Issue Category: Health Equity/Social Determinants of Health

Trust for America’s Health is a Healthy People 2030 Champion!

As an organization that prioritizes optimal health for all people, Trust for America’s Health (TFAH) is pleased to be recognized as a Healthy People 2030 Champion by the U.S. Department of Health and Human Services (HHS). TFAH shares the Healthy People 2030 vision of a society in which all people can achieve optimal health and well-being across the lifespan. This commitment is reflected in TFAH’s overall vision and mission and within its Age-Friendly Public Health Systems (AFPHS) initiative.  TFAH prioritizes achieving equity in all of our work and promotes optimal well-being for all by focusing on the social determinants of health (SDOH).

TFAH has worked closely HHS leadership, particularly within the Office of Disease Prevention and Health Promotion, which administers Healthy People 2030, to promote stronger collaborations between state departments of health and state aging agencies.

The Age-Friendly Public Health Systems initiative and Healthy People 2030 are well aligned as they share a focus on optimal health in every community. AFPHS’s 6C’s strategy provides a roadmap for state and local health departments to engage in activities that support healthy aging in their communities including:

Connecting and convening multi-sector stakeholders

Coordinating existing supports and services

Collecting, analyzing, and translating relevant data

Communicating important public health information

Complementing existing health promoting programs

Creating and leading policy, systems, and environmental changes

In addition to the Healthy People 2030/AFPHS alignment, TFAH supports the Healthy People 2030 vision in the following ways:

Promoting and increasing access to disease prevention and health promotion activities.

TFAH’s federal advocacy priorities focus on strengthening the public health system so that every state, tribal, local, and territorial health department has the funding and capacity to improve and sustain optimal health for every person and community.

Addressing social determinants of health, eliminating disparities, achieving health equity, and/or promoting well-being.

TFAH is leading advocacy efforts to increase public health’s capacity to fully address the social determinants of health, with a focus on equity and eliminating disparities in health across the lifespan.

Providing training and other necessary resources to adapt or modify disease prevention and health promotion activities to meet the needs of diverse populations, address SDOH, eliminate disparities, achieve health equity, and/or promote well-being.

Many of TFAH’s reports and policy briefs document states where health promotion activities need improvement, as well as feature best practices. In addition, TFAH’s website includes detailed health data on every state and territory including on emergency preparedness, prevalence of chronic diseases and flu vaccination rates.

Developing partnerships across a variety of sectors, including public health, healthcare, government, philanthropy, civil rights, academia, education, community, faith-based, media, business, and technology

TFAH routinely hosts convenings of representatives across sectors including public health, healthcare, government, philanthropy, academia, community, and education. Such convenings have focused on the COVID-19 pandemic, adolescent health, healthy aging, state policies to promote health and control costs, and many other topics.

TFAH looks forward to continuing our strong partnership with the HHS Office of Disease Prevention and Health Promotion and other Healthy People 2030 Champions to create and sustain opportunities for all Americans to live healthfully and productively throughout their lives.

TFAH Announces Board Chair Transition

Distinguished Board Chair Dr. Gail C. Christopher to Step Down, Board Member Dr. Stephanie Mayfield Gibson elected Incoming Chair

(Washington, DC – December 19, 2022) — Trust for America’s Health (TFAH) announced today that the chairperson of its Board of Directors, Gail C. Christopher, DN, will be stepping down after 10 years of visionary leadership.  The Board of Directors has unanimously elected Board member Stephanie Mayfield Gibson, MD, as the incoming Board Chair, effective January 1, 2023.

Dr. Christopher has a noteworthy 15 years of service on the TFAH Board, becoming a member of the Board in 2007, and serving as chair for a decade.  She informed the Board of her intention to step down as chair at last year’s annual Board meeting, and the Board subsequently underwent a thoughtful succession planning process.  Dr. Mayfield, who joined the TFAH Board in 2017, and is currently a member of the Board’s Finance Committee, was nominated and elected as the next chair.

“Drs. Christopher and Mayfield are nationally renowned and visionary leaders in public health and health equity,” said TFAH’s President and CEO Dr. J. Nadine Gracia.  “TFAH is extremely fortunate to have benefited from Dr. Christopher’s brilliant leadership and will continue to be guided by Dr. Mayfield’s passion and vast experience in our next chapter as an organization.”

While stepping down from the TFAH Board, Dr. Christopher will continue in her roles as the Executive Director of the National Collaborative for Health Equity and as a Senior Scholar at George Mason University’s Center for Well-Being. In addition, Dr. Christopher is president and founder of Ntianu Center for Healing and Nature. Prior to her Ntianu Center tenure, Dr. Christopher was senior adviser and vice president at the W.K. Kellogg Foundation where she was the architect of the Foundation’s Truth, Racial Healing, and Transformation Initiative, an adaptation of the globally recognized Truth and Reconciliation Commission model.

“It has been my honor to serve TFAH and to follow the leadership of former statesman, and Connecticut senator, Lowell Weicker in this vital role as President, then Chair of the TFAH board,” Dr. Christopher said. “I am particularly proud of TFAH’s legacy as a bipartisan convener and problem-solver during challenging and polarized times. I will continue to cherish the meaningful relationships with all my fellow board members and the outstanding staff, stakeholders, funders, and partners of this amazing organization. TFAH is a strong organization and I’m sure that we’ll continue to do great things lead by our incoming board chair, Dr. Stephanie Mayfield, our outstanding organizational president, Dr. Nadine Gracia, and all of the dedicated members of the TFAH Board.”

