Issue Category: Health Equity/Social Determinants of Health

Supporting and Promoting Native American Health

In 1990, then President George H.W. Bush signed a joint Congressional resolution designating November as Native American Heritage Month. Native American communities and culture are strongly rooted in community health and healing, an emphasis that has supported generations of Native Americans, despite experiencing past systemic atrocities.

This November, in recognition of the annual observance, Trust for America’s Health (TFAH) urges federal lawmakers to address hardships within Native American communities caused by government actions of past eras and to renew its commitment to improving health outcomes for Native American peoples by removing barriers to federal funding and by fully respecting Tribal Nations’ right to self-determination.

TFAH’s Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress outlines several recommendations that the Administration and Congress taking office in January should act on to help promote healthier tribal communities and reduce health disparities that have long burdened Native American populations.

The well-documented history of forced removal from original homelands and assimilation away from cultural and generational ties, along with centuries of underinvestment and underfunding of tribal communities, have perpetuated the poor health outcomes seen in American Indian/Alaska Native populations. Nearly 30 percent of American Indian/Alaska Native high schoolers have obesity, according to TFAH’s 2024 State of Obesity report – the highest rate among populations groups in the United States. The report also noted that 45 percent of American Indian/Alaska Native adults had obesity, according to a self-reported study. That was higher than white adults at 34 percent.

American Indian/Alaska Native adults also have the highest rates of drug overdose, alcohol-related deaths, and suicide deaths as compared to other population groups, as noted in the latest edition of our Pain in the Nation report.

Despite the loss of much of cultural and ancestral homelands, many traditional Native American health practices are still used to this day. In October 2024, the Centers for Medicare & Medicaid Services announced an historic action for Medicaid and the Children’s Health Insurance Program to cover traditional health care practices when provided by Indian Health Service facilities.

TFAH’s Blueprint report details several additional recommendations to advance the federal government’s  trust responsibility and treaty obligations to promote tribal self-government and support the health and well-being of Native populations. Those recommendations include removing barriers that currently exist to fully funding the programs identified in Executive Order 14112 – Reforming Federal Funding and Support for Tribal Nations to Better Embrace Our Trust Responsibilities and Promote the Next Era of Tribal Self-Determination.

The report also recommends that the federal government ensures more complete and accurate collection of health-related data across demographic characteristics to ensure that investments in health-promoting programs are made where they are most needed, including in Native communities. In addition, the report calls on all federal agencies to regularly update and report progress on their agency equity plans and to be more transparent about their progress toward meeting equity goals.

Federally funded, community driven programs have demonstrated effectiveness in improving the well-being of Native Americans. The Special Diabetes Program for Indians, for example, has provided $150 million annually for local prevention programs around the country for nearly 30 years and has been able to incrementally decrease diabetes prevalence in American Indian/Alaska Native  communities, according to the latest report to Congress.

More recently, the Strengthening Public Health Systems and Services in Indian Country grant program facilitated by the Centers for Disease Control and Prevention (CDC) has supported dozens of tribal organizations’ efforts to reduce chronic disease and promote healthy living in American Indian and Alaska Native populations. One of the programs funded by this grant program is the CDC’s Tribal Suicide Prevention Program, which is using holistic, community and culturally-centered approaches to reduce deaths from suicide. Also, a partnership between the CDC and AmeriCorps, Public Health AmeriCorps, has launched the public health careers of more than 4,000 individuals, to work in underserved rural, tribal, and urban communities.

Since 2020, TFAH’s Age-Friendly Public Health Systems initiative has partnered with the Washington State Department of Health and the Northwest Washington Indian Health Board (NWWIHB), a coalition of six federally recognized tribes in Washington state, to support exploration of the needs of tribal elders so that the NWWIHB can better provide resources and supports to its tribal elders.

Investing and scaling these evidence-based strategies that prioritize prevention are key steps in leading the systemic change needed to eradicate health inequities and disparities, including in Native American communities.

