Issue Category: Complete Streets

Bipartisan Infrastructure Law Will Help Protect Communities from the Health Effects of Climate Change

On November 15, 2021, President Biden signed the Infrastructure Investment and Jobs Act into law. The legislation, in addition to addressing other vital priorities, represents one of the most significant—if not the most significant—federal actions to protect U.S. residents from health threats posed by climate change and weather-related emergencies. We increasingly experience longstanding threats that are being turbocharged by a warming planet, including heat waves that are becoming hotter and longer; severe storms that break records year after year; wildfires that outmatch traditional methods of control; pollution and contaminants increasingly endangering the quality of our air and water; pests bringing disease and threatening staple foods; and the trauma of it all on our mental health.

As with all health hazards, these effects are not felt equally, as a mix of environmental, social, and demographic factors influence people’s exposure and vulnerability. Some people are more vulnerable because of age (e.g., children, older adults) or preexisting medical conditions (e.g., diabetes, asthma). People who work outdoors or as first responders may face greater exposure. Large portions of other groups, such as immigrants, people of color, people living in poverty, or people experiencing homelessness may have less access to resources that would allow them to avoid exposures, seek care or treatment, or navigate long-term recovery. In many cases, vulnerability to the health impacts of climate change reflect existing health risk factors and disparities. In the United States, the legacy of colonization, slavery, and ongoing structural and systemic racism contribute to such inequities.

“Climate change and its impacts on health are a reality we must acknowledge and respond to,” said J. Nadine Gracia, President and CEO of Trust for America’s Health. “The new Infrastructure Investment and Jobs Act provides critical direction and funding to do so. Also important to protecting the health of all U.S. residents is designing adaptation programs that are rooted in the recognition that some communities are at greater risk and that strive to promote health equity.”

Below is an analysis of the law that highlights key adaptation-related measures. These range from programs to mitigate coastal and inland flooding to preparations for severe drought to proactive wildfire mitigation initiatives to innovative strategies for reducing urban heat islands and more.

For more information on the health impacts of climate change and the extent of states’ preparedness, see “Climate Change & Health: Assessing State Preparedness,” which Trust for America’s Health (TFAH) produced in partnership with the Johns Hopkins Bloomberg School of Public Health. And for examinations of concrete steps states and localities are taking to equitably protect their communities, see TFAH’s case studies series.

Coastal Storm and Flood Risk Management

  • $17.1 billion for the U.S. Army Corps of Engineers, to remain available until expended, for a range of priorities, including $2.55 billion for coastal storm risk management, hurricane and storm damage reduction projects, and related activities; and $2.5 billion for inland flood risk management projects, with a directive to prioritize projects in communities that are economically disadvantaged, or where the percentage of people that live in poverty or identify as belonging to a minority group is greater than the average such percentage in the United States.
  • $3.5 billion ($700 million annually over five years FY 2022-26) for the Flood Mitigation Assistance program, which is administered by the U.S. Federal Emergency Management Agency (FEMA). The program provides competitive grants to states, local governments, Tribal governments, and territories to support projects that reduce or eliminate the risk of repetitive flood damage to buildings insured by the National Flood Insurance Program.
  • $2.611 billion for operational, research, and facility costs of the U.S. National Oceanic and Atmospheric Administration (NOAA), including $492 million for the National Oceans and Coastal Security Fund, established by NOAA and the National Fish and Wildlife Foundation to restore, increase, and strengthen coastal ecosystems (e.g., wetlands, dunes, coral reefs) that offer flood protection for coastal communities; $492 million for coastal and inland flood and inundation mapping and forecasting, and for next-generation water modeling activities; and $491 million for, among other purposes, protecting ecological features that help mitigate coastal flooding or coastal storms.

Wildfire Risk Reduction

  • $3.37 billion for the U.S. Department of the Interior and the U.S. Department of Agriculture to support a range of wildfire risk reduction activities, including $600 million for the salaries and expenses of federal wildland firefighters; $500 million for conducting mechanical thinning and timber harvesting; $500 million to award community wildfire defense grants to at-risk communities; and $500 million for planning and conducting prescribed fires and related activities.
  • $50 million for NOAA to improve its capabilities related to wildfire prediction, detection, observation, modeling, and forecasting.
  • Amends the Robert T. Stafford Disaster Relief and Emergency Assistance Act to include wildfire within the hazard mitigation program so that recipients of FEMA grants may engage in such fire-prevention activities as replacing or installing electrical transmission or distribution utility pole structures and installing fire-resistant wires, infrastructure, and underground wires.

Water Infrastructure

  • $8.3 billion for the Bureau of Reclamation, an agency within the U.S. Department of the Interior, to fund western water infrastructure projects, including $3.2 billion for projects that rehabilitate or replace aging infrastructure; $1.15 billion for water storage, groundwater storage, and conveyance projects; $1 billion for water recycling and reuse projects, and $250 million for water desalination projects and studies.
  • $1.4 billion ($280 million annually over five years: FY 2022-26) to the existing Sewer Overflow and Stormwater Reuse Municipal Grants program, which is administered by the U.S. Environmental Protection Agency (EPA). Grants may be used to plan, construct, and design certain treatment works; to take measures to better manage, reduce, or recapture stormwater or subsurface drainage; and to implement notification systems to inform the public of overflows that result in sewage being released into rivers and other waters. At least 25 percent of the funds a state receives are to be used in rural and/or financially distressed communities.
  • $300 million for implementing the Colorado River Basin Drought Contingency Plan, a joint effort by the Department of the Interior and seven states (Arizona, California, Colorado, Nevada, New Mexico, Utah, and Wyoming) to reduce risks from ongoing drought and protect this shared water resource.
  • $250 million ($50 million annually over five years: FY 2022-26) to the new Midsize and Large Drinking Water System Infrastructure Resilience and Sustainability program, to be administered by the EPA. Grants will be available to public water systems that serve communities with a population of 10,000 or more for the purposes of increasing resilience to natural hazards and extreme weather events, and for reducing cybersecurity vulnerabilities. Funds may be used to conserve water or enhance water-use efficiency, create desalination facilities, relocate or modify existing water systems that are vulnerable to natural hazards or extreme weather events (e.g., risks to drinking water from flooding), enhance water supply, and develop and implement measures to increase resiliency to natural hazards, among other permitted uses.
  • $125 million ($25 million annually over five years: FY 2022-26) to the new Clean Water Infrastructure Resiliency and Sustainability program, to be administered by the EPA. Grants will be available to municipalities and other owners of publicly owned treatment works to plan, design, or construct projects that increase their resilience to natural hazards (e.g., extreme weather events, sea-level rise, extreme drought conditions) or cybersecurity vulnerabilities. Funds may be used to conserve water; enhance water-use efficiency; improve wastewater and stormwater management; and modify or relocate existing publicly owned treatment works, conveyance, or discharge systems that are vulnerable, among other permitted uses.
  • $125 million ($25 million annually over five years: FY 2022-26) to the existing Pilot Program for Alternative Water Source Projects initiative, which is administered by the EPA. The grants may be used to engineer, design, construct, and test alternative water source projects that conserve, manage, reclaim, or reuse water for groundwater recharge and potable reuse.