During Dr. Christopher’s tenure, TFAH experienced tremendous growth and notable achievement in addressing our nation’s most pressing public health issues, such as public health funding, emergency preparedness, obesity, substance misuse and suicide, healthy aging, healthy schools, the health impacts of climate change, and the social determinants of health.  Her exemplary leadership strengthened TFAH’s focus on health equity as foundational to policymaking at all levels.  And, along with her fellow Board members, Dr. Christopher provided steady and sage counsel to the organization in navigating the unprecedented COVID-19 pandemic.

“TFAH owes Dr. Christopher a large debt of gratitude for her service to the organization. Her vision, mentorship, and expertise in racial healing and equity have been an inspiration to her fellow Board members and to the TFAH staff,” said Dr. Gracia.  “We look forward to working with her in the future as she continues to be a leader in the nation’s journey toward health equity.”

VIDEO: Drs. Gracia and Christopher discuss TFAH’s work

Dr. Stephanie Mayfield is a board-certified anatomic and clinical pathologist and an experienced health executive in both the public and private sectors.  As the incoming TFAH Board Chair, she brings critical frontline public health, healthcare system, and academic experience to the position.  Furthermore, she is a longtime advocate of promoting population health and advancing health equity.

“It’s a privilege to be the incoming board chair for Trust for America’s Health, a well-established and meaningful organization,” said Dr. Mayfield. “As a former state public health commissioner and former state laboratory director, we utilized TFAH’s reports for their rich data and policy recommendations to shape an informed systems approach to advance health equity. It’s an exciting time to support the organization in this new role in furtherance of our mission – to promote optimal health for every person and community and make the prevention of illness and injury a national priority. Thank you to our funders for enabling TFAH to pursue its mission and to our outgoing board chair, Dr. Gail Christopher, for her keen stewardship and visionary leadership.”

From 2020 to 2022, Dr. Mayfield served as the Director of the U.S. COVID-19 Response Initiative and Senior Advisor for U.S. Partnerships for Resolve to Save Lives.  The initiative provided COVID-19 response guidance and technical support to local and state health departments, other community partners, and to agencies of the Federal government. In her role as senior advisor, Dr. Mayfield additionally advised on a multi-sector, community-driven, best practices hypertension control initiative focused on optimizing patient empowerment and addressing social determinants of health.

In 2012, Dr. Mayfield was appointed commissioner of public health for the Commonwealth of Kentucky. She was the first African American and first woman to serve in that role. Prior to her tenure as state public health commissioner, she was the state’s director of laboratory services under the Cabinet of Health and Family Services. In 2016, Dr. Mayfield joined KentuckyOne Health and KentuckyOne Health Partners, as the senior vice president and chief medical officer for population health and led the transformation of the state’s largest healthcare system by addressing basic human needs across the continuum of health. Dr. Mayfield has also held faculty positions at the Louisville School of Medicine and served as the Associate Chief of Staff and Staff Pathologist at the Louisville Veteran’s Administration Medical Center. Dr. Mayfield’s research includes early evaluation of what is now the gold-standard heart disease marker, Troponin.

 

 

Nation’s Obesity Epidemic is Growing: 19 States Have Adult Obesity Rates Above 35 Percent, Up From 16 States Last Year

Social and Economic Factors Are Key Drivers of Increasing Obesity Rates

(Washington, DC – September 27, 2022) – Four in ten American adults have obesity, and obesity rates continue to climb nationwide and within population groups, according to a report State of Obesity 2022: Better Policies for a Healthier America released today by Trust for America’s Health (TFAH). The report amplifies the importance of the White House Conference on Hunger, Nutrition and Health happening tomorrow. The Conference and the report are intended to spotlight the links between hunger, nutrition, and health, and diet-related diseases including obesity. In addition, they will drive policy action to address food insecurity and health disparities, factors often at the root of diet-related health issues.

The report finds that persistent increases in obesity rates across population groups underscores that obesity is caused by a combination of factors including societal, biological, genetic, and environmental, which are often beyond personal choice. The report’s authors conclude that addressing the obesity crisis will require attending to the economic and structural factors of where and how people live.

Based in part on newly released 2021 data from the Centers for Disease Control and Prevention’s Behavioral Risk Factors Surveillance System, and analysis by TFAH, the report tracks rates of overweight and obesity by age, race/ethnicity, and state of residence. Among the most striking findings are:

Nineteen states have adult obesity rates over 35 percent.  West Virginia, Kentucky, and Alabama have the highest rate of adult obesity at 40.6 percent, 40.3 percent, and 39.9 percent, respectively. The District of Columbia, Hawaii, and Colorado had the lowest adult obesity rates at 24.7 percent, 25 percent, and 25.1 percent respectively.

A decade ago, no state had an adult obesity rate at or above 35 percent.  (See state-by-state rate chart).

