Prevention and Public Health Policy Archives - Page 14 of 19

Lansing’s Efforts to Prevent and Respond to Childhood Lead Exposure

“We started asking about lead, and what is the safe level of lead, and there isn’t one, especially for kids. So we said the prudent thing to do is to improve the testing and start getting these lead pipes out. Get the lead out.”

Virgil Bernero, Mayor of Lansing

Background

In 2004, then-Michigan State Senator Virg Bernero encouraged local officials to work with Lansing Board of Water and Light (BWL) Commissioners to speed up the removal of lead service lines (LSLs). The BWL, a municipally-owned utility, funded the program as an infrastructure investment, and utility customers shared the cost through an increase in their water rates. BWL gave priority to lines serving schools and licensed day care facilities, areas where children had elevated blood lead levels, households with pregnant women or children under age 6, and other places with high concentrations of LSLs.

From 2004 to 2016, Lansing, Michigan, replaced 12,150 LSLs with copper lines, becoming only the second city in the country to remove all its active lead service lines. The total cost was $44.5 million.

Lead Service Line Replacement

BWL has developed a faster, more efficient way to replace pipes; what had been a nearly 8-hour job, $9,000 job requiring a trench to be dug from the main in the street to the foundation of the house, has been streamlined to 4 hours at a cost of $3,600. Instead of trenching, BWL now digs a hole in the street and another where the shut-off valve is, pulls the old pipe out from underground and slides in the new one.

Additionally, where possible, the lead service line replacement program has followed planned street, sewer, and other infrastructure improvement projects to minimize street closures and reduce the cost of street reconstruction.

Service line replacements were scheduled to prioritize replacing any lead service lines serving schools and licensed day care centers, areas having children with elevated blood lead levels, households with pregnant women or children under age six, and other areas with large concentrations of lead service lines.

The lead service line replacement program engages customers through outreach (distribution of brochures and articles in bills, open houses at schools and community centers, and information inserted in routine water quality reports).

BWL water quality reports indicate a decrease in lead levels in the water over 10 years, from 2005 to 2015, with 90 percent of homes at or below 7.8 parts per billion in 2015 (down from 11.3 parts per billion in 2005). Although the BWL completed its lead service line replacement program, it will continue its corrosion control process.

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

Omaha’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

Lead is a significant environmental health hazard to children in Omaha, home to the nation’s largest residential U.S. Environmental Protection Agency (EPA) Superfund site– a program that provides resources to address lead contamination in soil caused by an old refinery. In 1998, after it was revealed that nearly 10 percent of the children tested in Douglas County had blood lead levels higher than 10 µg/dL, the Omaha City Council requested assistance from the EPA. In 2003, Omaha was added to the Superfund National Priorities List, with approximately 14 square miles of residential property in East Omaha considered at high risk.

Superfund

In 1998, when the Omaha City Council requested EPA assistance to address the high frequency of children in eastern Omaha found by the Douglas County Health Department to have elevated blood lead levels, the EPA began investigating the lead contamination in the Omaha areas under the authority of the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), also known as the Superfund law.

After blood tests revealed elevated lead levels in nearly 600 children, the EPA formed the Omaha Lead Superfund Site in 1999, which has become the largest residential lead remediation in the country. Cleanup of residential properties included testing a wide array of soil in places like child care facilities, schools, playgrounds, parks, and homes; removal and replacement of contaminated soil; and planting new sod and grass seed.

The Douglas County Health Department Childhood Lead Poisoning Prevention Program offers free inspections to families in Douglas County living in pre-1978 housing where children under seven-years-old live and play. Families with children who have been found to have elevated blood lead levels are given top priority. They also administer an EPA-funded interior dust program where residents who have had their soil remediated can receive education and a free HEPA vacuum.