Energy Infrastructure

  • $5 billion over five years (FY 2022-26) for the U.S. Department of Energy (DOE) to administer grants to states, Tribal governments, electric grid operators, electricity storage operators, and other eligible entities for the purposes of preventing power outages and enhancing the resilience of the electric grid. Recipients may use grants to reduce the risk of power lines causing a wildfire or to reduce the likelihood and consequences of disruptive events—an event in which operations of the electric grid are disrupted, preventively shut off, or cannot operate safely due to extreme weather, wildfire, or a natural disaster.
  • $5 billion over five years (FY 2022-26) for the new Program Upgrading Our Electric Grid and Ensuring Reliability and Resiliency initiative, to be administered by the DOE. Grants will be available to states, Tribal governments, local governments, and other eligible entities to coordinate and collaborate with electric sector owners and operators for the purposes of demonstrating innovative approaches to enhancing the resilience of transmission, storage, and distribution infrastructure, and to demonstrate new approaches to enhancing regional grid resilience. In addition, the DOE is directed to assess the resilience, reliability, safety, and security of energy infrastructure in the United States, in collaboration with the U.S. Department of Homeland Security, the Federal Energy Regulatory Commission, and the North American Electric Reliability Corporation.
  • $3 billion for FY 2022, to remain available through FY 2026, for the new Smart Grid Investment Matching Grant program, to be administered by the DOE. The program would facilitate the deployment of technologies to enhance electric grid flexibility and mitigate impacts of extreme weather or natural disasters on grid resiliency, among other purposes.

Transportation Infrastructure

  • $8.7 billion over five years (FY 2022-26) to the new Promoting Resilient Operations for Transformative, Efficient, and Cost-saving Transportation (PROTECT) program, to be administered by the U.S. Department of Transportation (DOT). The law makes $7.3 billion available for formula grants to states and $1.4 billion ($250 million annually from FY 2022-23; $300 million annually from FY 2024-26) available for competitive grants to states, local governments, public authorities, Tribal governments, and other eligible entities for the purposes of making transportation infrastructure assets more resilient against weather events, natural disasters, and changing conditions, including sea level rise.
  • $550 million ($55 million annually over 10 years: FY 2022-31) for the DOT to designate 10 regional Centers of Excellence for Resilience and Adaptation and one national Center of Excellence for Resilience and Adaptation to advance research and development that improves the resilience of regions of the United States to natural disasters and extreme weather by promoting the resilience of surface transportation infrastructure and infrastructure dependent on surface transportation.
  • $500 million ($100 million annually over five years: FY 2022-26) to the new Healthy Streets program, to be administered by the DOT. Competitive grants will be available to states, local governments, Tribal governments, and other eligible entities to utilize cool pavements and porous pavements, and to expand tree cover, for the purposes of mitigating urban heat islands, improving air quality, and reducing the extent of impervious surfaces, storm water runoff and flood risks, and heat impacts to infrastructure and road users. (For more information on urban heat islands and how some places are working to protect their residents, see TFAH’s case study on Philadelphia’s Beat the Heat program.)
  • Directs the DOT to conduct a study on permeable pavements to gather existing information on their effect on flood control in different contexts and to develop models for their performance in flood control and best practices for designing them.
  • Directs the DOT and EPA to offer to partner with the Transportation Research Board of the National Academies of Sciences, Engineering, and Medicine on a study on stormwater management practices to estimate pollutant loads from stormwater runoff from highways and pedestrian facilities, provide recommendations of stormwater management and total maximum daily load compliance strategies within a watershed, and examine the potential for the DOT to assist state departments of transportation in carrying out and communicating stormwater management practices for highways and pedestrian facilities.
  • Directs the Federal Highway Administration, a division of the DOT, to update within one year and at least every five years thereafter two previously issued reports on stormwater management practices: ‘‘Determining the State of the Practice in Data Collection and Performance Measurement of Stormwater Best Management Practices” and “‘Stormwater Best Management Practices in an Ultra-Urban Setting: Selection and Monitoring.”

Cross-cutting

  • $1 billion ($200 million annually over five years FY 2022-26) for the Building Resilient Infrastructure and Communities (BRIC) program, which is administered by FEMA. The program provides competitive grants to states, local governments, Tribal governments, and territories to support pre-disaster hazard mitigation projects.
  • $500 million ($100 million annually over five years FY 2022-26) for the Safeguarding Tomorrow through Ongoing Risk Mitigation Act (STORM) Act, which authorizes FEMA to enter into agreements with states or Tribal governments to make capitalization grants for the establishment of hazard mitigation revolving loan funds. Such funds are meant to support local government projects to reduce disaster risks for homeowners, businesses, nonprofit organizations, and others.
  • $216 million ($43.2 million annually over five years FY 2022-26) for the S. Bureau of Indian Affairs to distribute to tribes and tribal organizations for climate resilience, adaptation, and community relocation planning, design, and implementation of projects which address the varying climate challenges facing tribal communities across the country. Of the total, $130 million is set aside for community relocation and the remaining $86 million is for climate resilience and adaptation projects.

