Issue Category: Health Equity/Social Determinants of Health

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.

TFAH Recognizes National Public Health Week, April 4 – 10, 2022

Trust for America’s Health is proud to participate in National Public Health Week and its 2022 theme “Public Health is Where You Are.”

Public health’s mission is to promote health and protect people from health risks, including diseases and natural or man-made disasters. Prevention and disease surveillance are central to that mission, as are population-level health interventions including addressing the social determinants of health. Public health practitioners work at the community level to ensure that everyone has an opportunity for optimal health. A critical premise of that work is engaging with and empowering communities, including identifying and addressing root causes of health inequities and barriers to good health.

The COVID-19 pandemic has illustrated the urgent need to grow the public health workforce and ensure that it has the tools it needs to fulfill its mission. TFAH and other public health leaders have called for an annual investment of $4.5 billion to support public health infrastructure and workforce. Much of what we spend as a nation on healthcare today is spent on preventable illness and injury. Rebuilding the public health system would help address health inequities,  would make the country better prepared for future health emergencies, and would improve health outcomes.

Additional Readings:

TFAH’s 2022 Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism report for more information on public health emergency readiness and the connection between health equity and emergency preparedness.

TFAH’s annual report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021 tracks the dearth of funding for public health and the impact that scarcity has had on the public health infrastructure, readiness, and workforce.

 

The Challenge of Vaccine Hesitancy Didn’t Start with COVID-19, and it Won’t End There

Will COVID-19 Vaccine Misinformation Lead to More Measles, Flu and Shingles?

Cecelia Thomas, JD

Just over one year has passed since the first availability of the COVID-19 vaccine. At this one-year mark 63 percent of U.S. adults are fully vaccinated. This ranks the United States as 60th in the world based on the percentage of fully vaccinated individuals. To say that these rates are troubling is an understatement. Even before the COVID-19 pandemic, the World Health Organization named vaccine hesitancy, the reluctance or refusal to vaccinate despite the availability of vaccines, as one of the top ten threats to global health. The consequences of this threat are tragically apparent with the deaths of mostly unvaccinated Americans. High levels of vaccine hesitancy have slowed the world’s ability to move past the pandemic and may be what’s allowed new variants of the virus to emerge.  Without addressing the root causes of vaccine hesitancy, more preventable infectious disease outbreaks will occur, and they will cost thousands of more lives in addition to further social and economic disruption.

Reasons for Vaccine Hesitancy
The problem of vaccine hesitancy did not start with COVID-19 and it likely won’t end there. In communities of color, vaccine hesitancy stems from long-standing health disparities and medical mistreatment . These deep and painful roots in this country’s history are exacerbated by the persistence of racial discrimination and bias in healthcare today and by practical barriers to vaccination such as health coverage limitations, inadequate transportation, and insufficient paid time off. While communities of color and low-income communities have had the most pervasive vaccine hesitancy historically, these groups are far from the only groups driving current vaccine hesitancy.

Efforts to rectify these past and present injustices should focus on cultural competence training for medical providers and community leaders on issues related to COVID-19 and routine vaccinations for children and adults. In addition, we need to improve vaccine accessibility and transparency. Other groups, other than populations that are systematically marginalized, such as white Evangelical Christians, have also expressed high rates of vaccine hesitancy before and throughout the pandemic. The politicization of public health that occurred during the last election intensified anti-vaccine sentiments, while social media and other platforms have allowed for the increased spread of misinformation.

Addressing Vaccine Hesitancy through Policy
Congress has recently passed legislation to fund fortified public health infrastructure to conduct and support widespread outreach, engagement, and vaccinations to communities across the nation. In addition, the COVID-19 Health Equity Task Force served as a forum for experts in the field to comprehensively address disparities in pandemic-related inequalities and develop solutions to issues such as vaccine accessibility and hesitancy. These are crucial steps at the federal level. States should follow suit with steps to bolster vaccination access and education.  Vaccine mandate bans are a step in the wrong direction and bad public policy.

