Outbreaks: Protecting Americans from Infectious Diseases

TFAH Releases “The Truth about the Prevention Fund”

June 6, 2013

Washington, DC, June 6, 2013 – Trust for America’s Health (TFAH), today, released a new report of key facts about the Prevention and Public Health Fund, which was created by the Affordable Care Act (ACA).

The Truth about the Prevention Fund includes an overview of the Fund, which is the nation’s largest single investment in prevention, using evidence-based and innovative partnership approaches to improve the health of Americans. The Fund provides more than $14.5 billion in mandatory appropriations over 10 years to improve health and prevent chronic illnesses by expanding preventive care and supporting proven community-based programs that reduce obesity, tobacco use and other preventable conditions.

Currently, more than half of Americans suffer from chronic diseases, such as type 2 diabetes and heart disease. Two thirds of Americans are currently obese or overweight and nearly 20 percent of Americans smoke. Obesity costs the country $147 billion and tobacco use $96 billion in direct healthcare costs each year. A 2012 TFAH study found that if obesity rates continue on their current trajectory, half of Americans could be obese by 2030, and the rise in obesity-related healthcare costs could reach between $196 billion and $213 billion in direct medical costs.

“Today’s kids could become the first in American history to live shorter, less healthy lives than their parents,” said Jeffrey Levi, PhD, executive director of TFAH. “We can resign our kids to that fate – or invest in proven, effective programs to reduce obesity, tobacco use and the prevalence of preventable chronic conditions. The Prevention Fund is the best and most targeted effort the nation has made toward getting the health of this country back on track.”

The Prevention Fund invests in programs that are proven and effective. Oversight and evaluation is a key component of every Fund-sponsored program, and strict performance measures ensure accountability before federal dollars are spent. The Fund supports community-driven prevention efforts targeted at reducing tobacco use, increasing physical activity, improving nutrition, expanding mental health and injury prevention programs and improving prevention activities.

For instance, for one component of the Fund – the Community Transformation Grants (CTGs) – grantees are required within five years to reduce by 5 percent death and disability due to tobacco use; the rate of obesity (through nutrition and physical activity approaches); and death and disability due to heart disease and stroke. States and local communities have the flexibility to decide what problems are most pressing for them to address and decide which approaches to use as long as they are evidence based. All grantees are expressly forbidden from using any funds for lobbying. U.S. Centers for Disease Control and Prevention (CDC) has initiated extra controls to ensure grantees are restricted from ever using funds on prohibited lobbying activities and has mechanisms in place to identify any violations. No such violations have been confirmed.

“Obesity, tobacco-use and other preventable health problems are crippling this nation. The Prevention Fund provides states and communities with the flexibility to address their most pressing health challenges. We will never be successful unless we invest in programs and approaches we know work,” said Levi.

The full report also profiles examples of how communities are effectively using Prevention Fund support – The Truth about the Prevention Fund is available on TFAH’s web site .

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. www.healthyamericans.org

###

Examples of CTG Efforts in Communities:

West Virginia is supporting local health departments to address top challenges facing their community and develop solutions. The West Virginia Department of Health is using CTG support to help local health departments in every county in the state implement targeted initiatives including: safe places in communities to work and play, Farm-to-School Initiatives to improve nutrition in school settings, Child and Day Care Center Nutrition Programs to educate and empower children to choose healthy lifestyles through physical activity and healthy food choices, and community coordinated care systems that link and build referral networks between the clinical system and community-based lifestyle programs so people can manage their health.

Oklahoma is using a CTG to work with a range of sectors to make healthier choices easier in the state. Nearly 70 percent of Oklahoma County’s premature deaths are largely preventable, arising from an unhealthy lifestyle, poor diet or the use of tobacco, alcohol or other substances. The county spends about $920 million every year to treat chronic disease. In September 2011, Oklahoma City was awarded a $3.5 million CTG. Using a portion of those funds, the Oklahoma City-County Health Department (OCCHD) expanded the use of community health workers to ensure more people access the “My Heart, My Health, My Family” program, which provides prevention programs and services, specifically focused on cardiovascular disease. The program includes lesson plans on healthy living (e.g. portion control and the benefits of substituting water for sugar sweetened beverages) and participants receive access to free regular clinical checkups four times a year and free medication. The CTG money will also support other obesity-specific initiatives, including expanded walking and biking trails, a push to help schools offer healthy menu options and a physical education coordinator for city schools.