EPA’s work is ending after it completed testing soil samples from 40,000 properties and cleaned up more than 12,000 properties that were contaminated with lead; however, the work of lead remediation will continue in partnership with the city. In May 2015, the EPA awarded $40 million to the City of Omaha through a cooperative agreement to address the final phases of the work, including ongoing attempts to collect soil samples and clean up the remaining properties. The rationale is that the owners of remaining properties will feel more at ease working with the city than with the federal government.

Updated Nuisance Ordinance

In December 2010, the Omaha City Council amended the “nuisance” chapter of the Omaha Municipal Code, adding lead-based paint to the list of specific examples of situations declared to be nuisances. Under the revised law, lead-based paint or other lead-based coating materials (such as liquid coatings on furniture) is a hazard and a “nuisance” on the interior or exterior of a home when it is accessible, or may become accessible, to ingestion or inhalation.

Once notified of a lead-based paint “nuisance,” a designated city officer and/or health director of the health department gives written “notice to abate” to the property owner and/or occupant or to the person causing the nuisance. If the person ordered to remove the hazard neither requests a hearing nor abates it within the specified time, the city will take care of it and bill the responsible party. In addition, that person may be fined up to $500 and/or imprisoned for up to six months for each day the nuisance remains.

Lead Hazard Control Program

A HUD-funded initiative, the City of Omaha Lead Hazard Control program, repairs interior lead-based paint hazards, including window and door replacement and paint stabilization, in homes occupied by children under age 7 within the boundaries of the Superfund site. The Omaha Healthy Kids Alliance (OHKA) works in tandem with this program to address additional environmental hazards and structural concerns, to provide education and referrals, and to monitor the program’s impact on health and track data.

OHKA is a nonprofit children’s environmental health organization working to improve children’s health through their Healthy Homes initiative. OHKA evaluates residences for health, safety, and environmental risks, works with families to create individual plans for a healthy home environment, and advocates for policies and best practices that promote health and protect children. It assists clients by delivering supplies, repairing houses, and referring them to community partners.

Grassroots Latino Environmental Education Program

OHKA partnered with the University of Nebraska Medical Center’s College of Public Health, Omaha community-based organizations, and the EPA in 2014 to launch the Grassroots Latino Environmental Education (GLEE) program. GLEE’s goal is to make information about environmental hazards more easily available in Spanish. Understanding that promotoras – community health workers – are effective at disseminating information to the Latino population, it was important to teach them about the connections between a person’s personal health and the environment in which they live. Through GLEE, OHKA trained more than 40 promotoras who educated over 1,000 Spanish-speaking Omaha residents in two years.

Lead Education Action Program

In 2016, OHKA received 6 years of funding from the EPA and the City of Omaha for the Lead Education Action Program (LEAP). The goal of the $5.4 million LEAP program is to support the City’s efforts to take over the Superfund cleanup activities, to educate the community about lead and healthy homes, and to direct residents to use the Omaha Lead Registry website, which is kept up-to-date with new information provided by government agencies, community groups, and private citizens.

One LEAP’s key initiatives is the Lead Free in Five campaign. Launched in October of 2016, with a convening of over 100 community leaders, the campaign aims to address childhood lead poisoning in Omaha through a community-wide strategy of policies, education, and infrastructure.
Results

In 2012, the Douglas County Health Department reported 119 children had tested positive for elevated blood lead levels, compared to 451 children in 1998. Not only were more children tested (17,294) in 2012 than had been previously but only 0.5 percent of the children showed blood lead levels higher than 9.5 µg/dL, a marked decrease from 13 percent in 1998. As of June 2013, fewer than two percent of eastern Omaha children tested showed elevated lead levels, compared to 33 percent before the Superfund cleanup.

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The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

New York State’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

Although rates of childhood lead poisoning in New York have steadily declined since 1998, childhood lead poisoning remains a significant public health problem, where rates outside of New York City remain above national averages. New York State also consistently ranks high on key risk factors associated with lead poisoning, including many young children living in poverty, a large immigrant population, and an older, deteriorated housing stock.