Long-term Impacts of Vaccine Hesitancy
The U.S. also remains vulnerable to vaccine-preventable diseases such as flu, hepatitis B, pneumococcal, and shingles, due to under-vaccination. The threat of increased hesitance could further endanger people at higher risk for severe outcomes including older adults and people with underlying health conditions.  A year before the pandemic, the U.S. was in the midst of its worst measles outbreak in two decades and just narrowly preserved its measles elimination status.  The seasonal flu vaccine has also remained significantly underutilized in recent years. The lowest flu vaccination rate in recent years,  42% during the 2017-2018 flu season, contributed to 2017-2018 being the deadliest flu season in 40 years with 80,000 deaths. Despite this tragic reality check, the flu vaccination rate has yet to increase past 49% . If vaccination rates for diseases such as the seasonal flu do not improve, the combined burden of these infectious diseases will further strain the healthcare system and cause needless death and illness. There has also been a significant drop in routine vaccination rates across all ages due to the pandemic.  Adult vaccination rates are already far below Healthy People 2030 goals pre-pandemic and an estimated 26 million doses for adults and adolescents were missed in 2020.

Looking Forward
Congress, the Biden Administration and public health advocates must continue to work on immunization catch-up and support efforts to maintain high immunization coverage rates. These efforts are especially critical for the communities most impacted by COVID-19, such as communities of color and children. In October 2020, Trust for America’s Health co-hosted a national convening on building vaccine confidence and ensuring equitable access to the COVID-19 vaccine in communities of color, in partnership with the National Medical Association and UnidosUS. The policy recommendations of this report apply to other groups with growing rates of vaccine hesitancy, such as people who identify as politically conservative. Recommendations from the resulting policy brief also extend beyond the COVID-19 vaccine:

  • Expanding federal funding to support and strengthen national, state, local, Tribal and territorial work on equitable and effective vaccination planning, communications, distribution and administration, including funding to support vaccine distribution at the local level and by community-based organizations;
  • Collaborating with trusted community messengers/leaders for vaccine administration and education;
  • Creating culturally and linguistically appropriate vaccine education;
  • Ensuring zero out-of-pocket costs for individuals receiving recommended vaccines; and
  • Collecting complete disaggregated racial and ethnic data on adverse experiences in healthcare as well as health outcomes.

While these recommendations are most immediately applicable to the COVID-19 pandemic, they will also be important to increasing vaccine trust in the future.  These methods have already begun to work, vaccine hesitancy and racial gaps in vaccinations are beginning to slowly decrease. We must build on this momentum and prioritize increasing vaccine confidence across the U.S. to ensure that the nation is better prepared for future public health crises.

Cecelia Thomas, JD, is a Senior Government Relations Manager at Trust for America’s Health

 

New Report: Fewer States Placed in Top Performance Tier for Public Health Preparedness in 2021

COVID–19 Pandemic Continues to Illustrate the Critical Need to Invest in Public Health Infrastructure and the Social Determinants of Health

(Washington, DC – March 10, 2022) – As the nation enters its third year of the COVID-19 pandemic, a new report calls for urgent investment to create a public health system able to protect all Americans’ health during emergencies. The report, released today by Trust for America’s Health, measures states’ performance on 10 key emergency preparedness indicators and identifies gaps in states’ readiness to respond to emergencies. The report includes policy recommendations for strengthening the nation’s health security.

The report, Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, measures states’ degree of preparedness to respond to a wide spectrum of health emergencies and to provide ongoing public health services, including disease surveillance, seasonal flu vaccination, safe water, and expanded healthcare services during emergencies. It tiers states and the District of Columbia into three performance levels: high, middle, and low, placing 17 states and DC in the high-performance tier, 20 states in the middle performance tier, and 13 states in the low performance tier. The 2021 report placed, 20 states and the District of Columbia in the high-performance tier.

States’ Performance by Tiers

Performance Tier States Number of States
High Tier AL, CO, CT, DC, FL, IL, IA, KS, MD, MA, NJ, OH, PA, SC, UT, VA, VT, WA 17 states and DC
Middle Tier AZ, CA, DE, GA, ID, ME, MI, MO, MS, NE, NH, NM, NY, NC, ND, OK, RI, TN, TX, WI 20 states
Low Tier AK, AR, HI, IN, KY, LA, MN, MT, NV, OR, SD, WV, WY 13 states

 

This year’s report found that 12 states improved their performance while 16 states slipped in their ranking. All states’ performance is relative to that of other states.

Three states, Ohio, Pennsylvania and South Carolina, improved their performance by two tiers.

Nine states improved by one tier: Alabama, Arizona, Florida, Illinois, Iowa, Missouri, New Hampshire, New Jersey, and New York.

Sixteen states fell one tier: Delaware, Georgia, Idaho, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Montana, Nebraska, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, and Wisconsin.

