      Montana

23.2

15.   Texas

33.3

32.          Missouri

29.4

49.      Vermont

22.2

16.   Ohio

33.1

33.          Nebraska

29.2

50.      Oregon

20.3

17.   South Carolina

32.9

34.          Maine

28.2

51.      Utah

19.2

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Trust for America‘s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

How Embedding Health Access and Nurses in Schools Improves Health in Grand Rapids, Michigan

For more than 20 years, Grand Rapids Public Schools (GRPS) has partnered with Spectrum Health to improve educational and health outcomes for their students through Spectrum’s School Health Program. Started in 1995, the School Health Program will be expanded to its 14th additional school districts in 2017.

The GRPS Model

The GRPS program utilizes school health teams comprised of registered nurses (RNs), licensed practical nurses (LPNs), and health aides to provide direct services to students in 48 schools. GRPS’ branch of the School Health Program currently employs 34 RNs, 11 LPNs, and 34 health aides and operates four full-service school-based health centers.

In the GRPS model, school teams operate under the supervision of a school nurse whose primary responsibility is oversight of health care delivery to students during the school day. The district has established policies and procedures to describe how care is to be delivered by the team under the supervision of the Registered Nurse. The nurse may delegate care to other school staff.

School nurse responsibilities include: identification of students who have health conditions; developing a plan for care during the school day; training and oversight of staff for safe delivery of medications and treatments; providing services that cannot be delegated; establishing medical response teams to respond to emergencies; telephone triage and support; surveillance and reporting of communicable diseases; connecting students to medical, dental, and mental health care through referrals; promoting health; health education; health screenings and follow up; and assisting students in obtaining immunizations.

GRPS uses funds from a variety of sources to support their school nurses including:

  • the district budget;
  • their local intermediate school district;
  • the State Department of Education—including grants and 31A funds (for students deemed at high risk); and
  • Spectrum Health.

The full-time equivalent (FTE) for the nurses for each school is adjusted based on the health needs of the student population and the availability of funds. Even though some funding for school nurses is still provided through Title I, GRPS has largely moved to alternative funding streams due to cumbersome reporting requirements.

While RNs serve as the cornerstones in the model, GRPS also braids together funding streams from both public and private entities to allow for reimbursement and service provision under a variety of health delivery models beyond the traditional school nurse reimbursement model. Coordinating funds and services across the spectrum of health providers and sources enables GRPS to provide services outside of the traditional school nurse model—such as dental services.

GRPS has also partnered with Cherry Health Services a local Federally Qualified Health Center (FQHC) to deliver health services in their school-based health centers and through a traveling dental program. Because these services are provided through an FQHC, they are eligible for Medicaid reimbursement and receive the FQHC enhanced reimbursement rate.

While data systems and privacy concerns have hindered data sharing and integration in the past, GRPS is actively moving towards linking education and health data under one system. The new data system is built upon the district’s student record system and has the potential to more easily link school health metrics to attendance and academic data. These system improvements are crucial steps to helping Spectrum Health and GRPS track and accomplish both its short-term goals to improve attendance and reduce chronic absenteeism and its long-term goals to improve graduation rates, workplace readiness and college entry.

Consultative RN Hub Model

In more rural districts, Spectrum Health has developed a consultative RN hub model for service delivery. Nurses are able to serve students utilizing telemedicine through its MedNow program—reducing travel time for school nurses and costs for the district. The Regional program will serve 13 districts in 2017 with 14 RN and two LPN.

Results

The partnership between Spectrum Health and the school districts have produced significant improvements in important school health indicators. Key accomplishments from FY 2015 included:

  • 97 percent of students at participating schools met current immunization requirements to attend school;
  • 98 percent of problems identified were resolved on-site by the school health care team;
  • 195,092 visits occurred to the school health office; and
  • 28,864 students were served across 7 school districts.

 

For more information, please visit http://www.spectrumhealth.org/healthier-communities/our-programs/school-health-program

TFAH Statement: Strongly Opposed to the House Obamacare Replacement Bill

Washington, D.C., March 7, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH).