 

Increases in Drug Overdose Death Rates Were Up Before COVID-19 and Are Continuing to Rise During the Pandemic

Trust for America’s Health and Well Being Trust Call for Renewed Focus on Preventing Deaths of Despair

DISTRICT OF COLUMBIA & OAKLAND, CA – Dec. 23, 2020 – According to data released this week by the National Center for Health Statistics, in 2019 age-adjusted drug overdose deaths increased slightly over the prior year.  Coupled with data released last week by the CDC showing increases in drug overdose deaths in early 2020, these reports demonstrate the continuing upward trajectory of drug deaths in the U.S, a trend that is being compounded by the COVID-19 pandemic.

The age-adjusted rate of drug overdose during 2019 was 21.6 per 100,000 deaths, up from the 2018 rate of 20.7 per 100,000. In 2019, 70,630 people died due to drug overdose in the United States.

Between 1999 and 2019 the rate of drug overdose deaths increased for all groups aged 15 and older, with people aged 35-44 experiencing the highest single year increase in 2019.  While rates of drug overdose deaths involving heroin, natural and semisynthetic opioids, and methadone decreased between 2018 and 2019 the rate of overdose deaths involving synthetic opioids other than methadone continued to increase.

2018 data showing only minor progress after decades of worsening trends, provisional drug overdose data showing an 18% increase over the last 12 months, and the recent CDC Health Alert Network notice on early 2020 increases in fatal drug overdoses driven by synthetic opioids all underscore the continued impact of the deaths of despair crisis and how the COVID-19 pandemic has further diminished the mental health and well-being of many Americans.

“These 2019 overdose rates and the outlook for 2020 are extremely alarming and the result of insufficient prioritization and investment in the well-being and health of Americans for decades,” said John Auerbach, President and CEO of the Trust for America’s Health. “As we work to recover from the COVID-19 pandemic, we must take a comprehensive approach that includes policies and programs that help Americans currently struggling and target upstream root causes, like childhood trauma, poverty and discrimination in order to help change the trajectory of alcohol, drug, and suicide deaths in the upcoming decades.”

Over the last five years, Trust for America’s Health (TFAH) and Well Being Trust (WBT) have released a series of reports on “deaths of despair” called Pain in the Nation: The Drug, Alcohol and Suicides Epidemics and the Need for a National Resilience Strategy, which include data analysis and recommendations for evidence-based policies and programs that federal, state, and local officials.

“If leaders don’t act now to stymie America’s mental health and addiction crises, next year’s data will easily surpass the astounding numbers we’re seeing today,” said Dr. Benjamin F. Miller, PsyD, Chief Strategy Officer at Well Being Trust. “Overdose deaths can be prevented if individuals who are struggling are able to access the appropriate services and supports – and with greater demonstrated success if the care individuals receive is rooted in their immediate communities.”

 

Drug Overdose Deaths, 1999-2019 (Rates age-adjusted)

Year Deaths Deaths per 100,000
1999 16,849 6.1
2000 17,415 6.2
2001 19,394 6.8
2002 23,518 8.2
2003 25,785 8.9
2004 27,424 9.4
2005 29,813 10.1
2006 34,425 11.5
2007 36,010 11.9
2008 36,450 11.9
2009 37,004 11.9
2010 38,329 12.3
2011 41,340 13.2
2012 41,502 13.1
2013 43,982 13.8
2014 47,055 14.7
2015 52,404 16.3
2016 63,632 19.8
2017 70,237 21.7
2018 67,367 20.7
2019 70,630 21.6

 Sources:
CDC – NCHS – National Center for Health Statistics
https://emergency.cdc.gov/han/2020/han00438.asp
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

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About Trust for America’s Health
Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @HealthyAmerica1

 

About Well Being Trust
Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community well-being. www.wellbeingtrust.org Twitter: @WellBeingTrust

 

Policymakers and Health Systems Must Earn Trust within Communities of Color and Tribal Nations to Ensure COVID-19 Vaccine Receptivity, Say Health and Public Health Leaders

Policy brief calls for building vaccine acceptance in communities of color and tribal communities through data transparency, tailored communications via trusted messengers, ensuring ease of vaccine access and no out-of-pocket costs

(Washington, DC – Dec. 21, 2020) – A woeful history of maltreatment of communities of color and tribal nations by government and the health sector, coupled with present day marginalization of these communities by the healthcare system, are the root of vaccine distrust among those groups, according to a policy brief, Building Trust in and Access to a COVID-19 Vaccine Among People of Color and Tribal Nations released today by Trust for America’s Health (TFAH) and co-authors the National Medical Association (NMA) and UnidosUS.

This historic maltreatment, coupled with current day structural racism, has played out in COVID-19’s disproportionate impact on communities of color and tribal communities. These factors also make ensuring vaccine receptivity and access within those communities challenging and of critical importance to protecting lives and ending the pandemic.

In October 2020, TFAH, NMA and UnidosUS hosted a policy convening with 40 leading health equity, healthcare, civil rights, and public health organizations. The purpose of the convening was to advise policymakers on the barriers to vaccine receptivity within communities of color and tribal communities and how to overcome those barriers.

“Earning trust within communities of color and tribal communities will be critical to the successful administration of the COVID-19 vaccine. Doing so will require prioritizing equity, ensuring that leaders from those communities have authentic opportunities to impact vaccine distribution and administration planning, and, the resources to fully participate in supporting vaccine outreach, education and delivery in their communities,” said Dr. J. Nadine Gracia, Executive Vice President and COO of Trust for America’s Health.

The convening created recommendations for policy actions that should be taken immediately within six key areas:

Ensure the scientific fidelity of the vaccine development process.

  • HHS and vaccine developers should release all available vaccine data at frequent and regular intervals to improve transparency and increase confidence in the vaccine evaluation process. Leadership at FDA and HHS must commit to advancing any vaccine only after it has been validated based on established federal and scientific protocols. Programs to monitor for adverse events must also be in place and transparent. Any perception of bypassing safety measures or withholding information could derail a successful vaccination effort.
  • FDA should engage health and public health professional societies, particularly those representing healthcare providers of color, local public health officials, as well as other stakeholders with a role in vaccination, and allow these groups to validate all available data, review the vaccine development and approval process, and issue regular updates on data to their patients, members, and the public.