In addition, the report found:

  • A majority of states had plans in place to expand healthcare and public health laboratory capabilities in an emergency.
  • Most states are accredited in the areas of public health, emergency management or both.
  • A large majority of Americans who receive their household water through a community water system had access to safe water.
  • Only about half of the U.S. population is served by a comprehensive local public health system.
  • Seasonal flu vaccination rates have risen significantly in recent years but are still lower than the goal set by Healthy People 2030.
  • Just over half of workers used some kind of paid time-off in a one-month sample. The need for paid time off has become particularly apparent during the pandemic, as many workers became ill or needed to care for a sick family member.
  • Only 28 percent of hospitals, on average, earned a top-quality patient safety grade during the year, down from 31 percent the year prior.

“The major takeaway of this report is that underinvestment in the nation’s public health system, and attacks on its authority, have had deadly consequences during the COVID-19 pandemic. Action and investment are urgently needed. This report’s findings can help federal and state officials identify gaps in public health preparedness and the steps needed to better protect lives and the economy during the next health emergency,” said J. Nadine Gracia, MSCE, President and CEO of Trust for America’s Health.

The report measured states’ performance during a year that presented intense demands on the nation’s public health system. In addition to the ongoing COVID-19 pandemic, 2021 saw record heat in many places, extensive flooding, wildfires throughout the Western U.S., a highly active hurricane season, and unusual and deadly December tornados in eight states. At the same time, hundreds of public health officials having experienced burn-out, threats to their safety, and attempts to limit their public health authorities have resigned, retired, or been fired.

While critical progress was made in fighting COVID-19 during 2021, particularly through the widespread availability of vaccines and a more coordinated federal response, the pandemic continued to illuminate the ways in which health inequities put communities of color and low-income communities at heightened risk for worse health outcomes during an emergency.

“Social, economic, and health inequities undermine a community’s ability to prepare for, respond to, and recover from a public health emergency. If we enter the next public health crisis with the same magnitude of health inequities in our communities as has been evident during this pandemic, the impact will be similar: preventable loss of life, disproportionate impact on communities of color and low-income communities, and widespread social and economic disruption.  It is impossible to separate strong public health emergency preparedness and health equity,” said Dr. Gracia.

Among the report’s policy recommendations:

  • Congress and states should provide stable, flexible, and sufficient funding for public health, including for infrastructure, data systems, and the public health workforce.
  • Congress should create a COVID-19 Commission to review and address gaps in the pandemic response, and leaders at all levels of government should reject attempts to weaken public health authorities.
  • Policymakers should take steps to prevent disease outbreaks by investing in vaccination infrastructure, antibiotic resistance programs, and by providing paid leave for all workers.
  • Congress should create programs to help build resilient communities by investing in health equity and the social determinants of health, including anti-poverty programs and programs that build financial security for families.
  • Congress should invest in the development and distribution of medical countermeasures to enable rapid development and effective deployment of life-saving products during emergencies and federal and state policymakers and healthcare systems leaders should work together to prioritize effective coordination and communication during emergencies.
  • The White House, Congress, and states should develop plans and provide funding to minimize the health impacts of climate change and do so in ways that address health equity.

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

Nuevo Reporte: Pocos estados han clasificaron en el nivel de rendimiento superior de la preparación de salud pública en el 2021

La pandemia de COVID-19 continúa ilustrando la necesidad crítica de invertir en la infraestructura de la salud pública y los factores sociales determinantes de la salud

 

(Washington, DC – 10 de marzo del 2022) – A medida que la nación atraviesa su tercer año de pandemia del COVID-19, un nuevo informe demuestra la necesidad de una inversión urgente para crear una infraestructura de salud pública capaz de proteger la salud de todos los estadounidenses durante emergencias. El informe, publicado hoy por Trust for America’s Health, mide el desempeño de los estados basado en 10 indicadores claves de preparación para emergencias e identifica diferencias considerables en la preparación de los estados para responder durante emergencias. El informe incluye recomendaciones de políticas públicas para fortalecer la seguridad sanitaria de la nación.

El informe Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism (Protegiendo la Salud Pública de Enfermedades, Desastres y Bioterrorismo), mide el grado de preparación de los estados para responder a un amplio número de emergencias de salud, ofreciendo continuos servicios de salud pública, incluyendo vigilancia sanitaria,  vacunación contra la influenza estacional, agua potable entre otros servicios de salud ampliados durante emergencias. El reporte clasifica los estados y el Distrito de Columbia en tres niveles de rendimiento: alto, medio y bajo, colocando 17 estados y DC en el nivel de alto rendimiento, 20 estados en el nivel de rendimiento medio y 13 estados en el nivel de bajo rendimiento. Durante el 2020, 20 estados y el Distrito de Columbia se ubicaron en el nivel de alto rendimiento.