National data from the 2017-2020 National Health and Nutrition Examination Survey also included in the report show the following:

  • Nationally, 41.9 percent of adults have obesity.
  • Black adults had the highest level of adult obesity at 49.9 percent.
  • Hispanic adults had an obesity rate of 45.6 percent.
  • White adults had an obesity rate of 41.4 percent.
  • Asian adults had an obesity rate of 16.1 percent.
  • Rural parts of the country had higher rates of obesity than did urban and suburban areas.

Structural and social determinants are significantly influencing the rates of obesity among adults and youth.  Factors such as structural racism, discrimination, poverty, food insecurity, housing instability, and lack of access to quality healthcare are key drivers of the differences in obesity rates across racial and ethnic groups. These systemic barriers make it inappropriate to assign blame to individuals with obesity for their weight. The purpose of this report is to analyze conditions in people’s lives which make them more likely to develop obesity and recommend policies to address those conditions.

Obesity rates are also increasing among children and adolescents with nearly 20 percent of U.S. children ages 2 to 19 having obesity. These rates more than tripled since the mid-1970s and Black and Latino youth have substantially higher rates of obesity than do their white peers.

A special section of the report looks at the relationship between food insecurity and obesity. Food insecurity, defined as being uncertain of having or unable to acquire enough food because of insufficient money or resources, is driven by many of the same social and economic factors that drive obesity including poverty and living in communities with many fast-food establishments but limited or no access to healthy, affordable foods such as available in full-service supermarkets or farmers markets. Being food and nutrition insecure often means families must eat food that costs less but is also high in calories and low in nutritional value.

Obesity is multifactored and involves more than individual behavior

Social and economic factors including experiencing poverty and the impact of long-standing structural racism and health inequities are strongly associated with obesity and are at the root of higher rates of obesity in low-income communities that have fewer resources to support healthy eating and being physically active.

“The continued increase in rates of obesity across all population groups is alarming,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “Policies and programs to reduce obesity need to be implemented at a systems level. We must advance policies that address the community, institutional, and structural factors that are barriers to healthy eating and physical activity and that exacerbate health inequities.”

Addressing obesity is critical because it is associated with a range of diseases including type 2 diabetes, heart disease, stroke, arthritis, sleep apnea, and some cancers. Obesity is estimated to increase U.S. healthcare spending by $170 billion annually (including billions by Medicare and Medicaid).

The report includes recommendations for policy actions that federal, state, and local policymakers and other stakeholders should take including:

  • Increase funding for the CDC’s National Center for Chronic Disease Prevention and Health Programs to prevent obesity and related chronic diseases. Funding increases need to be sufficient to put proven obesity prevention programs to work in every state and should prioritize those communities where the need is greatest to address health inequities.
  • Make healthy school meals for all students a permanent policy, extend COVID-19 flexibilities that expand nutrition access for students and their families, strengthen school nutrition standards, and increase students’ opportunities for physical activity during the school day.
  • Expand the CDC’s social determinants of health program to address the upstream, structural drivers of chronic disease.
  • Decrease food insecurity and improve the nutritional quality of available food by increasing funding for and participation in nutrition assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Child and Adult Care Food Program.
  • End unhealthy food marketing to children by closing tax loopholes and eliminating business-cost deductions related to the advertising of unhealthy food and beverages to young people.
  • Impose excise taxes on sugary drinks and devote the revenue to local obesity prevention programs and to reduce health disparities.
  • Expand support for maternal and child health, including supporting breastfeeding.
  • Fund active transportation projects like pedestrian and biking paths in all communities and make local spaces more conducive to physical activity such as opening school recreational facilities to community groups outside of school hours.
  • Expand access to healthcare and require insurance coverage with no cost sharing for U.S. Preventive Task Force recommended obesity prevention programs.

Read the full report

 

La epidemia de obesidad de la nación está creciendo: 19 estados tienen tasas de obesidad en adultos superiores al 35 por ciento, frente a los 16 estados del año pasado

Factores sociales y económicos son impulsores clave del aumento de las tasas de obesidad

(Washington, DC – 27 de septiembre de 2022) – Cuatro de cada diez adultos estadounidenses tienen obesidad, y las tasas de obesidad continúan aumentando en todo el país y dentro de los grupos de población, según un informe State of Obesity 2022: Better Policies for a Healthier America publicado hoy por Trust for American Health (TFAH). El informe amplifica la importancia de que la Conferencia de la Casa Blanca sobre el Hambre, la Nutrición y la Salud (White House Conference on Hunger, Nutrition and Health) que se llevara cabo mañana. La Conferencia y el informe tienen como objetivo destacar los vínculos entre el hambre, la nutrición y la salud, y las enfermedades relacionadas con la dieta, incluida la obesidad. Además, impulsarán la acción política para abordar la inseguridad alimentaria y las disparidades en la salud, factores que a menudo son la raíz de los problemas de salud relacionados con la dieta.

El informe encuentra que los aumentos persistentes en las tasas de obesidad en los grupos de población subrayan que la obesidad es causada por una combinación de factores que incluyen factores sociales, biológicos, genéticos y ambientales, que a menudo están más allá de la elección personal. Los autores del informe concluyen que abordar la crisis de la obesidad requerirá prestar atención a los factores económicos y estructurales de dónde y cómo vive la gente.