 Equip trusted community organizations and networks within communities of color and tribal nations to participate in vaccination planning, education, delivery and administration.  Ensure their meaningful engagement and participation by providing funding.

  • Congress should fund CDC and its state, local, tribal, and territorial partners to provide training, support, and financial resources for community-based organizations to join in vaccination planning and implementation, including community outreach, training of providers, and participation in vaccination clinics. State, local, tribal, and territorial authorities should authentically engage and immediately begin vaccination planning with community-based organizations, community health workers/promotores de salud, faith leaders, educators, civic and tribal leaders, and other trusted organizations outside the clinical healthcare setting as key, funded partners.

Provide communities the information they need to understand the vaccine, make informed decisions, and deliver messages through trusted messengers and pathways.

  • Congress should provide at least $500 million to CDC for outreach, communication, and educational efforts to reach priority populations in order to increase vaccine confidence and combat misinformation. All communications must be culturally and linguistically appropriate and tailored as much as possible to reach diverse populations as well as generations within groups.
  • FDA and CDC should initiate early engagement with diverse national organizations and provide funding and guidance for state, local, tribal, and territorial planners to help shape messaging and engage locally with healthcare providers in communities of color and tribal communities, such as nurses, pharmacists, promotores de salud, community health workers, and others to ensure they have the information they need to feel comfortable recommending the vaccine to their patients. Congress and HHS should provide funding for training and engagement of trusted non-healthcare communicators to help shape messaging and to train informal networks, civic and lay leaders, and other trusted community leaders and community-based organizations to answer questions and encourage vaccination.
  • All messaging about the vaccine must be appropriate for all levels of health literacy. Communication should be realistic and clear about timelines and priority groups (and the rationale for these decisions), vaccine effectiveness, types of vaccines, the number of doses, costs, and the need for ongoing public health protections. Planners must provide information that meets people where they are (e.g., barber shops, bodegas, grocery stores, places of worship, etc.) and ensure that trusted messengers in those places have the information they need to be credible and authentic spokespeople.

 

Ensure that it is as easy as possible for people to be vaccinated. Vaccines must be delivered in community settings that are trusted, safe and accessible.

  • We urge the administration and Congress to appropriate the resources necessary to expand and strengthen federal, state, local, territorial, and tribal capacity for a timely, comprehensive, and equitable COVID-19 vaccination planning, communications, distribution, and administration campaign, including funding to support vaccine distribution at the local level and by community-based organizations.
  • Congress and HHS should allocate funding to increase access to vaccination services to ensure that people seeking to be vaccinated do not experience undue increased exposure to the virus as they travel to, move through, and return home from vaccination sites. Flexibility in funding is needed to enable transport of people to vaccination sites, increase accessibility to people without cars, and promote safety and minimize exposure at vaccination locations. Funding should also be provided to health and community-based agencies to assist those for whom transportation or childcare costs are an obstacle to receipt of the vaccine.
  • Planners should ensure that vaccination sites are located in areas that have borne a disproportionate burden of COVID-19, especially leveraging community-based organizations such as Federally Qualified Health Centers, community health centers, rural health centers, schools and places of worship. Mobile services will be particularly important in rural areas. Planners should prioritize congregate living facilities, such as long-term care, prisons, and homeless shelters. In addition, some families, displaced by the COVID economic fallout, may be living with relatives. Planners should ensure vaccination sites have services that meet the Americans with Disabilities Act (ADA) and HHS Office for Civil Rights (OCR) standards for disability and language access.
  • Federal state, local, tribal, and territorial officials must guarantee and communicate with the public that immigration status is not a factor in people’s ability to receive the vaccine and that immigration status is not collected or reported by vaccination sites/providers. Similarly, the presence of law enforcement officers or military personnel could be a deterrent for vaccination at locations, so planners should consider other means of securing sites.
  • In the initial phase, as communities vaccinate healthcare workers, planners must be sure to prioritize home health, long-term care, and other non-hospital-based healthcare workers, who are more likely to be people of color. Other essential workers that comprise large numbers of workers who are people of color and should be treated as within the vaccination priority groups are the food service industry, farmworkers and public transportation employees.

Ensure complete coverage of the costs associated with the vaccine incurred by individuals, providers of the vaccine, and state/local/tribal/territorial governments responsible for administering the vaccine and communicating with their communities about it.

  • Congress, the Centers for Medicare and Medicaid Services, and private payers must guarantee that people receiving the vaccine have zero out-of-pocket costs for the vaccine, related health care visits, or any adverse events related to the vaccine, regardless of their health insurance status.
  • HHS, with emergency funding from Congress, should provide funding so that state, local, tribal, and territorial governments do not bear any cost of vaccine communication efforts, working with their communities, organizing sites, training their staff, and providing personal protective equipment (PPE).

 Congress must provide additional funding and require disaggregated data collection and reporting by age, race, ethnicity, gender identity, primary language, disability status, and other demographic factors on vaccine trust and acceptance, access, vaccination rates, adverse experiences, and ongoing health outcomes.

  • CDC, and state, local, tribal, and territorial authorities should include leaders from communities of color and tribal communities and to plan on-going data collection on vaccination efforts, interpret data, add cultural context, share data with communities, and determine implications and next steps.
  • CDC, and state, local, tribal, and territorial authorities should use these data to inform ongoing prioritization of vaccine distribution and rapidly address gaps in vaccination that may arise among subpopulations by race, ethnicity, neighborhood, or housing setting.

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @healthyamerica1

 

La tasa de obesidad en adultos de EE. UU. Supera el 42 por ciento; el más alto jamás registrado

Tener obesidad es un factor de riesgo de consecuencias graves durante el COVID; La pandemia podría aumentar los niveles de obesidad en el futuro debido al aumento de la inseguridad alimentaria.