New National Adult Obesity Data Show Level Trend

Stabilization of Obesity Rates is Welcome News but More Investment in Prevention Policies and Programs is Needed

(Washington, DC – October 10, 2024) – Over the last two decades, obesity has increased across the country in both adults and children. Newly released National Health and Nutrition Examination Survey (NHANES) data from 2021–2023 find that 40.3 percent of adults had obesity, which is slightly lower than the previous data (2017–2020). This is tentatively positive news, as it suggests a possible stabilization of the overall adult obesity rates in the United States in recent years— though the rate is still much higher than prior decades.

Percent of Adults Ages 20 and Older with Obesity, 1999-2023


Source: NHANES

Obesity is a complex disease that is influenced by many factors beyond personal behavior. Reversing the nation’s obesity crisis requires sustained investment in multidimensional strategies and policies, that are tailored for population groups and regional differences. As TFAH’s September 2024 State of Obesity report explores, there are a number of evidence-based policies and programs that improve nutrition and support healthy eating, and help to reduce rates of obesity and chronic disease.

This includes important policy progress, like:

  • Improving nutritional quality of the food supply and diets by prohibiting trans fats in foods, instituting voluntary guidance to reduce sodium in commercial foods, and taxing sugar sweetened beverages to reduce added sugar consumption.
  • Empowering consumers through better labeling and education, like improved Nutrition Facts labels, new restaurant menu labeling, and family education programs.
  • Increasing nutritional quality and access in schools, institutions, and nutrition programs, including aligning child nutrition programs and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) with the Dietary Guidelines for Americans.

(See State of Obesity report pages 14–17 for more on these nutrition and food environment policies.)

Looking forward, we need to build on these initial steps to ensure that adult obesity rates continue to trend in the right direction, including critical policies like:

  • Increase federal resources for evidence-based, effective efforts that reduce obesity-related disparities and related conditions including funding for CDC’s chronic disease and obesity prevention programs, such as the State Physical Activity and Nutrition, Racial and Ethnic Approaches to Community Health, and Healthy Tribes
  • Decrease food and nutrition insecurity while improving the nutritional quality of available foods in every community by, among other activities, providing healthy school meals for all students and maintaining progress on the final 2024 school nutritional meal standards. In addition, Congress should expand access to nutrition support programs such as the Supplemental Nutrition Assistance Program (SNAP) and WIC, and increase the value of their benefits.
  • To help consumers make informed choices, the Food and Drug Administration should swiftly implement a front-of-package label that will help people more easily understand the nutrients of concern in packaged foods.

(See State of Obesity 2024 recommendations on pages 67–76 for additional measures policymakers should take to continue to make progress in efforts to help all Americans maintain a healthy weight.)

“It is welcome news that the latest NHANES data suggest the overall adult obesity rate in this country has not been increasing in recent years,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “However, much more needs to be done to address this health crisis. This is a critical moment to increase our efforts: boost and sustain investment in proven obesity prevention policies and programs and build healthier communities where everyone has access to affordable, nutritious foods and safe places to engage in physical activity.”

The new NHANES report also highlights the link between obesity and socioeconomic status. Like previous years, the new data show clear differences in obesity prevalence by educational attainment, with lower obesity rates for adults with a bachelor’s degree (31.6 percent) than in adults with less education (high school diploma or less (44.6 percent) and those with some college (45.0 percent). This underscores the critical role of policies and programs that boost accessibility and affordability of healthy food for all Americans.

Notably, the newly released report does not include data by race/ethnicity, though we hope that will be released later this year. Previous years’ data have shown large differences in obesity prevalence and trends by race/ethnicity. Understanding trends across different racial/ethnic groups, and if disparities are increasing or decreasing, is essential for a complete picture and successful policy response.

See TFAH’s State of Obesity 2024: Better Policies for a Healthier America report for more information about obesity rates and solutions.

 

 

 

Racial and Ethnic Approaches to Community Health (REACH) Program’s 25th Anniversary

Trust for America’s Health hosted a virtual Congressional briefing and national webinar honoring the 25th anniversary of the Centers for Disease Control and Prevention (CDC) Racial and Ethnic Approaches to Community Health (REACH) program. REACH aims to improve health, prevent chronic diseases, and reduce health disparities among racial and ethnic populations with the highest risk, or burden of chronic disease. Since 1999, the program has empowered communities to develop and share effective solutions, fostering a healthier future for all.