Basado en parte en los datos recientemente publicados en el 2021 del Sistema de Vigilancia de Factores de Riesgo de Comportamiento de los Centros para el Control y la Prevención de Enfermedades y el análisis realizado por TFAH, el informe rastrea las tasas de sobrepeso y obesidad por edad, raza/etnicidad y estado de residencia. Entre los hallazgos más llamativos se encuentran:

Diecinueve estados tienen tasas de obesidad en adultos superiores al 35 por ciento. West Virginia, Kentucky y Alabama tienen la tasa más alta de obesidad en adultos con un 40,6 %, 40,3 % y 39,9 %, respectivamente. El Distrito de Columbia, Hawái y Colorado tenían las tasas más bajas de obesidad en adultos con 24,7 %, 25 % y 25,1 %, respectivamente.

Hace una década, ningún estado tenía una tasa de obesidad en adultos igual o superior al 35 por ciento. (Consulte el cuadro de tarifas estado por estado).

Los datos nacionales de la Encuesta Nacional de Examen de Salud y Nutrición 2017-2020 también incluidos en el informe muestran lo siguiente:

  •  A nivel nacional, el 41,9 por ciento de los adultos tienen obesidad.
  • Los adultos afroamericanos tenían el nivel más alto de obesidad en adultos con un 49,9 por ciento.
  • Los adultos hispanos tenían una tasa de obesidad del 45,6 por ciento.
  • Los adultos blancos tenían una tasa de obesidad del 41,4 por ciento.
  • Los adultos asiáticos tenían una tasa de obesidad del 16,1 por ciento.
  • Las zonas rurales del país tenían tasas más altas de obesidad que las zonas urbanas y suburbanas.

Los determinantes estructurales y sociales están influyendo significativamente en las tasas de obesidad entre adultos y jóvenes. Factores como el racismo estructural, la discriminación, la pobreza, la inseguridad alimentaria, la inestabilidad de la vivienda y la falta de acceso a una atención médica de calidad son factores clave de las diferencias en las tasas de obesidad entre los grupos raciales y étnicos. Estas barreras sistémicas hacen que sea inapropiado culpar a las personas con obesidad por su peso. El propósito de este informe es analizar las condiciones en la vida de las personas que las hacen más propensas a desarrollar obesidad y recomendar políticas para abordar esas condiciones.

Las tasas de obesidad también están aumentando entre los niños y adolescentes, con casi el 20 por ciento de los niños estadounidenses de 2 a 19 años que tienen obesidad. Estas tasas se triplicaron con creces desde mediados de la década de 1970 y los jóvenes negros y latinos tienen tasas de obesidad sustancialmente más altas que sus pares blancos.

Una sección especial del informe analiza la relación entre la inseguridad alimentaria y la obesidad. La inseguridad alimentaria, definida como la incertidumbre de tener o no poder adquirir suficientes alimentos debido a la insuficiencia de dinero o recursos, está impulsada por muchos de los mismos factores sociales y económicos que impulsan la obesidad, incluida la pobreza y vivir en comunidades con muchos establecimientos de comida rápida, pero con pocos recursos o ningún acceso a alimentos saludables y asequibles, como los disponibles en supermercados de servicio completo o mercados de agricultores. La inseguridad alimentaria y nutricional a menudo significa que las familias deben comer alimentos que cuestan menos pero que también tienen un alto contenido de calorías y un bajo valor nutricional.

La obesidad es multifactorial e involucra más que el comportamiento individual

Los factores sociales y económicos, incluida la experiencia de la pobreza y el impacto del racismo estructural de larga data y las desigualdades en salud, están fuertemente asociados con la obesidad y son la raíz de las tasas más altas de obesidad en comunidades de bajos ingresos que tienen menos recursos para apoyar una alimentación saludable y estar físicamente bien activo.

“El aumento continuo de las tasas de obesidad en todos los grupos de población es alarmante”, dijo J. Nadine Gracia, M.D., MSCE, presidenta y directora ejecutiva de Trust for America’s Health. “Las políticas y los programas para reducir la obesidad deben implementarse a nivel de sistemas. Debemos promover políticas que aborden los factores comunitarios, institucionales y estructurales que son barreras para la alimentación saludable y la actividad física y que exacerban las inequidades en salud”.

Abordar la obesidad es fundamental porque está asociada con una variedad de enfermedades que incluyen diabetes tipo 2, enfermedades cardíacas, derrames cerebrales, artritis, apnea del sueño y algunos tipos de cáncer. Se estima que la obesidad aumenta el gasto en atención médica en los Estados Unidos a más de $ 170 mil millones anuales (incluidos los miles de millones de Medicare y Medicaid).