(Washington, DC – September 17, 2020) – La tasa de obesidad en adultos de los Estados Unidos superó la marca del 40 por ciento por primera vez, situándose en 42,4 por ciento, según el reporte  State of Obesity: Better Policies for a Healthier America, publicado hoy por Trust for America’s Health (TFAH). La tasa nacional de obesidad en adultos ha aumentado en un 26 por ciento desde el 2008.

El informe, basado en parte en los datos recientemente publicados en el 2019 del Sistema de Vigilancia de Factores de Riesgo del Comportamiento (BFRSS) de los Centros para el Control y la Prevención de Enfermedades (BFRSS) y el análisis de TFAH, proporciona anualmente las tasas de sobrepeso y obesidad en todo el país, incluso por edad, raza y estados de residencia.

Las tendencias demográficas y las condiciones de vida de las personas tienen un gran impacto en su capacidad para mantener un peso saludable. Generalmente, los datos muestran que cuanto más gana una persona, es menos probable que tenga obesidad. Las personas con menos educación también tienen más probabilidades de tener obesidad. Las comunidades rurales tienen tasas más altas de obesidad y obesidad severa que las áreas suburbanas y metropolitanas.

Factores socioeconómicos como la pobreza y la discriminación han contribuido a tasas más altas de obesidad entre ciertas poblaciones raciales y étnicas. Los adultos afroamericanos tienen el nivel más alto de obesidad adulta a nivel nacional con un 49,6 por ciento; esa tasa es impulsada en gran parte por una tasa de obesidad adulta entre las mujeres negras del 56,9 por ciento. Los adultos latinos tienen una tasa de obesidad del 44,8 por ciento. La tasa de obesidad para los adultos blancos es del 42,2 por ciento. Los adultos asiáticos tienen una tasa de obesidad general del 17,4 por ciento.

La obesidad y su impacto en la salud, incluidos los riesgos de COVID-19

La obesidad tiene serias consecuencias para la salud, incluyendo un mayor riesgo de diabetes tipo 2, presión arterial alta, aturdimiento y muchos tipos de cánceres. Se estima que la obesidad aumenta el gasto en atención médica en $ 149 mil millones al año (aproximadamente la mitad de los cuales son pagados por Medicare y Medicaid) y el sobrepeso y la obesidad es la razón más común por la que los adultos jóvenes no son elegibles para el servicio militar. Las preocupaciones sobre el impacto de la obesidad han adquirido nuevas dimensiones este año, ya que tener obesidad es una de las condiciones de salud subyacentes asociadas con las consecuencias más graves de la infección por el COVID, incluidas la hospitalización y la muerte. Estos nuevos datos significan que el 42 por ciento de todos los estadounidenses tienen un mayor riesgo de sufrir impactos graves, posiblemente fatales, en la salud por el COVID-19 debido a su peso y las condiciones de salud relacionadas con la obesidad.

“Para resolver la crisis de obesidad del país será necesario abordar las condiciones de la vida de las personas que conducen a la inseguridad alimentaria y crean obstáculos para tener mejores opciones de alimentos saludables y la actividad física segura. Esas condiciones incluyen pobreza, desempleo, viviendas segregadas y discriminación racial ”, dijo John Auerbach, presidente y director ejecutivo de Trust for America’s Health. “La pandemia de este año ha demostrado que estas afecciones no solo aumentan el riesgo de obesidad y enfermedades crónicas, sino que también aumentan el riesgo de los resultados más graves del COVID”.

La obesidad infantil también va en aumento

Las tasas de obesidad infantil también están aumentando según los últimos datos que muestran que el 19,3 por ciento de los jóvenes estadounidenses, de 2 a 19 años, tienen obesidad. A mediados de la década de 1970, el 5,5 por ciento de los jóvenes tenía obesidad. Tener sobrepeso u obesidad en la juventud los pone en mayor riesgo de tener obesidad y los riesgos para la salud relacionados en la edad adulta. Además, los niños presentan un inicio más temprano de lo que solían considerarse afecciones adultas, como la hipertensión y el colesterol alto.

Doce estados tienen tasas de obesidad en adultos superiores al 35 por ciento

Las tasas de obesidad varían considerablemente entre los estados y regiones del país. Mississippi tiene la tasa de obesidad adulta más alta del país con un 40,8 por ciento y Colorado tiene la más baja con un 23,8 por ciento. Doce estados tienen tasas de adultos superiores al 35 por ciento, son: Alabama, Arkansas, Indiana, Kansas, Kentucky, Luisiana, Michigan, Mississippi, Oklahoma, Carolina del Sur, Tennessee y Virginia Occidental. Recientemente en el 2012, ningún estado tenía una tasa de obesidad en adultos superior al 35 por ciento; en el 2000 ningún estado tenía una tasa de obesidad en adultos superior al 25 por ciento.

Inseguridad alimentaria y su relación con la obesidad

El informe incluye una sección especial sobre la inseguridad alimentaria y su relación con la obesidad. La inseguridad alimentaria está relacionada con dietas de menor calidad y con niveles más altos de obesidad en muchos grupos de población. La inseguridad alimentaria está estrechamente vinculada a las condiciones económicas. Hubo niveles más altos de inseguridad alimentaria durante la crisis financiera del 2008-2009 y los primeros datos indican un gran aumento en el número de familias estadounidenses que están experimentando inseguridad alimentaria debido a la crisis del COVID-19. Según los datos de la encuesta de la Oficina del Censo de los Estados Unidos, el 25 por ciento de todos los encuestados y el 30 por ciento de los encuestados con niños informaron haber experimentado inseguridad alimentaria entre abril y junio de este año.

Resolver la crisis de la obesidad requerirá iniciativas multisectoriales y cambios de política

El informe incluye recomendaciones sobre la mejor manera de abordar la crisis de la obesidad basada en dos principios: 1) la necesidad de un enfoque multisectorial y multidisciplinario y 2) un enfoque en los grupos de población que se ven afectados de manera desproporcionada por la crisis de la obesidad.