Gráfico de niveles de rendimiento de los estados (2021) AQUÍ (manuscrito tabla 2 – página 10)

 

Este año el reporte indicó que 12 estados mejoraron su clasificación de desempeño, mientras que 16 estados descendieron en su clasificación. Las clasificaciones de todos los estados son relativas a las de otros estados.

Tres estados, Ohio, Pensilvania y Carolina del Sur mejoraron su desempeño en dos niveles.

Nueve estados mejoraron en un nivel: Alabama, Arizona, Florida, Illinois, Iowa, Missouri, New Hampshire, New Jersey y New York.

Dieciséis estados bajaron un nivel: Delaware, Georgia, Idaho, Kentucky, Luisiana, Maine, Minnesota, Mississippi, Montana, Nebraska, Nuevo México, Carolina del Norte, Oklahoma, Oregón, Rhode Island y Wisconsin.

Además, el informe demostró:

  • La mayoría de los estados tenían planes para expandir la asistencia médica y la salud publica mejorando sus capacidades de laboratorios en las emergencias.
  • La mayoría de los estados están acreditados en las áreas de salud pública, manejo de emergencias o ambas.
  • Una gran mayoría de estadounidenses que reciben agua para su hogar a través de un sistema de agua comunitario tenían acceso a agua segura.
  • Solo alrededor de la mitad de la población de los EE. UU. cuenta con un sistema integral de salud pública local.
  • Las tasas de vacunación contra la gripe estacional han aumentado significativamente en los últimos años, pero siguen siendo inferiores a la meta establecida por Healthy People 2030.
  • Poco más de la mitad de los trabajadores utilizaron algún tipo de tiempo libre remunerado. La necesidad de tiempo libre remunerado se ha vuelto particularmente necesario durante la pandemia, ya que muchos trabajadores se enfermaron o tuvieron que cuidar a un familiar enfermo.
  • En promedio, sólo el 28 por ciento de los hospitales obtuvo una calificación de máxima calidad de seguridad por parte del paciente durante el año, comparado a un 31 por ciento registrado el año anterior.

“La conclusión principal de este informe es que la inversión es insuficiente en el sistema de salud pública de la nación y los ataques a su autoridad han tenido consecuencias mortales durante la pandemia del COVID-19. Se necesitan acciones e inversiones con urgencia. Los hallazgos de este reporte pueden ayudar a funcionarios federales y estatales a identificar las deficiencias en la preparación de la salud pública y los pasos necesarios para proteger vidas de una manera más eficiente y lograr una mejor economía durante una próxima emergencia de salud”, dijo J. Nadine Gracia, MSCE, presidenta y directora ejecutiva de Trust for America’s Health.

El informe midió el desempeño de los estados durante un año que presentó altas demandas en el sistema de salud pública de la nación. Además de considerarnos en medio de la pandemia del COVID-19,  se debe tomar en cuenta que en el 2021 se registraron altas temperaturas récord de calor en muchos lugares, y como consecuencia hubo inundaciones extensas, incendios forestales en todo el oeste de los EE. UU., una temporada de huracanes muy activa y tornados inusuales y mortales en diciembre en ocho estados. Al mismo tiempo, cientos de funcionarios de salud pública experimentaron agotamiento, amenazas a su seguridad e intentos de limitar sus autoridades de salud pública, los cuales renunciaron, se jubilaron o fueron despedidos.

Es cierto que se logró un progreso crítico en la lucha contra el COVID-19 durante 2021, particularmente a través de la disponibilidad generalizada de vacunas y una respuesta federal más coordinada, pero es un hecho que la pandemia resaltó las formas en que las desigualdades en salud ponen a las comunidades de color y de bajos ingresos en mayor riesgo y peores resultados de salud durante una emergencia.

“Las desigualdades sociales, económicas y de salud debilitan la capacidad de una comunidad para prepararse, responder y recuperarse de una emergencia de salud pública. Si entramos en la próxima crisis de salud pública con la misma magnitud de inequidades en temas de salud pública en nuestras comunidades como ha sido evidenciado durante esta pandemia, el impacto será similar:  evitar la pérdida de vidas, el impacto desproporcionado en comunidades de color y comunidades de bajos ingresos, y las perturbaciones sociales y económicas generalizadas. Es imposible separar una sólida preparación para emergencias de salud pública y la equidad en salud”, dijo la Dra. Gracia.