A panel of subject matter experts discussed the history, achievements, and future of the REACH program.

Ensuring Culturally and Linguistically Appropriate Mental Health Services Will Reduce Health Disparities and Promote Well-being

In 1966, Dr. Martin Luther King, Jr. famously condemned injustice in health as the most shocking of all forms of inequality.  As TFAH recognizes Mental Health Awareness Month almost 60 years later, populations of color and other underserved groups in the United States continue to experience disparities in behavioral health outcomes and the availability and quality of care.  By supporting and promoting culturally and linguistically appropriate services (or CLAS), however, policymakers can reduce these disparities and promote well-being for all Americans.

The Office of Minority Health at the U.S. Department of Health and Human Services (HHS) defines CLAS as services that are respectful of and responsive to cultural and communication needs, including through consideration of cultural health beliefs, health literacy levels, and preferred languages.  By incorporating CLAS, providers can ensure individuals and families receive respectful, understandable, effective, and equitable care.  Among other features, CLAS can involve recruiting and supporting a culturally and linguistically diverse workforce, offering language assistance to individuals with limited English proficiency, and collecting and maintaining accurate data to evaluate impacts on health equity and outcomes.

The U.S. mental health care system, specifically, has struggled to address the needs of culturally and linguistically diverse populations; as a result, racial and ethnic minority populations have historically been less likely to receive necessary mental health care and more likely to receive low-quality care.  In addition, these groups are more likely to use hospitals and inpatient facilities to address mental health needs instead of community-based services.  Across the healthcare system, non-white patients report lower quality patient-physician interactions, less participation in medical decision making, and lower overall satisfaction with care. Other social and economic factors like lack of health insurance, limited income, transportation barriers, and experiences of racism and bias also contribute to these outcomes. In addition, a recent report found that 50 percent of LGBTQ+ young people who wanted mental healthcare could not get it due, in part, to a lack of affordable options and fears of negative reactions or other consequences.

Racial and ethnic health disparities impose a high burden in the United States—one study found $451 billion in costs, including medical expenses, lost productivity, and premature death, for 2018 alone—but CLAS can significantly improve quality of care and advance equity.  One study found that the single most important factor for increasing use of mental health services for individuals with limited English language proficiency was access to providers speaking their native languages.  In addition, the use of peer support specialists and other lay health workers with community-specific experience can promote access to care and help to reduce dropout rates and boost attendance rates for patients during mental health treatment.  In Native communities, for example, these workers can help overcome practical barriers to mental healthcare like lack of transportation and reduce symptoms of depression and suicide-related outcomes.  An integrated care approach that coordinates a variety of services can also improve mental health outcomes for patients from racially and ethnically diverse populations.

The Biden-Harris Administration has undertaken significant efforts to support and enhance CLAS across the spectrum of behavioral healthcare.  The 988 Suicide and Crisis Lifeline, which launched in July 2022, for example, has implemented specialized services for the LGBTQ+ population, and the Substance Abuse and Mental Health Services Administration announced the addition of Spanish language text and chat services in July 2023.  In November 2023, the White House also released the U.S. Playbook to Address Social Determinants of Health.  This document outlines strategies to “support equitable health outcomes by improving the social circumstances of individuals and communities,” including the structural inequities that “often disproportionately impact historically underserved individuals.” The 2023 HHS Equity Action Plan similarly outlined measures to improve access to behavioral healthcare coverage for underserved populations, including by developing an inclusive workforce, promoting behavioral health integration, and enhancing language services.  Relatedly, in January 2024, the Centers for Medicare & Medicaid Services (CMS) announced the Innovation in Behavioral Health (IBH) Model, which will comprehensively address health-related social needs of Medicaid and Medicare populations with moderate to severe mental health conditions and substance use disorder.  Importantly, this model requires participating Medicaid agencies to develop a health equity plan to address disparities in the populations they serve.