Las recomendaciones incluyen:

  • Debido a que la emergencia de salud pública del COVID-19 continúa vigente, continuar con las exenciones de políticas de nutrición del Departamento de Agricultura (USDA) y expandir las comidas escolares sin costo para todos los estudiantes inscritos durante todo el año escolar 2020-2021.
  • Aumentar los fondos para permitir la expansión de los programas críticos de prevención de la obesidad de los CDC, incluido el Programa Estatal de Actividad Física y Nutrición y el programa Enfoques Raciales y Étnicos para la Salud Comunitaria.
  • Ampliar los beneficios en el Programa de Asistencia de Nutrición Suplementaria (SNAP, anteriormente conocido como “cupones de alimentos”) al aumentar los niveles máximos de beneficios, extender Pandemic-EBT (P-EBT) para estudiantes y niños, duplicar las inversiones en SNAP-Ed y encontrar formas voluntarias de mejorar la calidad de la dieta sin perjudicar el acceso o los niveles de beneficios.
  • Incentivar las empresas y el uso de la tierra pública para aumentar las opciones de alimentos saludables y lugares seguros para hacer actividad física.
  • Desincentivar las opciones de alimentos poco saludables cerrando los vacios fiscales y eliminando las deducciones de costos comerciales relacionadas con la publicidad de alimentos y bebidas poco saludables para los niños y promulgando impuestos a las bebidas azucaradas donde los ingresos fiscales se asignan a los esfuerzos locales para reducir las disparidades socioeconómicas y de salud.
  • Alentar a Medicaid a cubrir los programas pediátricos de control de peso para todos los beneficiarios elegibles.

 

El texto completo del informe está disponible

La Fundación Robert Wood Johnson proporcionó apoyo para la serie de Informes sobre el estado de la obesidad. Las opiniones expresadas en este informe no reflejan necesariamente la opinión de la Fundación.

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Trust for America’s Health es una organización no partidista sin fines de lucro que promueve una salud óptima para cada persona y comunidad y hace de la prevención de enfermedades y lesiones una prioridad nacional.

New Data Show Few State Policies Require Specific Action for Implementation of Complete Streets

(Washington D.C. – August 20, 2020)

Nearly half of all US states have mandatory Complete Streets policies, according to new data published today to LawAtlas.org.

While many states agree on whom the policy should protect — of the 24 jurisdictions with mandatory Complete Streets policies on July 1, 2020, all address bicyclists, pedestrians, and public transit users, and the majority require consideration for individuals of all ages and abilities — efforts to expedite or ensure implementation vary:

  • One-third (seven states and the District of Columbia) of the jurisdictions with mandatory policies include provisions that establish a deadline for implementation of the policy.
  • Fewer than half (10 states and the District of Columbia) indicate that existing street design guidelines be revised to include Complete Streets elements.
  • New construction will trigger the policy in almost all jurisdictions with mandatory policies. In contrast, maintenance projects will trigger the policy in only 14 such jurisdictions
  • Thirteen jurisdictions with mandatory policies include performance measures meant to track implementation success in the policy, but the vast majority do not specify what exactly those performance measures should be. Only Indiana includes the numbers of injuries or deaths as a required performance measure in its policy.
  • Sixteen jurisdictions require that justification be provided as a part of the policy’s exemption process. Only four jurisdictions require that justification be made publicly available.
  • Twenty-three jurisdictions have policies that assign a specific entity to oversee the implementation.

“These data offer a nuanced look at Complete Streets policies in the United States, and are an important first step in filling a much-needed gap in our understanding about whether these policies are actually addressing the dangerous conditions for pedestrians, cyclists, and users of public transit,” said Adam Lustig, the manager of the Promoting Health & Cost Control in States initiative at Trust for America’s Health, which is the umbrella project for these data.

“Complete Streets policies can provide a framework to shift roadway infrastructure design to consider the needs of all users, but they need to be evidence-based. We can’t provide effective guidance to policymakers without research.”

The Promoting Health and Cost Control in States initiative’s legal data resources are a collaboration with the Temple University Center for Public Health Law Research with Trust for America’s Health and support from the Robert Wood Johnson Foundation. The Complete Streets dataset is the third in a series of datasets on laws and policies that can support cost-savings for states and promote health and well-being.

Access the Complete Streets dataset on LawAtlas.org.

 

 

 

 

COVID-19 School Closures Put 30 Million Children at Risk of Hunger

Many States with High COVID-19 Infection Rates Also Have Highest School-Meal Programs Participation Rates

(Washington, DC – July 16, 2020) – As COVID-19 infection rates continue to increase in states across the country, many of those jurisdictions are facing the complex dilemma of high infections rates complicating school re-openings and thereby limiting students’ access to school-based meal programs. Among the states with spiking infection rates and a high percentage of students participating in school-based meal programs are Arizona, Florida, Louisiana, Mississippi and South Carolina.

In March schools across the country began closing to stop the spread of the COVID-19 virus. In response, and recognizing the important source of nutrition school-based meals were to millions of American children, the U.S. Department of Agriculture’s Food and Nutrition Service began approving nationwide waivers to provide school systems flexibility in how meals were provided to students.  For example, these waivers enable schools to serve meals in non-congregate settings and outside of standard mealtimes, serve afterschool snacks and meals outside of structured environments, and waive requirements that students be present when meals are picked up.

Over half of all students in elementary and secondary schools across the country depend on the National School Lunch Program, and 12.5 million of those students also participate in the School Breakfast Program. As the COVID-19 pandemic closed schools this spring, these students were placed at risk of not having enough to eat.

A new policy brief, Beyond School Walls: How Federal, State and Local Entities are Adapting Policies to Ensure Student Access to Healthy Meals During the COVID-19 Pandemic, released today by Trust for America’s Health, reviews steps the federal and state governments have taken to ensure students’ access to healthy meals when schools are closed and what needs to be done to ensure continued meal access as all school systems face uncertainties about how to safely reopen for the 2020-2021 school year.

“School meal programs are the most important source of nutritious food for millions of American children. To the degree possible, school systems, with financial and regulatory relief from the federal government,  should continue to be innovative about how to deliver meals to students and should strive to meet or exceed federal nutrition standards for these meals despite product shortages created by the pandemic,” said Adam Lustig, Project Manager at Trust for America’s Health and the brief’s author.