Since 1993, New York State’s lead poisoning regulations have included a Notice and Demand (N&D) component that requires property owners to address lead hazards to prevent exposure. After inspecting a unit for lead-based paint hazards (including deteriorated lead paint and contaminated dust and bare soil), the local health department can issue a written N&D, which outlines the lead-based hazards present and requires owners to submit a corrective work plan within a fixed number of days. The Commissioner of Health or a designated representative determines the location and methods of controlling the hazards. Property owners are responsible for complying with federal, state, and local laws governing building construction, housing, worker health and safety, and disposal of lead-containing wastes and must provide documentation showing their compliance upon request. Individuals who fail to remedy issues within the specified time frame may face fines or prosecution.

Primary Prevention Program

The state-funded New York State Childhood Lead Poisoning Primary Prevention Program (NYS CLPPPP) was established in 2007 (under New York State Public Health Law1370-a [3]) to combat New York’s high rates of childhood lead poisoning through primary, rather than secondary, prevention methods.

Unlike most other existing lead programs, the NYS CLPPPP takes action to reduce lead hazards in housing units before a child’s blood lead-level exceeds federal standards. Under the program, local health departments receive funds to find and correct lead hazards in homes where children could be at risk. The New York State Department of Health (NYSDOH) is responsible for:

Coordinating with local health departments to implement the NYS CLPPPP and identifying housing at greatest risk of lead-based paint hazards;
developing partnerships and engaging with communities to promote primary prevention;
Promoting interventions to create lead-safe housing units;
Building workforce capacity to implement lead-safe work practices; and
Identifying community resources for lead-hazard control.

The New York State Department of Health uses surveillance data to find communities in the state with a high burden of childhood lead poisoning, then provides grants to local health departments in these communities to implement approved primary prevention programs.

Grantees are required to establish a housing inspection program that prioritizes units for inspections, corrects identified hazards using lead-safe work practices, and provides appropriate oversight of remediation work and clearance by certified inspectors. Grantees are also required to perform additional primary and secondary prevention actions beyond applicable Notice & Demand requests. If a child under the age of six in an inspected unit has not received required blood lead tests, the grantee is required to refer them to a primary care provider or local health department lead prevention program for follow-up. Grantees must also collect and report data to the NYSDOH to aid in continued program evaluation.

Although the NYS CLPPPP does not provide funding to property owners for repairing identified hazards, grantees coordinate available financial and technical resources to assist property owners with remediation and must also develop and implement lead-safe work practices training for property owners, contractors and residents. Previous NYS CLPPPP evaluation reports have identified this lack of funding for required repairs as a primary barrier to timely remediation in N&D cases, making this grantee task essential to the overall success of the program.

Lastly, grantees are required to develop formal partnerships and agreements with other county and municipal agencies/programs—possibly including code enforcement offices, local housing agencies, HUD Lead Hazard Control grantees, weatherization programs, and community groups. As a result, nearly one-third of all inspections in 2015 were conducted by staff of a code enforcement agency, not local health department officials.

Results

In the first eight years of the program, grantees visited and inspected the interiors of 37,731 homes, impacting over 23,000 children, and have cleared 75 percent of the units found to have at least one confirmed or potential interior lead hazard (roughly a third of the units inspected).

Over this same time frame, the state has invested $52.76 million in the program, equating to roughly $4,800 for each of the 11,020 children living in homes with confirmed or potential lead hazards (not including the homes into which other children will move in the future).

From 2007 to 2015, the percentage of children tested with confirmed blood lead levels (BLLs) greater than 10 µg/dL in New York dropped from 0.99 percent to 0.47 percent. Rates have dropped among both children tested in New York City and Upstate New York; however, the rates of children tested with confirmed elevated BLLs remains over three times higher in Upstate New York compared to New York City (0.91 percent versus 0.29 percent). Overall, rates dropped from 1.45 percent to 0.91 percent from 2007 to 2015 in Upstate New York and 0.68 percent to 0.29 percent in New York City.