El informe incluye recomendaciones para acciones de políticas que los legisladores federales, estatales y locales y otras partes interesadas deben tomar, incluyendo:

  • Aumentar la financiación del Centro Nacional para la Prevención de Enfermedades Crónicas y los Programas de Salud de los CDC para prevenir la obesidad y las enfermedades crónicas relacionadas. Los aumentos de fondos deben ser suficientes para poner en funcionamiento los programas probados de prevención de la obesidad en todos los estados y deben priorizar aquellas comunidades donde la necesidad es mayor para abordar las inequidades en salud.
  • Hacer que las comidas escolares saludables para todos los estudiantes sean una política permanente, extender las flexibilidades de COVID-19 que amplían el acceso a la nutrición para los estudiantes y sus familias, fortalecer los estándares de nutrición escolar y aumentar las oportunidades de actividad física de los estudiantes durante el día escolar.
  • Ampliar el programa de determinantes sociales de la salud de los CDC para abordar los impulsores estructurales de las enfermedades crónicas.
  • Disminuir la inseguridad alimentaria y mejorar la calidad nutricional de los alimentos disponibles al aumentar la financiación y la participación en programas de asistencia nutricional como el Programa de Asistencia Nutricional Suplementaria (SNAP), el Programa Especial de Nutrición Suplementaria para Mujeres, Bebés y Niños (WIC), y el Programa de Alimentación para el Cuidado de Niños y Adultos.
  • Poner fin a la comercialización de alimentos no saludables para los niños cerrando las lagunas fiscales y eliminando las deducciones de costos comerciales relacionadas con la publicidad de alimentos y bebidas no saludables para los jóvenes.
  • Imponer impuestos especiales sobre las bebidas azucaradas y dedicar los ingresos a los programas locales de prevención de la obesidad y para reducir las disparidades en la salud.
  • Ampliar el apoyo a la salud materno infantil, incluido el apoyo a la lactancia materna.
  • Financiar proyectos de transporte activo como senderos para peatones y ciclistas en todas las comunidades y hacer que los espacios locales sean más propicios para la actividad física, como abrir instalaciones recreativas escolares a grupos comunitarios fuera del horario escolar.
  • Ampliar el acceso a la atención médica y requerir cobertura de seguro sin costo compartido para los programas de prevención de la obesidad recomendados por el Grupo de trabajo preventivo de EE. UU.

Lea el informe completo.

New Report: Nation’s Chronic Lack of Investment in Public Health Puts Americans’ Lives and Livelihoods at Risk

COVID-19 emergency funding was critical to initial pandemic response but did not address nation’s long-standing underinvestment in public health; $4.5 billion in annual infrastructure funding is needed

(Washington, DC – July 28, 2022) – Chronic underfunding has created a public health system that cannot address the nation’s health security needs, its persistent health inequities, as well as emerging threats, and, was a contributing factor in the inadequate response to the COVID-19 pandemic, according to a report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2022, released today by Trust for America’s Health.

Lack of funding in core public health programs slowed the response to the COVID-19 pandemic and exacerbated its impact, particularly in low-income communities, communities of color, and for older Americans – populations that experience higher rates of chronic disease and have fewer resources to recover from an emergency. TFAH is one of numerous organizations within the public health community calling for an annual $4.5 billion investment in public health infrastructure at the state, local, tribal, and territorial levels.

This annual report examines federal, state, and local public health funding trends and recommends investments and policy actions to build a stronger public health system, prioritize prevention, and address the ways in which social and economic inequities create barriers to good health in many communities.

“As we navigate the next stages of the pandemic and beyond, it is critical that we modernize public health data infrastructure, grow and diversify the public health workforce, invest in health promotion and prevention programs, and reduce health inequities. Investments in public health are needed in every community but should particularly be directed to those communities, which due to the impacts of structural racism, poverty, systemic discrimination, and disinvestment are placed at greatest risk during a health emergency,” said Dr. Gracia.

Emergency funding is not sufficient to address system weaknesses created by chronic underfunding

State and local public health agencies managed two divergent realities during 2021. Short-term funding was up significantly as the federal government provided funding to states and localities in an effort to control the pandemic.  But this funding was one-time money and often specifically tied to COVID-19. Most of it could not be used to address longstanding deficits in the public health system, including ensuring the provision of basic public health services, replacing antiquated data systems, and growing the public health workforce. An October 2021 analysis conducted by the de Beaumont Foundation and the Public Health National Center for Innovations, found that state and local health departments need an 80 percent increase in the size of their workforce to be able to provide comprehensive public health services to their communities.

Another challenge for state and local health departments is that emergency response funding, while critical during the emergency, is too late to build prevention and preparedness programs, programs that must be in place before an emergency if they are going to protect lives. To be adequately prepared for the next public health emergency, the nation needs to sustain higher levels of public health funding and provide more flexible funding.

“Emergency funding is important but not sufficient to fill the longstanding gaps in public health investments. The ‘boom-and-bust’ cycle of public health funding has meant that the system does not have the tools or workforce to modernize and respond to the range of threats impacting our communities,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health.

Funding for two key emergency preparedness and response programs are down sharply over the past two decades:

  • The U.S. Centers for Disease Control and Prevention (CDC) is the country’s leading public health agency and the primary source of funding for state, local, tribal, and territorial health departments. CDC’s annual funding for Public Health Emergency Preparedness (PHEP) programs increased slightly between FY 2021 and FY 2022, from $840 million to $862 million, but has been reduced by just over one-fifth since FY 2002, or approximately in half when adjusted for inflation.
  • The Hospital Preparedness Program, administered by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response, is the primary source of federal funding to help healthcare systems prepare for emergencies. It has experienced a nearly two-thirds reduction over the last two decades when adjusted for inflation.