“We are strongly opposed to the House Obamacare Replacement bill, which would repeal significant portions of the Affordable Care Act (ACA), including the Prevention and Public Health Fund.

Under this plan, millions of people could lose health insurance—a devastating blow to the health of many of our nation’s most vulnerable individuals and families. Without affordable insurance coverage we will see increased levels of preventable illnesses, injuries and deaths.

In addition, eliminating the Prevention Fund would erase 12 percent of the Centers for Disease Control and Prevention’s (CDC) budget. Of that investment, $625 million directly supports state and local public health efforts to fight preventable diseases such as diabetes, heart disease and cancer.

Losing this funding would wreak havoc on our efforts to reduce chronic disease rates, immunize our children, stop the prescription drug and opioid epidemic and prepare the public health system to prevent infectious disease outbreaks.

We know how to prevent many chronic and infectious illnesses—which make up a significant portion of the $3 trillion the nation spends yearly on healthcare.  If we lose access to health care coverage and to the Prevention Fund, our children, families and communities will suffer and ultimately costs will rise.

The bottom line? This Bill would make untold numbers of the American people less healthy.”

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

TFAH Statement on the Draft House Republican Obamacare Replacement Bill: Our Nation’s Health Will Suffer

Washington, D.C., February 24, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH).

“The draft House Republican Obamacare replacement bill—which would eliminate the Prevention and Public Health Fund—would threaten the health of American children, families and communities.

Thanks to the Prevention Fund, hundreds of thousands of Americans benefit from increased access to vaccines and other preventive health services. Quite simply, more people are getting and remaining healthy because of the Prevention Fund.

Yet, the proposed replacement bill would eliminate this important Fund and 12 percent of the U.S. Centers for Disease Control and Prevention’s (CDC) budget along with it.

And, without the Prevention Fund, states will lose substantial sums of money—totaling as much as $3 billion over the next 5 years—which fight growing epidemics and emerging diseases.

Every year, we spend $3 trillion on healthcare, yet millions suffer from chronic diseases and death rates among Blacks and other people of color remain too high. At the same time, death rates among white middle-aged Americans increased for the first time in decades, mainly due to preventable conditions.

Time and again research shows that the vast majority of these conditions—heart disease, diabetes and others—can be prevented by investing in addressing the root causes. Yet, the country has repeatedly failed to do so.

The nation cannot afford to trade away our single best investment in preventing disease, preparing for and responding to infectious disease outbreaks, reducing rates of chronic illness, and saving lives and money.

If this draft becomes law, our nation’s health will suffer—and it will be exponentially harder to fight growing epidemics, like the rise in prescription drug and heroin overdoses.”

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

It Takes a Village: How Mancelona, Michigan Worked Together to Improve Health and Education

By Mike Swain, MPH, Community Health Coordinator, Health Department of Northwest Michigan

In the early 1990s, residents of Mancelona (a northern Michigan town) had limited access to healthcare, social services and higher education and there were sparse employment opportunities.

With the lowest per capita income in the immediate area, most families lived in poverty, and were underinsured, uninsured altogether or enrolled in Medicaid.

Some of the community’s youngest were hardest hit: the area had the state’s highest rates of youth physical and sexual abuse, teen pregnancies, drinking and drug use. And as could be expected, these health risks had a significant impact on academic performance – with behavior problems in the classroom, low grades, and high dropout rates. In the 1994-95 school year, 39 percent of Mancelona high schoolers dropped out and just 64 percent of the senior class graduated.

Terry McCleod, the Middle School Principal at the time, recognized the critical role of student health and wellness in academic success – and he led the charge for change in Mancelona.

First, he brought together a grassroots network of public and private service providers. Along with a three year grant from the W.K. Kellogg Foundation, they built Project S.H.A.R.E. (School Home Alliance for Restructured Education) to provide a comprehensive assessment and evaluation of the gaps and needs in Mancelona.

The results made it clear that any successful, lasting intervention would need to improve the environment and families by addressing the underlying, interconnected issues of poverty. The layout of the community’s schools—all three were essentially on the same campus—allowed for a unique solution: building a dedicated family resource center right next to school grounds. With thoughtful outreach, community advocates and the public health administration were engaged in the cause, and the land for this building was secured.