Several recent Congressional initiatives have also focused on promoting CLAS in the behavioral health system.  The PEER Support Act, for example, would strengthen the peer support specialist workforce by ensuring accurate data reporting on the profession, supporting best practices on training and supervision, and addressing barriers to certification and practice.  In addition, the Pursuing Equity in Mental Health Act would help establish behavioral healthcare teams in areas with underserved populations, improve training and best practices for addressing mental health disparities, and enhance outreach to populations of color to promote mental health and reduce stigma.  Finally, the Health Equity and Accountability Act would help reduce health disparities by improving data reporting, supporting workforce diversity, and increasing access to CLAS.

TFAH encourages Administration officials and Congressional leaders to continue to bolster CLAS to improve behavioral health outcomes for populations of color and other underserved groups. These improvements will not only help address the high cost of health disparities in the United States but will also support foundational changes to improve access and outcomes in the future.

 

 

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

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

 

Resource:

Ready or Not 2024: State-by-State Factsheets

Mind, Body, and Soul: Supporting Mental Health through Physical Fitness and Sports

May is National Physical Fitness and Sports Month, a designation recognized each year by the President since 1983.

The U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion (ODPHP) and the President’s Council on Sports, Fitness & Nutrition (PCSFN) are highlighting how physical activity and sports benefit  both physical and mental health.

It is well documented that physical activity and sports participation help prevent chronic diseases, as well as reduce stress, anxiety and promote mental health and well-being.

Obesity and suicide  rates have increased over the last two decades, particularly among youth, certain communities of color, and people living in rural areas. Providing equitable access to safe places and opportunities to be active in every community would give more people the means to improve their health.

Earlier this year, the President’s Council on Sports, Fitness & Nutrition unveiled a landmark partnership with 14 major professional sports leagues and players associations to expand access to physical activity, bolster education on nutrition, and promote healthy lifestyle activities to millions of Americans.

“Every individual and community should have equitable access to opportunities to be physically active. Multisector collaborations, such as among public health, transportation, schools, sports leagues, and community-based organizations will improve access to physical activity for all,” said J. Nadine Gracia, M.D., MSCE, president and CEO of Trust for America’s Health and a member of the President’s Council on Sports, Fitness & Nutrition.

Several events are planned throughout the month, including Bike to Work Day on May 17.

Learn more about ways to be physically active by visiting the Move Your Way website.

Federal Government and States Take Action to Protect Black Maternal Health

The death of three-time Olympian Tori Bowie due to complications from childbirth in 2023 was yet another tragic loss.  Her death and that of far too many women highlight the disturbing maternal health crisis in the United States.

Despite having the highest healthcare spending among high-income countries, the United States has the highest maternal mortality rate among those countries. And this maternal health crisis is disproportionately impacting Black women, Native American women, and women in rural areas.

Roughly 700 women in the U.S. die each year from pregnancy-related or childbirth complications, according to the Centers for Disease Control and Prevention. Many of these deaths are preventable. The maternal mortality rate for Black women is almost three times greater than that of white women over the last decade.

Black Maternal Health Week is recognized each year from April 11-17 to bring attention and action improving Black maternal health.  It also coincides with April being National Minority Health Month.

The call to take action on Black maternal health has reached the highest levels of the U.S. government. The White House Blueprint for Addressing The Maternal Health Crisis  outlines actions the Biden-Harris Administration will take to improve maternal health, all rooted in a focus on health equity. The action steps include increasing access to and coverage of comprehensive high-quality maternal healthcare, advancing data and research on maternal health issues, expanding and diversifying the perinatal workforce, and strengthening economic and social supports for pregnant people and families.

States are also responding with innovative and collaborative solutions that could revolutionize how the country supports expecting mothers.

New Jersey is one such example.  The state rolled out a comprehensive plan in 2021 to address maternal health, especially for mothers and babies of color. Nurture New Jersey was launched by the state’s first lady, Tammy Murphy, and was informed by years-long, science-based, multisector planning. The final report includes actionable commitments to build and improve racial equity and community infrastructure, engage multiple public and private sectors to achieve collective impact on health, and strategies to shift narratives and mindsets around maternity.

Murphy initiated an annual Black Maternal and Infant Health Summit, bringing together stakeholders from healthcare, academia, and community-based organizations. The state has made efforts to improve access to midwifery services and to improve the workforce pipeline. And the state issues a maternal health hospital report card that grades every licensed birthing facility to provide residents with another layer of information during their family planning.