Due to the economic impact the pandemic has had on millions of American families and the numerous uncertainties about how to safely re-open schools, the currently in place program waivers should be extended through the summer and may need to be kept in place during the 2020–2021 school year, the brief says.

Many of the states hardest hit by COVID also have highest school meal programs participation rates

States with some of the highest rates of COVID-19 infections also have high percentages of students who depend on school meals for much of their nutrition. States in which both COVID-19 infection rates are above national medians and school meals program enrollment is high include Arizona, Florida, Georgia, Louisiana, Mississippi, and South Carolina.

States in which more than half of students are enrolled in school-meals programs are:

Percentage of students enrolled in school meal programs

D.C.                                        76.4%

Mississippi                           75.0%

New Mexico                         71.4%

South Carolina                    67.0%

Arkansas                              63.6%

Louisiana                             63.0%

Oklahoma                            62.5%

Georgia                                62.0%

Nevada                                60.8%

Kentucky                             58.7%

California                            58.1%

Florida                                 58.1%

Arizona                                57.0%

Missouri                              52.7%

New York                            52.6%

Illinois                                 50.2%

Alabama                              51.6%

Oregon                                 50.5%

Hunger, poor nutrition and food insecurity can increase a child’s risk of developing a range of physical, mental, behavioral, emotional, and learning problems. Hungry children also get sick more often and are more likely to be hospitalized. Maintaining children’s access to nutritious meals despite school closures not only ensure they do not go hungry, but also promotes children’s health.

“State and federal guidelines waivers have allowed school systems to provide meals to students during the pandemic response, keeping them in place this summer and into the 2020-2021 school year will be the difference between kids who have enough to eat and kids who go hungry,” Lustig said.

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 Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter:@HealthyAmerica1

New TFAH Web-based Tool Will Help Policymakers Better Understand Their Constituent’s Health Status

(Washington, DC – May, ) Trust for America’s Health has created a new web-based tool that will allow members of Congress, their staff and grassroots health advocates to identify the health needs of constituents and target programs and resources where they are most needed.

The new web tool, How Healthy is your Congressional District? created by TFAH with data provided by the Centers for Disease Control and Prevention, is a one-year snapshot of health measures for every congressional district in all 50 states and the District of Columbia. These data were reported within the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) for 2017.

Data, reported nationally, by state and by Congressional district, as part of this website are:

  1. Percentage of adults who lack health insurance
  2. Current percentage of adults who smoke
  3. Cholesterol screening within the previous five years among adults
  4. Visits to doctor for routine checkup within the past year among adults
  5. Percentage of adults who have been diagnosed with diabetes
  6. Percentage of adults who report their general health as fair or poor
  7. Percentage of adults who report they could not see a doctor due to cost
  8. Percentage of adults who have obesity
  9. Percentage of adults who report they have no leisure-time physical activity
  10. Percentage of adults who received a flu shot or flu vaccine during the past 12 months

Ten of the eleven indicators are measures of adults aged 18 years and older; the health insurance measure (#1) is of adults 18-64.

Data should drive policymaking. Toward that goal, TFAH is providing this data reporting tool to policymakers, community leaders, health promotion advocates, and other interested parties. The webpage provides data to policymakers and others who want to know more about the health of their congressional districts.

“Making these comparative data easily available to policymakers will help identify critical action steps and policies that if made will improve the health status of many Americans,” said John Auerbach, President and CEO of Trust for America’s Health. “These data also help identify those districts that are in the greatest need of health-promoting policy interventions”.

Why Analyze by Congressional District?

The webpage is a unique source of information on these select 11 indicators reported by the congressional district. Other existing data sources are most often available at the state or county levels. This lack of data reported at the congressional district level can make it challenging for elected officials, their staff, and local residents and organizations, to gain an accurate picture of the health concerns specific to a district.

There are health-related concerns in every district. The elevated health risk in certain districts is likely a reflection of the social, economic, and environmental conditions related to their demographic composition. These data will assist all of the residents of a district – including the elected officials – to understand what needs to be done to promote optimal health and wellbeing at the local level.

In addition, the constituents of a district may find the information useful in prioritizing their community-level efforts, when seeking resources from private and public organizations, or when tracking trends over time and when conferring with local leaders about issues of concern.

 

Nuevo Informe Coloca A 25 Estados Y Distrito De Columbia En Un Nivel De Alto Rendimiento (10) en Medidas De Salud Pública Para Preparación De Emergencias

A medida que aumentan las amenazas, la evaluación anual determina que el nivel de preparación de los estados para emergencias sanitarias está mejorando en algunas áreas, pero está estancado en otras

(Washington, DC) – Veinticinco Estados y el Distrito de Columbia tuvieron un alto desempeño en una medida de tres niveles de preparación de los Estados para proteger la salud public durante una emergencia, según un nuevo informe publicado hoy por Trust for America’s Health (TFAH, por su sigla en inglés).  El informe anual, Ready or Not 2020: Proteging the Public’s Health from Diseases, Disasters and Bioterrorism, encontró una mejora año tras año entre las 10 medidas de preparación para emergencias, pero también señala áreas que necesitan mejoras. El año pasado, 17 Estados se clasificaron en el nivel superior del informe.

Para 2020, 12 Estados se ubicaron en el nivel de rendimiento medio, por debajo de 20 Estados y el Distrito de Columbia en el nivel medio el año pasado, y 13 se ubicaron en el nivel de rendimiento bajo, el mismo número que el año pasado.

El informe encontró que el nivel de preparación de los estados ha mejorado en áreas claves, que incluyen fondos de salud pública, participación en coaliciones y pactos de atención médica, seguridad hospitalaria y vacunación contra la gripe. Sin embargo, otras medidas clave de seguridad de la salud, que incluyen garantizar un suministro de agua seguro y acceso a tiempo libre remunerado, está estancado o perdido.