Entre las recomendaciones del informe, se detacan:

  • El Congreso y los estados deben proporcionar fondos estables, flexibles y suficientes para la salud pública, incluida la infraestructura, los sistemas de datos y la fuerza laboral de salud pública.
  • El Congreso debe crear una Comisión COVID-19 para revisar y abordar las brechas en la respuesta a la pandemia, y los líderes en todos los niveles del gobierno deben rechazar los intentos de debilitar a las autoridades de salud pública.
  • Los legisladores deben tomar medidas para prevenir brotes de enfermedades invirtiendo en infraestructura de vacunación, programas de resistencia a los antibióticos y otorgando licencias pagadas a todos los trabajadores.
  • El Congreso debe crear programas para ayudar a construir comunidades resilientes invirtiendo en la equidad en la salud y los determinantes sociales de la salud, incluidos los programas antipobreza y los programas que generan seguridad financiera para las familias.
  • El Congreso debe invertir en el desarrollo y trabajar en medidas medicas de protección para permitir el desarrollo rápido y el despliegue efectivo de productos que salvan vidas durante emergencias, y los legisladores federales y estatales y los líderes de los sistemas de atención médica deben trabajar juntos para priorizar la coordinación y la comunicación efectivas durante las emergencias.
  • La Casa Blanca, el Congreso y los estados deben desarrollar planes y proporcionar fondos para minimizar los impactos del cambio climático en la salud y hacerlo de manera que aborde la equidad en el sistema de salud publica.

Trust for America’s Health es una organización no partidista y sin fines de lucro que promueve la salud óptima para cada persona y comunidad y hace de la prevención de enfermedades y lesiones una prioridad nacional.  Twitter: @HealthyAmerica1

Black History Month 2022: Policy Action to Support Black Health and Wellness

February 2022

A person’s health is impacted by a myriad of social and economic conditions in which they are born, live, work and age.  The availability of safe and affordable housing, education and employment opportunities, food security, and access to quality healthcare all influence a person’s opportunity for good health. But these factors are not equally available to all Americans.

This Black History Month, TFAH calls for an end to the systemic and structural racism that continue to prevent Black Americans from achieving optimal health.

Structural racism is a predominant driver of health inequities – inequities that, on average, lead to more chronic disease, less access to healthcare, higher rates of infant and maternal mortality, and shorter life expectancy for Black people and other people of color as compared to whites. This increased risk for poorer health outcomes persists when controlling for socioeconomic status.

TFAH offers the following policy recommendations to advance health equity:

  • Make advancing health equity and eliminating health disparities a national priority. Such a priority requires ending systemic barriers and advancing policies and programs that create equitable opportunity for health and well-being.
  • Strengthen public health’s capacity to address health inequities, including modernizing public health data systems to better track health disparities, strengthening workforce training and recruitment from diverse communities, and investing in health equity expertise at health departments.
  • Target the elimination of poverty by increasing the minimum wage and expanding the Earned Income Tax Credit at the national and state levels.
  • Increase funding for programs that address health inequities, such as the Centers for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health (REACH) program.
  • 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 and 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 policy actions to improve health outcomes in communities of color, see these TFAH reports and webinars:

Issue Backgrounder

Reports

Webinars

Trust for America’s Health Statement in Recognition of Martin Luther King, Jr. Day and the National Day of Racial Healing, 2022

Trust for America’s Health’s (TFAH) Board Chair, Gail Christopher, D.N., and President and CEO, J. Nadine Gracia, M.D., MSCE, released the following statement in honor of Martin Luther King, Jr. Day and the National Day of Racial Healing.

(Washington, D.C. – January 17, 2022)

“Today’s observation of Martin Luther King, Jr. Day and tomorrow’s National Day of Racial Healing is a time to take action on the work that needs to be done to end racism, heal the impacts of centuries of racial injustice, and promote equity for all people.

Structural racism has far-reaching impacts on people’s health, education, employment and economic opportunities, access to safe and affordable housing, access to transportation, access to high quality healthcare, and their treatment within the criminal justice system.

Our goal is to advance policies and actions that will create meaningful change, including addressing social inequities and promoting racial healing. Dismantling racism is a public health imperative. The disproportionate impact of the COVID-19 pandemic within communities of color is the most current example of the ways in which structural racism continues to have consequential and often tragic impacts on people’s lives.