The group secured a grant from the Michigan Department of Health and Human Services (MDHHS) to fund the beginning of construction, with the Mancelona Family Resource Center (MFRC) officially opening in 1996.

MFRC housed health, social, daycare, educational, and economic services, offering a unique and comprehensive suite of services to support Mancelona’s students and their families. Staffing and programs were brought in with continued support from Project S.H.A.R.E., including the Michigan Works! Association – which resided in a dedicated wing of the MFRC.

Michigan Works! played a critical role in turning the tide of poverty by strengthening the employability of adults with workforce development services and mobilization of local businesses.

Still, quality healthcare was at the heart, with the local Health Department providing previously unattainable care, including a Dental Health Clinic, on site. Additionally, the MFRC team provided convenient and confidential, family planning, reproductive health services, and education. And working closely with the school, this innovative approach included the development of a dedicated class for pregnant mothers to help improve the health of future Mancelona generations.

Over time, partnerships and additional resources were added within the center, the school and the community. In 2001, Communities In Schools (CIS) began providing programs and services in Mancelona. Founded on the national CIS model, this non-profit organization provided new programs for before/after school activities, mentoring and tutoring.

The CIS team worked in collaboration with the MFRC, providing care coordination and referrals for students and their families. And, when the state of Michigan expanded school-linked health center qualification requirements to include areas with rural status, the MFRC leadership were among the first applicants in line. Mancelona was included with the first round of funded centers under this new qualification.

In 2006, with this additional funding, the Mancelona school-linked health center opened, called the Ironmen Health Center, was opened. The Center offered services to students aged 10-21 regardless of health insurance status. In addition, social work and behavioral health services were provided.

By blending and braiding different funding sources and bringing to bear all community resources to link families to important social services and interventions, the community is much improved.

In fact, rates of teen pregnancy, drug and tobacco use, and child abuse are all down. And, high school graduation is up—to 91 percent, a 42 percent increase from the inception of project.

The benefits of this innovative care model doesn’t stop there: 60 percent of the 2013 graduating class enrolled in college that fall. And nearly 100 percent of the 2015 seniors are making plans to pursue some form of higher education or technical skills training post-graduation. What was once and ending is now just the beginning of a story.

Here you can find a timeline and more information on the model, including details on the Women’s Resource Center, Communities in Schools and the Ironmen Health Center. 

 

Survey Finds 73 Percent Support Investments to Improve Health; Obesity, Future Health of Children Top Concerns

Washington, D.C., January 19, 2017 —A new national survey of registered voters has found that nearly three-quarters (73 percent) of Americans support increasing investments to improve the health of communities.  Support spans across party lines (57 percent of Republicans, 87 percent of Democrats and 70 percent of Independents) and regionally across the country (75 percent in the Northeast, 71 percent in the Central U.S., 72 percent in the South, and 75 percent in the West).  Women are the strongest proponents of supporting health improvement efforts (62 percent of Republican women, 87 percent of Democratic women and 80 percent of Independent women).

The survey, released today by the Robert Wood Johnson Foundation and the Trust for America’s Health, was conducted by Greenberg Quinlan Rosner Research, in consultation with Bellweather Research, on September 8-9, 2016 of a nationwide sample of 1302 registered voters across the country.

A majority (51 percent) believe that today’s children will be less healthy than previous generations when they reach adulthood.  The groups who hold this belief most strongly include: Republicans (55 percent); rural residents (60 percent); Southerners (57 percent); Independent women (62 percent); and Black women (68 percent).  Most registered voters with children under age 18, however, believe their own children are very healthy (92 percent give an 8-10 rating on a 10-point scale); this is the case for parents of all ideologies, incomes, education levels, and ethnicities.

Additionally, 64 percent believe that the number of health issues facing the country has grown in recent years. Obesity is the top health concern (41 percent), cancer ranked second (33 percent), followed by heart disease and stroke (14 percent) and diabetes and substance misuse (both at 11 percent).