An Accountable Care Community (ACC) in Akron, Ohio – a CTG recipient – has brought together 70 community partners to coordinate healthcare and support inside and outside the doctor’s office for patients with type 2 diabetes. In just 18 months, the ACC has reduced the average cost per month of care for individuals with type 2 diabetes by more than 10 percent per month with an estimated program savings of $3,185 per person per year. This initiative also led to a decrease in diabetes-related emergency department visits.

The Iowa Department of Public Health (IDPH) is providing local communities with resources to better address obesity and other health risk factors. Utilizing a $3 million/year CTG, one key element is the Iowa Community Referral Project. The project will help ensure Iowans follow through with healthy lifestyle behaviors as a result of referral system changes between health providers and community agencies. The two components of the project include 1) A partnership with the Iowa Primary Care Association (IPCA) and selected communities where intensive training and technical assistance are provided to promote a seamless referral system, and 2) Implementation of local referral projects in the Iowa CTG intervention counties.

A CTG awarded to Broward Regional Health Planning Council’s Transforming Our Community’s Health (TOUCH) initiative is serving 1.7 million residents of Broward County, Florida to improve health, including by working with a range of partners to alleviate childhood obesity. TOUCH has brought together community-based organizations, multidisciplinary strategies and diverse communities to address the most recognizable factors contributing to childhood obesity. It is anticipated that these system, environmental and policy enhancements will positively impact the health, well-being and longevity of children.
Additional highlights of CTG program efforts in 2011 are available at: http://www.cdc.gov/communitytransformation/accomplishments/index.htm.

The Truth About the Prevention and Public Health Fund

Investing in America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts

New Report Provides High-Impact Recommendations to Improve Prevention Policies in America

January 29, 2013

Washington, D.C., January 29, 2013 – Today, Trust for America’s Health (TFAH) released A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years – which provides high-impact recommendations to prioritize prevention and improve the health of Americans.

The Healthier America report outlines top policy approaches to respond to studies that show 1) more than half of Americans are living with one or more serious, chronic diseases, a majority of which could have been prevented, and 2) that today’s children could be on track to be the first in U.S. history to live shorter, less healthy lives than their parents.

“America’s health faces two possible futures,” said Gail Christopher, DN, President of the Board of TFAH and Vice President – Program Strategy of the W.K. Kellogg Foundation. “We can continue on the current path, resigning millions of Americans to health problems that could have been avoided or we invest in giving all Americans the opportunity to be healthier while saving billions in health care costs. We owe it to our children to take the smarter way.”

The Healthier America report stresses the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective. Some recommendations include:

Advance the nation’s public health system by adopting a set of foundational capabilities, restructuring federal public health programs and ensuring sufficient, sustained funding to meet these defined foundational capabilities;
Ensure insurance providers reimburse for effective prevention approaches both inside and outside the doctor’s office;
Integrate community-based strategies into new health care models, such as by expanding Accountable Care Organizations into Accountable Care Communities;
Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs;
Maintain the Prevention and Public Health Fund and expand the Community Transformation Grant program so all Americans can benefit;
Implement all of the recommendations for each of the 17 federal agency partners in the National Prevention Strategy; and
Encourage all employers, including federal, state and local governments, to provide effective, evidence-based workplace wellness programs.

“Prevention delivers real value as a cost-effective way to keep Americans healthy and improve their quality of life,” said Jeffrey Levi, PhD, executive director of TFAH. “Everyone wins when we prevent disease rather than treating people after they get sick. Health care costs go down, our local neighborhoods are healthier and provide more economic opportunity, and people live longer, healthier, happier lives.”

A Healthier America also features more than 15 case studies from across the country that show the report’s recommendations in action, such as:

The first-of-its-kind Accountable Care Community (ACC) launched by the Austen BioInnovation Institute in Akron, Ohio, which brings together more than 70 partners to coordinate health care inside and outside the doctor’s office for patients with type 2 diabetes. By improving care and making healthier choices easier in people’s daily lives, the ACC reduced the average cost per month of care for individuals with type 2 diabetes by more than 10 percent per month within 18 months of starting the program – an estimated savings of $3,185 per person per year;
The Community Asthma Initiative (CAI), implemented by Boston Children’s Hospital, has provided support to improve the health of children with moderate to severe asthma in at-risk Boston neighborhoods. The CAI has led to a return of $1.46 to insurers/society for every $1 invested; an 80 percent reduction in percentage of patients with one or more asthma-related hospital admission; and a 60 percent reduction in the percentage of patients with asthma-related emergency department visits; and
The Healthy Environments Collaborate (HEC) in North Carolina is an innovative partnership across four state agencies – Health and Human Services, Transportation, Environment and Natural Resources and Commerce. The partnership focuses on creating win-win policies and programs that improve health while also meeting other priority goals, such as improved transportation, increased commerce and stable housing programs.