TFAH is committed to continuing its work to advocate for policies that overcome the impacts of racism and advance health equity. Meaningful change will require racial healing which will in turn necessitate acknowledging the historic and contemporary impacts of racism, reframing the narrative, and building relationships across communities.”

TFAH calls for the following actions to reverse the impact of structural racism in America:

  • Make advancing health equity and eliminating health disparities a national priority. Such a priority requires ending systemic barriers and advancing policies and programs that create equitable opportunity for health and well-being.
  • Target the elimination of poverty by increasing the minimum wage and expanding the Earned Income Tax Credit at the national and state levels.
  • Increase funding for programs that address health inequities, such as the Centers for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health (REACH) and Good Health and Wellness in Indian Country programs.
  • Recruit and sustain a diverse public health workforce through public health workforce loan repayment and support the hiring of public health equity experts through investments in public health infrastructure and workforce.
  • 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 and 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).
  • Funding agencies should meaningfully engage with historically underserved communities to best understand their needs and work with community leaders to co-lead teams that establish, lead, and evaluate programs.
  • Federal and state governments should act to protect voting rights for all.

For more information about these and other policy recommendations see TFAH reports A Blueprint for the 2021 Administration and Congress – The Promise of Good Health for All: Transforming Public Health in America. And Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity

 

 

Next Iteration of the Build Back Better Act Should Include Critical Investments in Public Health, Emergency Preparedness, and the Social Determinants of Health

(January 10, 2022) — As the 117th Congress begins its work in 2022, it is critical that it seeks to bolster the nation’s public health system and address longstanding inequities that have been exacerbated by the COVID-19 pandemic. As the country continues to grapple with the health and economic impacts of COVID-19, Congress has the opportunity to make urgent investments in core public health infrastructure, to modernize national, state and local public health laboratory systems, and to direct much needed resources to address current and longstanding public health challenges. As Congress considers the next steps for the Build Back Better Act, TFAH recommends that the following policies be prioritized as negotiations move forward:

  • Investing in chronically underfunded public health infrastructure to address the COVID-19 pandemic and ensure that public health is better equipped to effectively respond to future health threats. The pandemic exposed the impact of outdated, understaffed health departments. The Build Back Better Act includes $8.4 billion in funding to enable health departments to address longstanding infrastructure and workforce gaps and modernize public health data systems and laboratories across the country. TFAH recommends an additional $4.5 billion annual investment to support and sustain federal, state, local, territorial, and Tribal foundational public health capabilities.
  • Expanding availability of nutritious foods to ensure children, regardless of their socioeconomic status, can access high-quality, nutritious meals when school is in session and during school closures. The Build Back Better Act includes provisions to expand the Community Eligibility Program (CEP), invest in a Summer Electronic Benefits Transfer (EBT) program, and establish a Healthy Food Incentives Demonstration to support schools in developing healthy food offerings. TFAH also recommends extending Healthy School Meals for All, which provides students access to school meals at no charge regardless of their family income as a step to ending child hunger and ensuring access to healthy foods.
  • Increasing access to life-saving behavioral health programs. The Build Back Better Act includes $2.5 billion in funding to support public health approaches to reduce community violence and trauma, $75 million to support the infrastructure of the National Suicide Prevention Lifeline, and $15 million to support the Substance Abuse and Mental Health Services Administration’s Project Aware program, which helps schools promote the mental health of their students. TFAH recommends focusing on primary prevention of behavioral health concerns, including through suicide and Adverse Childhood Experiences prevention and increasing investments in social-emotional learning and wellness in schools.
  • Investing in early childhood education and services to ensure families have access to high-quality childcare and early education. The Build Back Better Act includes $400 billion to establish a birth-through-five childcare and early learning entitlement program, bolster Head Start, create a universal preschool program, and significantly strengthen the early childhood education workforce through training and increased pay.
  • Establishing a comprehensive paid family and medical leave policy to ensure workers can take time off to address health or caregiving needs. The Build Back Better Act includes provisions that grew out of the FAMILY Act and would provide up to 12 weeks of partial income while employees take family or medical leave. Access to paid family and medical leave can help control disease outbreaks, improve parental and child health, and contribute to a healthier, more productive workforce.
  • Increasing access to safe and affordable housing to address housing insecurity amongst low-income families. Stable and healthy housing is a significant social determinant of health. The Build Back Better Act includes $24 billion for new Housing Choice Vouchers and supportive services, $5 billion to address lead paint and other health hazards, $15 billion to support the preservation and creation of rental homes for low-income households, and $500 million to expand the supply of affordable housing with supportive services for older adults.