Americans also rate their own health better than the health of the community where they live (66 percent rate their own health as 8-10 (very good) on a 10 point scale, but only 36 percent rank their community’s health as very good).  There are differences based on income, age, education and area of the country on how people rank their health.  For instance:

  • 73 percent of college-educated Whites rank their health as very good compared to 57 percent of Whites without college degrees; and
  • 72 percent of individuals with a household income above $50,000 per year rank their health as very good compared to 59 percent of those with incomes below $50,000.

A majority of American registered voters also strongly support (rating 8-10 out of a 10 point scale) a range of priorities and strategies for improving health, including:

  • 74 percent of people highly support providing enough time — during the school day and afterschool – for kids’ physical education, physical activity or community sports;
  • 74 percent also highly support creating partnerships among farmers, food suppliers and community health groups to bring fresh produce trucks or mobile markets to communities that lack access to grocery stores;
  • 65 percent highly support providing kids with more information on making healthy food choices and being physically active;
  • 63 percent highly support investing more in preventing obesity and chronic diseases like heart disease, diabetes and stroke;
  • 62 percent highly support increasing early childhood health programs, including home visit programs, mobile health screenings and treatment for diseases like asthma;
  • 61 percent highly support investing more in preventing the spread of infectious diseases like the Zika virus, bird flu and hepatitis;
  • 60 percent highly support treating substance use, including addiction to prescription painkillers and heroin, like a disease, not a crime;
  • 60 percent highly support planning for building more parks, walking and biking trails and other recreation areas for people to be physically active in all communities;
  • 60 percent highly support increasing access to safe and affordable housing and routinely testing for things that create health problems in homes, like lead in water and paint, carbon monoxide, and harmful chemicals in the air;
  • 59 percent highly support increasing incentives that encourage business owners to open grocery stores in communities that lack access to healthy food options; and
  • 58 percent highly support building local partnerships across businesses, health systems, schools and community organizations to address specific health problems in communities.

Methodology:  On behalf of the Robert Wood Johnson Foundation and the Trust for America’s Health, Greenberg Quinlan Rosner Research, in consultation with Bellwether Research, conducted a survey among 1,320 registered voters nationwide (1,019 weighted). The survey was conducted between September 8th and 19th, 2016. Voters were randomly selected from a list of registered voters and reached on a landline or cell phone depending on the number they designated on their voter registration. Interviews were conducted by live telephone interviewers; 50 percent were reached on a cell phone. Included in the sample were three oversamples: 100 Black voters, 100 Hispanic voters, and 100 White non-college voters. Upon completion of the survey, the results were weighted to bring the three oversamples into line with the racial and ethnic composition of registered voters nationwide. The data was weighted to reflect the total population of registered voters, taking into account regional and demographic characteristics according to known census estimates and voter file projections. The data are subject to a margin of error of +/- 3.1 percentage points.  Full survey and topline results are available upon request.

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter atwww.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook. 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Majority of States Score 6 or Lower Out of 10 Indicators in Report on Health Emergency Preparedness

Washington, D.C., December 20, 2016 – In Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism, 26 states and Washington, D.C. scored a six or lower on 10 key indicators of public health preparedness.

The report, issued by the Trust for America’s Health (TFAH), found that the nation is often caught off guard when a new threat arises, such a Zika or the Ebola outbreak or bioterrorist threat, which then requires diverting attention and resources away from other priorities.

In the report, Alaska and Idaho scored lowest at 3 out of 10, and Massachusetts scored the highest at 10 out of 10, with North Carolina and Washington State scoring 9’s.

“Health emergencies can quickly disrupt, derail and divert resources from other ongoing priorities and efforts from across the government,” said Rich Hamburg, interim president and CEO, TFAH.  “Many areas of progress that were made after 9/11 and the anthrax attacks to improve health security have been undercut.  We aren’t adequately maintaining a strong and steady defense, leaving us unnecessarily vulnerable when new threats arise.”