Funding for health promotion, prevention, and equity also need sustained growth

As a nation, we spent $4.1 trillion on health in 2020 but only 5.4 percent of that spending targeted public health and prevention. Notably, this share nearly doubled last year as compared to 2019 – due to short-term COVID-19 response funding – but is still grossly inadequate and likely to return to pre-pandemic levels if the historic pattern of surging funding for public health during an emergency but neglecting it at other times resumes.  Inadequate funding means that effective public health programs, such as those to prevent suicide, obesity, and environmental health threats, only reach a fraction of states. This longstanding neglect contributes to high rates of chronic disease and persistent health inequities.

Recommendations for policy actions

The report calls for policy action by the administration, Congress, and state and local officials within four areas:

Substantially increase core funding to strengthen public health infrastructure and grow the public health workforce, including increasing CDC’s base appropriation and modernizing the nation’s public health data and disease tracking systems.

Invest in the nation’s health security by increasing funding for public health emergency preparedness, including within the healthcare system, improving immunization infrastructure, and addressing the impacts of climate change.

Address health inequities and their impact on root causes of disease by addressing the social determinants of health that have an outsized impact on health outcomes.

Safeguard and improve health across the lifespan. Many programs that promote health and prevent the leading causes of disease, disability, and death have been long neglected and do not reach all states or the populations most at risk. Reinvigorating programs that stem chronic disease, support children and families, and prevent substance misuse and suicide should be a top priority.

Read the full report

 

 

Over Thirty-Five Health and Child Wellness Organizations Endorse the Improving Data Collection for Adverse Childhood Experiences Act

(Washington, DC – July 11, 2022) – Adverse Childhood Experiences (ACEs) can have long-lasting effects over the lifetime of an individual including negative health impacts. Research shows that the higher the number of ACEs an individual experiences the higher their risk for negative health outcomes like asthma, diabetes, cancer, substance use, and suicide in adulthood. The Centers for Disease Control and Prevention estimate that 61 percent of U.S. adults report having at least one ACE, and that the prevention of ACEs could reduce cases of depression in adults by 44 percent and avoid 1.9 million cases of heart disease.

The Improving Data Collection for ACEs Act is a bipartisan effort to enable the collection of more inclusive data about ACEs. It would support additional research on the impact of ACEs with a focus on understanding of the frequency and intensity of ACEs, the relationship between ACEs and negative health outcomes, and the influence of risk and protective factors.

For more information, contact Brandon Reavis, Senior Government Relations Manager at Trust for America’s Health, BReavis@tfah.org.

Public Health Leaders Discuss the Importance of Sustained Public Health Funding in the Post COVID-19 Landscape

Trust for America’s Health (TFAH) President & CEO J. Nadine Gracia, and Coalition for Health Funding’s (CHF) Executive Director Erin Will Morton issued the following statement regarding the June 22nd Beyond Emergency Funding: Sustaining Public Health Funding in the Post-COVID Landscape discussion.

(Washington, DC) — Trust for America’s Health and the Coalition for Health Funding are proud to have hosted the Beyond Emergency Funding: Sustaining Public Health Funding in the Post-COVID Landscape discussion on June 22, 2022. This discussion included three expert panelists; Dr. Gracia, Trust for America’s Health, Lisa Macon Harrison, MPH, Health Director, Granville Vance Public Health (North Carolina), and the current President of the National Association of County and City Health Officials, and Dr. Michael Fraser, Chief Executive Officer, the Association of State and Territorial Health Officials. CHF’s president, Mila Becker, moderated the event.

According to the panelists, the COVID-19 pandemic demonstrated a clear need for a well-funded, broad-based public health infrastructure and workforce at all levels. Our organizations urge lawmakers to increase annual funding to achieve these goals and create a sustainable, long-term funding strategy for public health beyond emergency supplemental funding.

The panelists emphasized the following issues during the session:

  • The public health system our country needs cannot be built on the boom-and-bust cycle of emergency funding.
  • The system needs long-term, flexible funding. Short term and inflexible funding lines for public health make investing in essential infrastructure, workforce, and cross-cutting approaches to prevention, including addressing the social determinants of health, impossible.
  • Public health emergency response is more expensive than funding core public health infrastructure. Billions of dollars spent in the years before the COVID-19 pandemic could have saved the trillions of dollars spent in response to the crisis and would have saved lives.
  • We must invest in the public health programs and workforce needed to prevent illness and injury. Doing so would decrease the amount of money now spent on treating preventable disease.
  • We must be nimbler and better prepared in order to save lives during the next public health emergency. Core public health services most in need of sustained investment are:
  • Modernized data systems that provide real-time data for decision-making.
  • Sustained funding for recruitment and retention of a larger and more diverse public health workforce.
  • Programs to achieve health equity – during the pandemic many health departments increased their engagement with community leaders and organizations. Those partnerships and networks should be sustained and grown.
  • We are approaching a COVID “funding cliff” – emergency funding has been spent or is expiring, but core public health services still need to be provided, particularly in those communities where health inequities were exacerbated by the pandemic.