In addition, the report includes recommendations for a series of 10 key public health issues: reversing the obesity epidemic; preventing tobacco use and exposure; encouraging healthy aging; improving the health of low-income and minority communities; strengthening healthy women, healthy babies; reducing environmental health threats; enhancing injury prevention; preventing and controlling infectious diseases; prioritizing health emergencies and bioterrorism preparedness; and fixing food safety.

The report was supported by grants from the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation and The Kresge Foundation and is available on TFAH’s website at www.healthyamericans.org.

###

A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years

Ready or Not?

The Facts Hurt

«States» had the «capital_ranking» Rate of Injury Deaths in U.S.;

«States» scored a «capital_score» out of Ten on Key Indicators of Steps States can take to Prevent Injuries

Washington, D.C., May 22, 2012 (Scores were revised January 3, 2013 to reflect changes in seven state laws) – «States» had the «lower_ranking» rate of adult injury-related deaths for Americans with «rate» per 100,000 people suffering injury fatalities. Overall, the national rate is 57.9 per 100,000. The total lifetime medical costs due to fatal injury in «States» were «medical_costs».

The Facts Hurt report, released by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), concludes that millions of injuries could be prevented each year if more states adopted additional research-based injury prevention policies, and if programs were fully implemented and enforced. TFAH and RWJF worked with a committee of top injury prevention experts from the Safe States Alliance and the Society for the Advancement of Violence and Injury Prevention (SAVIR) to develop a set of indicators of leading evidence-based strategies that have been shown to reduce injuries and save lives.

«States» scored «total_score» out of 10 on key indicators of steps states can take to prevent injuries – nationally, 21 states scored a five or lower. Two states, California and New York, received the highest score of nine out of a possible 10, while Montana scored the lowest with two out of 10.

No.	Indicator	«States»	Number of States Receiving Points
A “Y” means the state received a point for that indicator
1	Seat Belts: Have primary seat belt laws. Source: Governors Highway Safety Association	«seat_blets»	32 and Washington, D.C.
2	Drunk Driving: Mandatory ignition interlocks for all convicted drunk drivers, even first offenders. Sources: Governors Highway Safety Association	«drunk_driving»	17
3	Motorcycle Helmets: Universal helmet law requiring helmets for all riders. Source: Governors Highway Safety Association	«motorcycle»	19 and Washington, D.C.
4	Booster Seats: Meet AAP standards — require booster seats to at least the age of eight. Source: AAP 2011 State Legislation Report	«boost_seaters»	33 and Washington, D.C.
5	Bicycle Helmet Use: Require bicycle helmets for all children. Source: American Academy of Pediatrics, 2011 State Legislation Report	«bicycle_helmets»	21 and Washington, D.C.
6	Intimate Partner Violence: Allow people in dating relationships to get protection orders. Source: Break the Cycle, 2010 Survey of Teen Dating Violence Laws	«intimate_partner_violence»	44 and Washington, D.C.
7	Teen Dating Violence: Receive an “A” in the Break the Cycle Report. Source: Break the Cycle, 2010 Survey of Teen Dating Violence Laws	«teen_dating_violence»	6 and Washington, D.C.
8	Concussions: Have a strong concussion law. Source: Momsteam.com and the Network for Public Health Law	«concussions»	43 and Washington, D.C.
9	Accidental Prescription Drug Overdose or Use: Have active prescription drug monitoring program. Source: Alliance of States with Prescription Monitoring Programs	«prescription_drug»	49
10	Ecodes: More than 90 percent of injury discharges of patients of emergency departments received external cause of injury codes, which help researchers track trends and develop prevention strategies. Source: HCUP E Code Evaluation Addendum – Updated Information for 2009, Agency for Healthcare Research and Quality	«ecodes»	23
Total			«score_numeric»

Injuries – including those caused by accidents and violence – are the third leading cause of death nationally, and they are the leading cause of death for Americans between the ages of one and 44.