Ready or Not? examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies.  Some key findings include:

  • 26 states increased or maintained funding for public health from Fiscal Year (FY) 2014-2015 to FY 2015-2016.
  • Just 10 states vaccinated at least half of their population (ages 6 months and older) against the seasonal flu during the 2015-2016 flu season (from July 2015 to May 2016).
  • 45 states and Washington, D.C. increased the speed of DNA fingerprinting using pulsed-field gel electrophoresis (PFGE) testing for all reported cases of Shiga toxin-producing E. coli O157, a measure of a state’s ability to detect foodborne outbreaks.
  • 10 states have a formal access program or a program in progress for getting private sector healthcare staff and supplies into restricted areas during a disaster.
  • 30 states and Washington, D.C. met or exceeded the overall national average score (6.7) of the National Health Security Preparedness Index™ (as of 2016).
  • 32 states and Washington, D.C. received a grade of C or above in States at Risk: America’s Preparedness Report Card, a national assessment of state-level preparedness for climate change-related threats – which have an impact on human health.

In addition, the report examined trends in public health preparedness over the last 15 years, finding successes and ongoing concerns.

  • One-third of funds for health security and half of funds for healthcare system preparedness have been cut:  Health emergency preparedness funding for states has been cut from $940 million in fiscal year (FY) 2002 to $660 million in FY 2016; and healthcare system preparedness funding for states has been cut by more than half since FY 2005 – down to $255 million.
  • Some major areas of accomplishment:  Improved emergency operations, communication and coordination; support for the Strategic National Stockpile and the ability to distribute medicines and vaccines during crises; major upgrades in public health labs and foodborne illness detection capabilities; and improvements in legal and liability protections during emergencies.
  • Some major ongoing gaps: Lack of a coordinated, interoperable, near real-time biosurveillance system; insufficient support for research and development of new medicines, vaccines and medical equipment to keep pace with modern threats; gaps in the ability of the healthcare system to care for a mass influx of patients during a major outbreak or attack; and cuts to the public health workforce across states.

The Ready or Not? report provides a series of recommendations that address many of the major gaps in emergency health preparedness, including:

  • Requiring strong, consistent baseline public health Foundational Capabilities in regions, states and communities—so that everyone is protected.
  • Ensuring stable, sufficient health emergency preparedness funding to maintain a standing set of foundational capabilities alongside a complementary Public Health Emergency Fund which would provide immediate surge funding during an emergency.
  • Improving federal leadership before, during and after disasters – including at the White House level.
  • Recruiting and training a next generation public health workforce with expert scientific abilities to harness and use technological advances along with critical thinking and management skills to serve as the Chief Health Strategist for a community.
  • Reconsidering health system preparedness for new threats and mass outbreaks by developing stronger coalitions and partnerships among providers, hospitals, insurance providers, pharmaceutical and health equipment businesses, emergency management, and public health agencies.
  • Prioritizing efforts to address one of the most serious threats to human health by expanding efforts to stop Superbugs and antibiotic resistance.
  • Improving rates of vaccinations for children and adults – which are one of the most effective public health tools against many infectious diseases.

Ready or Not? was released annually from 2003-2012, and more recently, TFAH has released Outbreaks: Protecting Americans from Infectious Diseases, from 2013-2015. The report was supported by a grant from the Robert Wood Johnson Foundation (RWJF).

Score Summary: 

A full list of all of the indicators and scores and the full report are available on TFAH’s website.  For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator.  Zero is the lowest possible overall score, 10 is the highest.  The data for the indicators are from publicly available sources or were provided from public officials.

10 out of 10: Massachusetts

9 out of 10: North Carolina and Washington

8 out of 10: California, Connecticut, Iowa, New Jersey, Tennessee and Virginia

7 out of 10: Colorado, Delaware, Florida, Indiana, Maryland, Michigan, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, South Carolina, Utah and Wisconsin

6 out of 10: Arizona, Arkansas, District of Columbia, Georgia, Hawaii, Illinois, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Montana, Nebraska, Ohio, Pennsylvania, Texas and Vermont

5 out of 10: Alabama, Missouri, Oklahoma, South Dakota and West Virginia

4 out of 10: Nevada and Wyoming

3 out of 10: Alaska and Idaho

 

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 Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.