Listen to the full session at: https://www.tfah.org/webinars-briefings/beyond-emergency-funding/

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About TFAH
Trust for America’s Health is a non-partisan public health policy, research and advocacy organization that envisions a nation that values the health and well-being of all and where prevention and health equity are foundational to policymaking at all levels of society.

About CHF
The Coalition for Health Funding works to preserve public health investments in the interest of all Americans. Our 81 member organizations together represent more than 100 million patients and consumers, health providers, professionals, and researchers. Coalition for Health Funding (publichealthfunding.org)

Trust for America’s Health (TFAH) Statement in Recognition of Juneteenth, 2022

Chair of the TFAH Board of Directors Gail Christopher, D.N. and President and CEO J. Nadine Gracia, M.D., MSCE released the following statement in recognition of Juneteenth, 2022

(Washington, DC – June 17, 2022) — “Juneteenth is a celebration of freedom. It’s also a day on which we should recognize that as a nation we have more work to do before all Americans are free from the burdens of social, economic, and health inequities.

Well over a century after the first Juneteenth, structural racism continues to have far-reaching impacts on health, well-being, and opportunity.

Our goal is to recommend policies that will advance the social, economic, and environmental conditions that promote health by ensuring equitable access to high-quality childcare, education, employment, safe and affordable housing, transportation, and healthcare for all Americans.”

Trust for America’s Health calls for the following policy actions to reverse the impact of structural racism in America:

  • Make advancing health equity and eliminating health disparities a national priority. This includes increasing funding for programs that advance healthy equity, such as the Centers for Disease Control and Prevention’s (CDC) Racial and Ethnic Approaches to Community Health and Healthy Tribes Programs.
  • Invest in multisector efforts to address upstream drivers of poor health through CDC’s Social Determinants of Health program.
  • Target the elimination of poverty by increasing the minimum wage and expanding the Earned Income Tax Credit at the national and state levels.
  • Increase access to high-quality healthcare for all by strengthening incentives to expand Medicaid in all states and by making marketplace coverage more affordable for low-and moderate-income people.
  • Create a national standard mandating job-protected paid family and medical leave for all employees.
  • Increase funding for programs that promote long-term security and good health for children and families, including programs designed to expand access to affordable housing, Head Start, Early Head Start, and nutrition support programs such as Healthy School Meals for All, the Supplemental Nutrition Assistance Program (SNAP), and the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC).

For more information about these and other policy recommendations see these TFAH reports:

A Blueprint for the 2021 Administration and Congress – The Promise of Good Health for All: Transforming Public Health in America.

Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity

Additional statement from the National Collaborative for Health Equity

The National Collaborative for Health Equity (NCHE) applauds the work of TFAH and supports these vital social policy actions. NCHE recognizes that we have to generate the public will for enacting and sustaining the needed policies. One vehicle for doing this is the Truth, Racial Healing, and Transformation (TRHT) work of communities across America. This work involves changing false narratives, building trusted relationships, as well as addressing the systemic and institutional legacies of the false ideology of the hierarchy of human value.

While the federal holiday, Juneteenth, enables us to celebrate the end of slavery, we must all remember that the beliefs that animated it for centuries lived on and continue to exist today. Racism must end.

Dr. Christopher is the Executive Director of the National Collaborative for Health Equity, in addition to her role as the TFAH Chair of the Board of Directors.

 

U.S. Experienced Highest Ever Combined Rates of Deaths Due to Alcohol, Drugs, and Suicide During the COVID-19 Pandemic

Deaths spanned ages, racial and ethnic groups, and geography but disproportionally harmed young people and people of color

Solutions are known and must be implemented

(Washington, DC – May 24, 2022) – Deaths associated with alcohol, drugs, and suicide took the lives of 186,763 Americans in 2020, a 20 percent one year increase in the combined death rate and the highest number of substance misuse deaths ever recorded for a single year, according to a report released today by Trust for America’s Health (TFAH) and Well Being Trust.  In addition, provisional data from the Centers for Disease Control and Prevention show drug overdose deaths continued to increase in 2021.

While alcohol, drug, and suicide deaths have been increasing for decades, the 2020 increase was unprecedented and driven by a 30 percent increase in the rate of drug-induced deaths and a 27 percent increase in the rate of alcohol-induced deaths.  Combined rates of alcohol, drug, and suicide deaths increased in all 50 states except New Hampshire, and for the first time two states – West Virginia and New Mexico – surpassed 100 deaths per 100,000 state residents from alcohol, drugs, and suicide combined in a single year.

  • The overall drug-induced death rate increased by 30 percent, largely driven by increases in deaths due to use of synthetic opioids and psychostimulants. The rate of drug-induced death rose for all but one population group – those over 75 years of age. There were particularly large increases in communities of color, among youth (17 years old and younger) and young adults (18-34 years of age) and in the South and West regions of the country.
  • Alcohol-induced death rates increased by 27 percent, and the increase spanned demographic groups and parts of the country, including in all 50 states and the District of Columbia. Increases were particularly high among young adults, American Indians/Alaska Native and Asian communities, and for those living in the Midwest.
  • Overall suicide rates declined by 3 percent but that trend was not universal. The decline occurred among white people but suicide deaths for the year increased among American Indian, Black, and Latino people. Suicide rates for adults ages 35-74, declined, but rates for youth and young adults increased.