Trust for America’s Health Applauds the Bipartisan Policy Center Report Public Health Forward: Modernizing the U.S. Public Health System

Sustained Investment in the nation’s public health system is critical to safeguarding the nation’s health security and achieving health equity

(Washington, DC – December 2, 2021) – Trust for America’s Health (TFAH) applauds and strongly endorses the Bipartisan Policy Center (BPC) report, Public Health Forward: Modernizing the U.S. Public Health System, released today. The report describes the ways COVID-19 exposed weaknesses in the nation’s public health system and pervasive disparities in conditions that affect Americans’ health. It outlines a five-year vision and actionable framework for how state, territorial and local elected and public health officials can enhance their jurisdiction’s public health infrastructure. TFAH’s President and CEO J. Nadine Gracia, M.D., MSCE and Distinguished Visiting Fellow David Fleming, M.D. served on the report’s Public Health Advisory Group.

The infusion of pandemic relief funds is an opportunity to address the community conditions that negatively impact health, according to the report.  And public health has a critical role to play by addressing health inequities, working to reverse the surge in the number of Americans living with a chronic disease, promoting healthy eating and active living, controlling infectious disease, and preventing injuries.

“BPC’s report is critical reading for policymakers. It provides a roadmap for the public health system our nation’s needs to protect everyone’s health, including communities currently at disproportionate risk due to systemic inequities,” said J. Nadine Gracia, President and CEO of Trust for America’s Health. “The report should guide immediate and sustained investment in public health.”

Many of the report’s policy recommendations align with recent Trust for America’s Health recommendations. Both BPC and TFAH are calling for the following:

  • Increase and sustain predictable and flexible public health funding. TFAH recommends an annual $4.5 billion public health infrastructure fund to support foundational public health capabilities at the federal, state, local, territorial and Tribal levels.
  • Invest in programs to address health inequities, including the root causes of disease and the impact of the social determinants of health.
  • Strengthen public health data collection and sharing. Data should be collected and disaggregated by race, ethnicity and other sociodemographic characteristics so the impacts of policies, interventions and health conditions on specific population and sub-populations groups are known.
  • Invest in the recruitment and retention of a diverse, well-trained public health workforce.
  • Protect public health departments’ ability to make science-based decisions free from inappropriate political influence.

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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.

 

New Data Underscores Impact of COVID-19 Pandemic on Americans’ Mental Health, Substance Use, and Suicide

December 2021

The impact of the COVID-19 pandemic on Americans’ physical health and economic security is evident. New data shows other significant impacts, like disruption of mental and behavioral healthcare, continued alarming increases in drug overdoses, more suicide attempts among adolescents, and divergent trends in suicide rates.

In May of 2021 TFAH and Well Being Trust’s Pain in the Nation report  described emerging data on many of COVID-19’s direct and indirect effects related to mental health and substance use, including more calls to crisis lines, worse reported mental health, more substance use, and higher rates of drug overdoses. Additional data and studies released in 2021 show a more complete picture of the effects of the pandemic on mental and behavioral healthcare, drug overdoses, and suicidal behaviors. Here’s what we’ve learned from four new studies:


Reduced utilization of mental and behavioral healthcare in 2020
A February 2021 report from Milliman examined utilization patterns for mental health and substance use healthcare for 12.5 million Americans with health coverage from private health plans, Medicaid, and Medicare between January 2019 and August 2020. The authors found that in-person mental and substance use services declined substantially in early 2020 at the beginning of the pandemic. This includes decreases in inpatient admissions, emergency services, primary care visits, and specialty care visits for mental and behavioral healthcare. The largest declines were in-person primary care and specialty care visits in April, May, and June 2020—these visits declined 75 percent for individuals with private health coverage. In June 2020, utilization began to increase until it reached or surpassed 2019 levels by the end of the summer.

The report also looked at telehealth visits, which increased dramatically in March and April, particularly for individuals with private plans and Medicare. In prior years, 1 percent or less of mental or behavioral healthcare visits were via telehealth, while it exceeded 75 percent for private plan enrollees and 50 percent for Medicare enrollees at the peak. For Medicaid enrollees, the uptake was much lower—peaking at 28 percent for Medicaid enrollees—pointing to limitations of telehealth to reach all patients.