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The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

Access a story on New York City’s efforts here.

Access a story on Rochester’s efforts here.

New Orleans’ Efforts to Prevent and Respond to Childhood Lead Exposure

Background

In New Orleans, Louisiana, more than 90 percent of housing structures were built prior to 1978 – the year lead was decreased in residential paint – making city residents vulnerable to lead-based paint hazards. In addition to deteriorating paint and the lead contaminated dust it generates, the lead dust from the use of leaded gasoline contributed significantly to elevated soil lead levels.

While leaded gasoline was phased out in the 1970s through the 1990s, the lead dust remains in soil, particularly within transit-heavy areas of the city. Researchers estimate that vehicles deposited more than 10,000 metric tons of lead dust in New Orleans soil between 1950 and 1985. In 2004, more than 40 percent of New Orleans soils exceeded the EPA’s cleanup standard for play areas.

Lead in soil can disproportionally impact children because they are more like to inhale and ingest dust and dirt.

Hurricanes Katrina and Rita

In August, 2005, storm surges from the Hurricanes flooded 80 percent of the homes of New Orleans and deposited massive quantities of low lead sediments into the city. The sediments created a natural barrier on top of the pre-existing high-lead soil establishing a cleaner, less hazardous landscape. This, combined with citywide cleanup and remediation efforts, reduced lead dust in homes and surrounding soil. Lead assessments conducted in Katrina’s immediate aftermath found a 46 percent reduction in median soil lead levels. And the declines continued. Before the storm, 15 of the city’s 46 census tract neighborhoods exceeded the EPA’s regulatory soil lead standards; by 2010, only 6 neighborhoods exceeded standards.

At the same time, there was a decrease in children’s BLL. Prior to the Hurricanes, 50 percent of New Orleans’s children had BLL’s equal or greater that the federal reference value of 5 µg/dL. Ten years after the Hurricanes, about 5 percent of the children’s BLL exceed that exposure value.

Lead-Safe Soil Emplacement Interventions

Inspired by the city’s unique natural experiment, researchers used a similar approach to clean up soil at 10 childcare centers in New Orleans, covering lead-contaminated surface soils with a water-permeable barrier and 6-inch layer of low-lead soil. Since 2005, nine of the 10 federal public housing projects were rebuilt using this process—landscaped with low lead soil to raise the elevation of the housing. This intervention was expanded to all New Orleans’s childcare center play areas and public playgrounds that tested high for lead.

Challenges Remain

These efforts, combined with the potential reduction of lead from fresh topsoil deposited by the storm surge during Hurricane Katrina, led to a decrease in the percentage of children with elevated BLLs in high-lead communities (mainly inner city) from 64 percent in 2005 to 19 percent by 2015. In short, household restoration and cleaning reduced lead-based paint hazards and washed-in sediments reduced soil lead. The remaining challenge is to reduce exposure in high lead communities by conducting more “soil emplacement interventions and continuing lead paint hazard reduction strategies.”

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The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

California’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

In the mid-1980s, the California state legislature declared childhood lead exposure the most significant environmental health problem in the state and subsequently established the Childhood Lead Poisoning Prevention Branch within the state’s Department of Public Health (CDPH).

The program compiles information, identifies target areas, and analyzes data to design and implement ways to reduce childhood lead exposure. The statutes also determine a “standard of care” to evaluate children for lead-exposure risk; mandate reporting by laboratories of all state blood lead test results; and require public health and environmental services for children identified with elevated blood lead levels, including ordering property owners to remove hazardous lead conditions. The state requires the establishment of procedures and the adoption of regulations regarding residential lead paint, and lead-contaminated dust and soil. It also authorizes and administers a lead-based paint prevention training, certification, and accreditation program.