Approximately 50 million Americans are medically treated for injuries each year, and more than 2.8 million are hospitalized. Nearly 12,000 children and teens die from injuries resulting from accidents each year and around 9.2 million are treated in emergency rooms. Every year, injuries generate $406 billion in lifetime costs for medical care and lost productivity.

“There are proven, evidence-based strategies that can spare millions of Americans from injuries each year,” said Jeff Levi, PhD, Executive Director of TFAH. “This report focuses on specific, scientifically supported steps we can take to make it easier for Americans to keep themselves and their families safer.”

The report found that many injury prevention activities have been scientifically shown to reduce harm and deaths, for instance:

Seat belts saved an estimated 69,000 lives from 2006 to 2010;
Motorcycle helmets saved an estimated 8,000 lives from 2005 to 2009;
Child safety seats saved around 1,800 lives from 2005 to 2009;
The number of children and teens killed in motor vehicle crashes dropped 41 percent from 2000 to 2009; and
School-based programs to prevent violence have cut violent behavior among high school students by 29 percent.

The report also identified a set of emerging new injury threats, including a dramatic, fast rise in prescription drug abuse, concussions in school sports, bullying, crashes from texting while driving and an expected increase in the number in falls as the Baby Boomer generation ages.

“Seat belts, helmets, drunk driving laws and a range of other strong prevention policies and initiatives are reducing injury rates around the country,” said Amber Williams, Executive Director of the Safe States Alliance. “However, we could dramatically bring down rates of injuries from motor vehicles, assaults, falls, fires and a range of other risks even more if more states adopted, enforced and implemented proven policies. Lack of national capacity and funding are major barriers to states adopting these and other policies.”

“While tremendous progress has been made in preventing and treating injury, it remains a leading cause of death for people of all ages and the number one cause of death for children,” said Dr. Andrea Gielen, ScD, Past President, SAVIR, and Director, Johns Hopkins Center for Injury Research and Policy. “Texting while driving, the increasing numbers of falls in older adults, domestic violence and the astonishing rise in misuse of prescription drugs mean we need to redouble our efforts to make safety research and policy a national priority.”

The report was supported by a grant from the Robert Wood Johnson Foundation and is available on TFAH’s website at www.healthyamericans.org.

Score Summary:

A full list of all of the indicators and scores, listed below, is available along with the full report on TFAH’s web site at www.healthyamericans.org and RWJF’s Web site at www.rwjf.org. 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 a number of sources, including: the Governors Highway Safety Association; the American Academy of Pediatrics; Break the Cycle; the Network for Public Health Law; momsTeam.com; the Alliance of States with Prescription Drug Monitoring Programs; and the Agency for Healthcare Research and Quality.

9 out of 10: California and New York
8 out of 10: Hawaii, Maryland, North Carolina, Oregon, Rhode Island and Washington
7 out of 10: Connecticut, Washington, D.C., Illinois, Kansas, Louisiana, Maine, Massachusetts, New Jersey, New Mexico and Tennessee
6 out of 10: Alabama, Alaska, Arizona, Delaware, Florida, Georgia, Missouri, Nebraska, New Hampshire, Vermont, Virginia and Wisconsin
5 out of 10: Arkansas, Colorado, Indiana, Iowa, Michigan, Minnesota, Oklahoma, Pennsylvania, Texas, Utah and West Virginia
4 out of 10: Mississippi and Nevada
3 out of 10: Idaho, Kentucky, North Dakota, Ohio, South Carolina, South Dakota and Wyoming
2 out of 10: Montana

STATE-BY-STATE INJURY DEATH RANKINGS

Note: Rates include all injury deaths for all ages, for injuries caused by accidents and violence (intentional and unintentional) 1 = Highest rate of injury fatalities, 51 = lowest rate of injury fatalities. Rankings are based on combining three years of data (2007-2009) from the U.S. Centers for Disease Control and Prevention’s Web-based Injury Statistics Query and Reporting System to “stabilize” data for comparison purposes. The data are age-adjusted using the year 2000 to standardize the data. This methodology, recommended by the CDC, compensates for any potential anomalies or usual changes due to the specific sample in any given year in any given state. The numbers are based on how many deaths per 100,000.