Continued increase in drug overdoses in 2020–2021
Provisional data from the CDC shows a rapid escalation in drug overdose deaths since the beginning of 2020 after several years of relatively flat death rates. The most recent data released—for the 12-month period May 2020­–April 2021—shows 97,990 provisional drug overdose deaths. In comparison, a year prior (May 2019–April 2020), had 77,007 provisional drug overdose deaths and two years prior (May 2018–April 2019), had 67,736 provisional drug overdose deaths. The increases were nearly universal across states with just three states (New Hampshire, New Jersey, and South Dakota) seeing decreases, and several states (Kentucky, Louisiana, Tennessee, Vermont, West Virginia) having staggering increases of more than 50 percent.

 

More suicide attempts among adolescents during the pandemic
A CDC study from June 2021 compared the number of emergency department visits for suspected suicide attempts for 12–17-year-olds before and during the pandemic. The study found that in May 2020, suspected suicide attempts among adolescents began to increase, particularly among girls, and remained higher through 2021. During the weeks of February 21–March 20, 2021, suspected suicide attempts were 51 percent higher among girls aged 12–17 years than during the same period in 2019; among boys aged 12–17 years, suspected suicide attempts increased 4 percent.

 

Suicide trends diverge by population groups in 2020
The National Center for Health Statistics released a report using provisional mortality data to examine suicide trends in 2020 in November 2021. The topline trend shows a drop in the overall suicide rate from 13.9 deaths per 100,000 in 2019 to 13.5 deaths per 100,000 in 2020. This includes a notable drop in suicides in April 2020, at the beginning of the pandemic. For the year 2020, suicide rates declined across many groups including for females of all race/ethnicities, middle age adults (aged 35-64), whites, and Asians. There are several major exceptions to this trend: younger Americans (aged 10-34) saw increases in suicide rates between 2019 and 2020— including a statically significant increase among young adults aged 25–34 years old— and likewise American Indian/Alaska Native, Black, and Hispanic males saw increases in suicide rates between 2019 and 2020—including a statistically significant increase for Hispanic males. These divergent trends by age, sex, and race/ethnicity highlight the importance of collecting demographic information and analyzing trends among populations in order understand the different outcomes and experiences, and how best to focus resources and policy responses towards those in need.


Policy action is needed
These new studies underscore the need for urgent action, or risk an increase in deaths from alcohol, drugs, and suicide — already on a grim trajectory—in the coming years.

“The pandemic has created new stressors, and worsened the substance use and mental health crises in our country. We need to focus on how we can better support individuals with emergent crises, mental health conditions, and substance use disorders now, as well as look ahead and invest in policies that promote good health, well-being, equity, and resilience for everyone,” said J. Nadine Gracia, President and CEO Trust for America’s Health.

Specifically, we need to make progress in three priority areas:

Invest in Prevention and Conditions that Promote Health

  • Reduce traumatic experiences, and promote resilience in children, families, and communities. Programs that promote economic security, such as a living wage, and create affordable housing help strengthen families and reduce traumatic experiences in childhood.
  • Expand substance use prevention, mental health, and resiliency programs and staff in schools.
  • Bolster crisis-intervention programs and supports.
  • Reduce availability of illicit opioids and inappropriate prescriptions.
  • Lower excessive alcohol use through evidence-based policies such as increasing pricing, reducing sales hours and enforcing underage drinking laws.
  • Limit access to lethal means of suicide, including drugs and firearms.

Address the Worsening Drug Use and Overdose Crisis

  • Implement policies targeting psychostimulant use.
  • Promote harm-reduction policies to reduce overdose and blood-borne infections.
  • Continue pandemic-related enhanced flexibilities in access to and rules for substance-use treatment.
  • Address the secondary impact of the substance use and overdoses on children.

Transform the Mental Health and Substance Use Prevention System

  • Expand efforts to combat stigma and improve social attitudes toward mental health.
  • Improve data accuracy, completeness, and timeliness through innovation and additional funding.
  • Increase access to mental health and substance use healthcare through full enforcement of the Mental Health Parity and Addiction Equity Act.
  • Expand the mental health and substance use treatment workforce.
  • Build community capacity for early identification and intervention for individuals with mental health needs.
  • Promote diversity and culturally appropriate care in the healthcare system and adopt trauma-informed and culturally competent practices in youth-services programs.

For more details on these policies, see the solutions and recommendations section in the latest Pain in the Nation report.