“With the trends continuing to go in the wrong direction we must ask ourselves, what will it take to move to robust and comprehensive action? The story behind these data is beyond devastating and heartbreaking to those families who have suffered loss,” said Dr. Benjamin F. Miller, President, Well Being Trust. “Let’s begin to address this crisis with the urgency it deserves by bringing care to where people are. From schools to primary care to our workplaces, let’s ensure that all places are equipped to address mental health and substance misuse. This is not just the responsibility of the mental health and addiction field – but all our responsibility.”

TFAH and Well Being Trust have been reporting alcohol-induced, drug-induced and suicide deaths as part of their Pain in the Nation initiative since 2017.  In the initiative’s inaugural 2017 report, alcohol, drug and suicide deaths accounted for 55,403 deaths per year, as compared to the 186,763 deaths associated with alcohol, drugs or suicide in this year’s report. According to the report authors and other experts, the stunning increase in alcohol and drug deaths in 2020 was exacerbated by: a continued rise in synthetic opioid and psychostimulant overdoses and the anxiety, stress, grief, disruption to substance misuse recovery programs, and financial hardship many individuals and families experienced during the COVID-19 pandemic.

The report includes recommendations for steps the federal, state, and local governments should take to begin to reverse the deaths of despair crisis.  They include:

Invest in programs that promote health and prevent substance misuse and suicide:

  • Support in-school programs focused on students’ mental health and preventing substance use.
  • Strengthen trauma-informed and culturally competent and linguistically appropriate programs within all youth-serving agencies, including the juvenile justice system.
  • Strengthen the continuum of crisis intervention programs with a focus on the newly established “988” lifeline.
  • Expand CDC comprehensive suicide-prevention efforts, including measures to strengthen economic supports, promote connectedness, and create protective environments.
  • Build programs that address the social determinants of health and promote resilience in children, families and communities including those focused on the prevention of adverse childhood experiences.

Address the substance misuse and overdose crises:

  • Promote harm-reduction policies to reduce overdose and blood-borne infections, including increasing access to syringe service programs, naloxone, and fentanyl test strips.
  • Preserve and extend programs that create more flexible access to substance use disorder treatment during the pandemic.
  • Direct funding from the opioid litigation settlement to primary prevention of youth substance misuse.
  • Lower excessive alcohol use through policies that limit where and when alcohol can be served/purchased and by the use of alcohol excise taxes.

Transform the mental health and substance abuse prevention system

  • Increase access to mental health and substance use treatment through full enforcement of the Mental Health Parity and Addiction Equity Act.
  • Combat stigma about mental health issues and access to service.
  • Modernize physical and mental health services by aligning service delivery, provider payment, quality measures, and training toward the whole health of individuals and integrated care.
  • Build grassroots community capacity for early identification and intervention for individuals with mental health and substance use disorders, including through community-based or non-traditional settings.

“It is imperative that officials at every level of government act on the recommended policies in this report.  The data are shockingly clear – lives are at risk in every community due to alcohol, drugs, and suicide and communities that experience disadvantage because of long-standing social, economic and environmental inequities suffer a disproportionate impact. There is an urgent need for action in order to save lives,” said J. Nadine Gracia, M.D., MSCE, President and CEO of the Trust for America’s Health.

Read the full report

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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. 

Well Being Trust is an impact philanthropy dedicated to advancing the mental, social, and spiritual health of the nation.

TFAH Recognizes National Minority Health Month

Trust for America’s Health (TFAH) is proud to support National Minority Health Month (NMHM) 2022 and its critical focus on addressing health inequities. This year’s NMHM theme Give Your Community a Boost! notes the importance of ensuring that everyone eligible to receive the COVID-19 vaccine is vaccinated, including all eligible booster doses. Being vaccinated is the best way to protect yourself and your loved ones against severe illness from COVID-19.

“Ensuring that communities of color have equitable access to and reliable sources of information about the COVID-19 vaccine is vital to promoting and protecting the health and well-being of the community,” said TFAH President and CEO, Dr. J. Nadine Gracia. “People of color have been disproportionately impacted by the pandemic, due to longstanding social, economic, and health inequities that led to higher rates of job loss, less access to essential resources for remote learning, and higher rates of infections, hospitalizations, and deaths. We need to focus on two priorities: protecting everyone from COVID-19 now and ensuring that no community is at heightened risk during the next public health emergency. ”

Additional Readings:

TFAH’s 2020 policy brief Building Trust in and Access to a COVID-19 Vaccine Within Communities of Color and Tribal Nations reports on challenges to building vaccine trust and access in communities of color and tribal communities and recommends solutions.

TFAH’s 2022 Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism reports on state-level public health emergency readiness and the connection between health equity and emergency preparedness.

TFAH’s Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity recommends policy action that if adopted will address the social determinants of health that currently drive poor health in many communities.

Read more about TFAH’s policy recommendations to rebuild the nation’s public health system and invest in the social determinants of health and health equity in our Blueprint report: The Promise of Good Health for All: Transforming Public Health in America. A Blueprint for the 2021 Administration and Congress.