1. New Mexico (97.8); 2. Montana (86.5); 3. Alaska (85.8); 4. Wyoming (84.7); 5. Mississippi (84.3); 6. Oklahoma (83); 7. West Virginia (82.2); 8. Louisiana (80.1); 9. Arkansas (76.9) 10. (tie) Alabama and Kentucky (76.5); 12. Tennessee (75.6); 13. South Carolina (71.7); 14. Nevada (71.3); 15. Arizona (70.7); 16. Missouri (70.2); 17. Colorado (67.8); 18. Florida (66.8); 19. North Carolina (66); 20. Idaho (65.3); 21. Utah (64.8); 22. Georgia (61.4); 23. Vermont (61.3); 24. Oregon (61.2); 25. North Dakota (61.6); 26. South Dakota (60.7); 27. (tie) Indiana and Kansas (60.4); 29. Washington, D.C. (60.2); 30. Pennsylvania (59.4); 31. (tie) Maine and Wisconsin (58.7); 33. Texas (58.5); 34. Washington (58.1); 35. Delaware (56.9); 36. Michigan (56.8); 37. Maryland (56.1); 38. Ohio (55.9); 39. Virginia (53.4); 40. Iowa (52.5); 41. Nebraska (51.3); 42. Minnesota (51.2); 43. Rhode Island (50.4); 44. New Hampshire (50); 45. Illinois (48.7); 46. Hawaii (48.3); 47. Connecticut (47.9); 48. California (47.6); 49. Massachusetts (41.1); 50. New York (37.1); New Jersey (36.1).

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need – the Foundation expects to make a difference in our lifetime. For more information, visit www.rwjf.org.

The Safe States Alliance is a national, non-profit organization and professional association whose mission is to serve as the national voice in support of state and local injury and violence prevention professionals engaged in building a safer, healthier America.

SAVIR is a national professional organization dedicated to fostering excellence in the science of preventing and treating violence and injury. Our vision is a safer world through violence and injury research and its application to practice.

The Facts Hurt

Ready or Not? 2011

Report Finds Preparedness for Bioterror and Health Emergencies Eroding in «state»

Cuts to Key Programs Could Hurt Ability to Detect and Respond to Crises

Washington, DC, December 20, 2011 – The Trust for America’s Health (TFAH) and Robert Wood Johnson Foundation (RWJF) released the ninth annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism today, which finds key «state» programs that detect and respond to bioterrorism, new disease outbreaks and natural or accidental disasters are at risk due to federal and state budget cuts.

Some key programs at risk due to continued cuts to federal public health emergency preparedness funds include:

51 of the 72 cities«cities_at_risk» in the Cities Readiness Initiative are at risk for elimination; the Initiative supports the ability to rapidly distribute and administer vaccines and medications during emergencies;
«chemical_testing» This would leave the U.S. Centers for Disease Control and Prevention (CDC) with the only public health lab in the country with full ability to test for chemical terrorism and accidents;
24 states, «epidemiology» «state», are at risk for losing the support of Career Epidemiology Field Officers – CDC experts who supplement state and local gaps to rapidly prevent and respond to outbreaks and disasters, such as during the H1N1 flu pandemic and responding to the health impact of the Gulf Oil Spill in 2010;
Support for all of the nation’s preparedness research and training centers is at risk for elimination«university_research»; and
The ability for CDC to mount a comprehensive response to nuclear, radiologic and chemical threats as well as natural disasters is at risk due to potential cuts to the National Center for Environmental Health. All 50 states and Washington, D.C. would lose the support CDC provides during these emergencies.

«funding»

“We’re seeing a decade’s worth of progress eroding in front of our eyes,” said Jeff Levi, PhD, Executive Director of TFAH. “Preparedness had been on an upward trajectory, but now some of the most elementary capabilities – including the ability to identify and contain outbreaks, provide vaccines and medications during emergencies, and treat people during mass traumas – are experiencing cuts in every state across the country.”

Combined federal, state and local budget cuts mean public health departments can no longer sustain a number of basic elements of preparedness. In the past year, 40 states and Washington, D.C. cut state public health funds – with 29 of those states and D.C. cutting their budgets for a second year in a row and 15 states for three years in a row. Federal funds for state and local preparedness declined by 38 percent from fiscal year (FY) 2005 to 2012 (adjusted for inflation) – and additional cuts are expected under budget sequestration.