Nivel de Rendimiento Estados Numero de Estados
Alto AL, CO, CT, DC, DE, IA, ID, IL, KS, MA, MD, ME, MO, MS, NC, NE, NJ,
NM, OK, PA, TN, UT, VA, VT, WA, W		 25 Estados y DC
Medio AZ, CA, FL, GA, KY, LA, MI, MN, ND, OR, RI, TX 12 Estados

Bajo		 AK, AR, HI, IN, MT, NH, NV, NY, OH, SC, SD, WV, WY 13 Estados

 

El informe mide el desempeño anualmente de los Estados utilizando 10 indicadores que, en conjunto, proporcionan una lista de verificación del nivel de preparación de una jurisdicción para prevenir y responder a las amenazas a la salud de sus residentes durante una emergencia. Los indicadores son:

Indicadores de Preparación
1 Gestión de incidentes: adopción del Pacto de licencia de enfermería 6 Seguridad del agua: Porcentaje de la población que utilizó un sistema de agua comunitario que no cumplió con todos los estándares de salud aplicables.
2 Colaboración comunitaria intersectorial: porcentaje de hospitales que participan en coaliciones de atención médica. 7 Resistencia laboral y control de infecciones: porcentaje de población ocupada con tiempo libre remunerado.
3 Calidad institucional: acreditación de la Junta de Acreditación de Salud Pública 8 Utilización de contramedidas: porcentaje de personas de 6 meses o más que recibieron una vacuna contra la gripe estacional.
4 Calidad institucional: acreditación del Programa de acreditación de gestión de emergencias. 9 Seguridad del paciente: porcentaje de hospitales con una clasificación de alta calidad (grado “A”) en el grado de seguridad del hospital Leapfrog.
5 Calidad institucional: tamaño del presupuesto estatal de salud pública, en comparación con el año pasado. 10 Vigilancia de la seguridad de la salud: el laboratorio de salud pública tiene un plan para un aumento de la capacidad de prueba de seis a ocho semanas.

Cuatro Estados (Delaware, Pensilvania, Tennessee y Utah) pasaron del nivel de bajo rendimiento en el informe del año pasado al nivel alto en el informe de este año. Seis Estados (Illinois, Iowa, Maine, Nuevo México, Oklahoma, Vermont) y el Distrito de Columbia pasaron del nivel medio al nivel alto. Ningún Estado cayó del nivel alto al bajo, pero seis pasaron del nivel medio al bajo: Hawaii, Montana, Nevada, New Hampshire, Carolina del Sur y Virginia Occidental.

“El creciente número de amenazas para la salud de los estadounidenses en 2019, desde inundaciones hasta incendios forestales y vapeo, demuestra la importancia crítica de un sistema de salud pública sólido. Estar preparado es a menudo la diferencia entre daños o no daños durante emergencias de salud y requiere cuatro cosas: planificación, financiamiento dedicado, cooperación interinstitucional y jurisdiccional, y una fuerza laboral calificada de salud pública “, dijo John Auerbach, presidente y CEO de Trust for America’s Health.

“Si bien el informe de este año muestra que, como nación, estamos más preparados para enfrentar emergencias de salud pública, todavía no estamos tan preparados como deberíamos estar”. Se necesita más planificación e inversión para salvar vidas”, dijo Auerbach.

El análisis de TFAH encontró que:

  • La mayoría de los Estados tienen planes para expandir la capacidad de atención médica en una emergencia a través de programas como el Pacto de Licencias de Enfermería u otras coaliciones de atención médica. Treinta y dos Estados participaron en el Pacto de Licencias de Enfermeras, que permite a las enfermeras licenciadas practicar en múltiples jurisdicciones durante una emergencia. Además, el 89 por ciento de los hospitales a nivel nacional participaron en una coalición de atención médica, y 17 estados y el Distrito de Columbia tienen participación universal, lo que significa que todos los hospitales del estado (+ DC) participaron en una coalición. Además, 48 ​​Estados y DC tenían un plan para aumentar la capacidad del laboratorio de salud pública durante una emergencia.
  • La mayoría de los Estados están acreditados en las áreas de salud pública, manejo de emergencias o ambos. Dicha acreditación ayuda a garantizar que los sistemas necesarios de prevención y respuesta ante emergencias estén implementados y que cuenten con personal calificado.
  • La mayoría de las personas que tienen agua de su hogar a través de un sistema de agua comunitario tenían acceso a agua segura. Según los datos de 2018, en promedio, solo el 7 por ciento de los residentes estatales obtuvieron el agua de su hogar de un sistema de agua comunitario que no cumplía con los estándares de salud aplicables, un poco más del 6 por ciento en 2017.
  • Las tasas de vacunación contra la gripe estacional mejoraron, pero aún son demasiado bajas. La tasa de vacunación contra la gripe estacional entre los estadounidenses de 6 meses en adelante aumentó del 42 por ciento durante la temporada de gripe 2017-2018 al 49 por ciento durante la temporada 2018-2019, pero las tasas de vacunación todavía están muy por debajo del objetivo del 70 por ciento establecido por Healthy People 2020.
  • En 2019, solo el 55 por ciento de las personas empleadas tenían acceso a tiempo libre remunerado, el mismo porcentaje que en 2018. Se ha demostrado que la ausencia de tiempo libre remunerado exacerba algunos brotes de enfermedades infecciosas. También puede evitar que las personas reciban atención preventiva.
  • Solo el 30 por ciento de los hospitales, en promedio, obtuvieron las mejores calificaciones de seguridad del paciente, un poco más que el 28 por ciento en 2018. Los puntajes de seguridad hospitalaria miden el desempeño en temas tales como las tasas de infección asociadas a la atención médica, la capacidad de cuidados intensivos y una cultura general de prevención de errores. Dichas medidas son críticas para la seguridad del paciente durante los brotes de enfermedades infecciosas y también son una medida de la capacidad del hospital para funcionar bien durante una emergencia.

Otras secciones del informe describen cómo el sistema de salud pública fue fundamental para la respuesta a la crisis de vapeo, cómo las inequidades en salud ponen a algunas comunidades en mayor riesgo durante una emergencia y las necesidades de las personas con discapacidad durante una emergencia.

Se puede acceder al informe completo en Ready or Not 2020 report.

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Trust for America’s Health es una organización sin fines de lucro y no partidista que promueve la salud óptima para cada persona y comunidad y hace de la prevención de enfermedades y lesiones una prioridad nacional. www.tfah.org. Twitter: @ healthyamerica1