New Jersey has the fourth highest maternal mortality rates in the nation with 46 maternal deaths per 100,000 live births, as reported in the Georgetown Institute for Women, Peace and Security’s 2020 U.S. Women, Peace and Security Index. For Black women within the state, that rate rises to 132 deaths per 100,000 live births. The state’s plan calls for reducing maternal mortality rates by 50 percent.

Other states have used targeted strategies to address specific areas of concern.

Forty-six states, including the District of Columbia, have extended Medicaid postpartum coverage from 60 days to 12 months, and two other states are planning to implement a 12 month extension. The American Rescue Plan Act of 2021 gave states the option to extend coverage. More than half of births to individuals of color are covered by Medicaid.

More than half of states allow Medicaid to cover doula services. Many of women of color choose doulas during their pregnancy for more personal support and due to concerns about implicit and explicit bias that exists within the healthcare system.

Other actions states can take to improve maternal care include postpartum coverage extension. To date, numerous states have introduced legislation to extend such coverage and two have succeeded: California and Texas.  In addition, states should prioritize Medicaid applications for pregnant people as Hawaii and Rhode Island have done.

By using the governmental, community, and cultural resources such as doulas and midwives to support Black women and families during pregnancy, the U.S. has the opportunity to vastly improve maternal health care and outcomes.

 

 

 

TFAH Celebrates National Public Health Week

April 1-7, 2024 is National Public Health Week. This year’s theme is Protecting, Connecting and Thriving: We Are All Public Health and TFAH is proud to celebrate and recognize all of the individuals, organizations, and agencies that work to protect health, advance equity, and promote well-being in communities nationwide.

Public health workers are on the front lines helping communities prevent chronic diseases and substance misuse, defending against disease outbreaks, protecting our water supply, and preparing for and responding to natural and human-caused disasters. Their work is constant and critically important to improving and protecting the health and safety of all communities.

Examples of the contributions of the public health system to advancing Americans’ health are many, including:

  • Increasing life expectancy – Americans’ life expectancy steadily increased during the 20th century and through 2009 the first decade of the 21st century, was flat between 2010 and 2018 the next decade, and declined during the COVID-19 pandemic. The latest available data, for 2022, showed a slight rebound in the life expectancy trendline.
  • Delivering vaccines – the 20th and beginning of the 21st centuries saw substantial decreases in vaccine preventable diseases such as measles and polio thanks in part to public health programs to ensure vaccine access, particularly in underserved communities.
  • Promoting maternal and infant health – programs to support pregnant people have created improved access to prenatal, post-partum, and infant healthcare, but more work needs to be done to address racial and ethnic disparities in maternal and postpartum health outcomes.
  • Helping people who smoke quit – the initial phase of the Centers for Disease Control’s Tips from Former Smokers campaign (2012 – 2018) helped more than one million people successfully stop smoking, which has prevented an estimated 129,000 early deaths and saved approximately $7.3 billion in smoking-related healthcare costs.
  • Protecting health during extreme heat – extreme heat threatens the public’s health. Several U.S. jurisdictions have heat response plans, and others are working on creating such plans. Heat response plans outline actions to mitigate the impact of the increasing number and intensity of heatwaves.

“Public health practitioners work tirelessly to prevent disease, prepare for and respond to disasters, address health disparities, and create healthy communities. This vital work deserves support and requires investment to fully fund the public health infrastructure and its workforce,” said Dr. J. Nadine Gracia, M.D. MSCE, President and CEO of Trust for America’s Health.

Most of the money spent on healthcare in the U.S. goes toward preventable illnesses and injuries. Increased and sustained funding for public health would be an investment in prevention and would help to reduce healthcare spending over time. TFAH has called for $4.5 billion annually to adequately fund public health infrastructure across the country.  As the White House and Congress work on FY 2025 appropriations, lawmakers should support the full range of work the CDC and health departments do every day to keep communities safe and healthy.

A different public health theme is highlighted each day during National Public Health Week. Visit the American Public Health Association and to access information and resources on each topic.