“Americans expect the public health system to have the capability to competently protect their health during emergencies. This is not an optional service,” said Mel Kohn, MD, MPH, State Health Officer and Public Health Director of the Oregon Health Authority. “We will be unable to absorb reductions of this magnitude simply by finding efficiencies. We have reached the point where our ability to do this work will be seriously compromised, with life and death consequences.”

“During the anthrax attacks and Hurricane Katrina, we witnessed what happens when public health doesn’t have the technology, resources, workforce or training needed to respond to emergencies,” said James S. Marks, Senior Vice President and Director of the Health Group of RWJF. “The old adage is that it’s better to be safe than sorry. Unfortunately if we ignore preparedness now, we’ll be sorry later when the next emergency strikes.”

The report includes a series of recommendations that will be important for improving America’s preparedness, including:

Assuring dedicated funding and strengthening the public health preparedness core capabilities;
Improving biosurveillance to rapidly detect and track outbreaks or attacks;
Improving research, development and manufacturing of vaccines and medications;
Enhancing the ability to provide care for a mass influx of patients during emergencies;
Providing better support to help communities cope with and recover from disasters; and
Coordinating food safety with other preparedness efforts through the strategic implementation of the FDA Food Safety Modernization Act of 2011.

Detailed Findings Summary

The 51 cities at risk for elimination from the Cities Readiness Initiative include: Albany and Buffalo, NY; Albuquerque, NM; Anchorage, AK, Baltimore, MD; Baton Rouge and New Orleans, LA; Billings, MT; Birmingham, AL; Boise, ID; Burlington, VT; Charleston, WV; Charlotte, NC; Cheyenne, WY; Cincinnati and Columbus, OH; Columbia SC; Des Moines, IA: Dover, DE; Fargo, ND; Fresno, Riverside, Sacramento and San Jose, CA; Hartford and New Haven, CT; Honolulu, HI; Indianapolis, IN; Jackson, MS; Kansas City, MO: Little Rock, AR; Louisville, KY; Manchester, NH; Memphis and Nashville, TN; Milwaukee, WI; Oklahoma City, OK; Omaha, NE: Orlando and Tampa, FL; Peoria, IL; Portland, ME; Portland, OR; Providence, RI; Richmond and Virginia Beach, VA; Salt Lake City, UT; San Antonio, TX; Sioux Falls, SD; Trenton, NJ; Wichita, KS.

The 21 cities NOT at risk for elimination from the Cities Readiness Initiative include: Atlanta, GA; Boston, MA; Chicago, IL; Cleveland, OH; Dallas, TX; Denver, CO; Detroit, MI; District of Columbia; Houston, TX; Las Vegas, NV; Los Angeles, San Diego and San Francisco, CA; Miami, FL; Minneapolis, MN; New York City, NY; Philadelphia and Pittsburgh, PA; Phoenix, AZ; Seattle, WA; St. Louis, MO.

The 10 state labs at risk for losing “Level 1” chemical testing abilities: California, Florida, Massachusetts, Michigan, Minnesota, New Mexico, New York, South Carolina, Virginia, Wisconsin.

The 24 states at risk to lose Career Epidemiology Field Officers: Alabama, Arizona, California, Florida, Idaho, Kentucky, Maine, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New York, North Carolina, North Dakota, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, Virginia, West Virginia, Wyoming.

The 14 universities at risk to lose Preparedness and Emergency Response Learning Center funds: Columbia University Mailman School of Public Health; Harvard University School of Public Health; Johns Hopkins University Bloomberg School of Public Health; Texas A&M School of Rural Public Health; University of Alabama at Birmingham School of Public Health; University of Albany SUNY School of Public Health; University of Arizona College of Public Health; University of Illinois at Chicago School of Public Health; University of Iowa College of Public Health; University of Minnesota School of Public Health; University of North Carolina Gillings School of Global Public Health; University of Oklahoma College of Public Health; University of South Florida College of Public Health; University of Washington School of Public Health.

The nine universities at risk to lose Preparedness and Emergency Response Research Center fund: Emory University; Harvard School of Public Health; Johns Hopkins University Bloomberg School of Public Health; University of California at Berkley and Los Angeles; University of Minnesota; University of North Carolina; university of Pittsburgh; University of Washington.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need–the Foundation expects to make a difference in our lifetime. For more information, visit rwjf.org