Funding

To help pay for the program, in 1993, California adopted an annual Childhood Lead Poisoning Prevention Fee, administered jointly by CDPH and the California Board of Equalization (BOE), on manufacturers and other entities involved with the production or sale of lead and lead-based products collected from businesses in the petroleum and architectural coatings industries and from facilities reporting releases of lead into the air. The department deploys a “historical market share attributions” concept to estimate each payer’s long-term contribution to environmental lead contamination and allocate fees. It then deploys collected funds (the fee generated $20.6 million in fiscal 2015) to support healthcare referrals, assessments of homes for hazards, and educational activities.

Banning Lead in Certain Products

California has led U.S. efforts to ban lead from a range of products beginning with a 1986 law, Proposition 65, which requires manufacturers, retailers, and other businesses to notify consumers when they are being exposed to toxic chemicals, including lead. The law has made consumers more aware of toxic chemicals in their environment, and advocates have successfully pressed for more regulations to ban or curtail the use of lead and other toxins in products. In conjunction with these efforts, California passed a number of strict laws to safeguard products and protect its citizens from lead exposure. For example:

In 2005, California implemented a lead-in-candy law. The state considers candies with lead levels in excess of 0.1 parts per million (ppm) to be contaminated. The Food and Drug Branch of the California Department of Public Health is required to test samples, notify the manufacturer of the adulteration, and issue a health advisory. The federal Food and Drug Administration subsequently issued national guidance in 2006 recommending that all candy likely to be consumed by children contain no more than 0.1 ppm of lead.
In 2006, California enacted the Metal-Containing Jewelry Law. This requires jewelry and components, such as dyes and crystal, that are sold, shipped, or manufactured for sale in California to meet limits set by the state under a 2004 consent judgment that applied to a number of manufacturers, retailers, and distributors in response to a lawsuit filed by the Attorney General of California and two environmental groups. The law forbids the manufacture, shipping, sale, or offer for retail sale or promotional purposes jewelry in California unless it is made wholly from one or more specified materials. It also mandates lead restrictions for certain specified materials allowed in manufacturing jewelry and establishes provisions for children’s jewelry and that used for body-piercing.
California passed additional legislation in 2006, effective in 2010, to reduce the lead content in water distribution products. The law prohibits more than 0.25 percent lead in commercial pipes, fittings, and fixtures. In 2010, the U.S. Congress amended the Safe Drinking Water Act, including provisions similar to the California standard, and, in 2014, the 0.25 percent standard for lead in pipes, fittings, and fixtures became national.
In 2009, California passed the California Lead in Wheel Weights Ban to prevent lead from wheel weights, used to balance tires in vehicles, from entering the environment. Before the ban, lead wheel weights, which can become dislodged from the wheels and end up on roads where they are abraded into lead dust and debris, were responsible for releasing 500,000 pounds of lead annually onto California roads. Since 2009, six other states, including Washington, Maine, Illinois, New York, Vermont, and Minnesota, have followed California’s lead. Also in 2009, the U.S. Environmental Protection Agency (EPA) started the process to consider banning lead wheel weights in the United States, but it has not taken formal action. The European Union has already banned lead wheel weights, while manufacturers in Japan and Korea stopped installing them in 2005.

In 2010, both California and Washington passed legislation restricting the use of heavy metals including lead in motor vehicle brake pads. In 2014, in California, and 2015 in Washington, brake pads sold in those states could not contain more than 0.1 percent by weight. The legislation also limits the levels of asbestiform fibers, cadmium, chromium, copper, and mercury in the brake friction materials. In January 2015, brake manufacturers signed a memorandum of agreement with the Environmental Protection Agency and the Environmental Council of the States declaring that all brake pads sold in the United States will meet the California/Washington standards. The brake- pad standards were adopted immediately, while standards for copper are being phased in.

In 2003, California passed the Toxics in Packaging Prevention Act, which limited harmful substances in packaging and reduced the levels of toxins contaminating soil and ground water near landfills. While the original law exempted lead paint or applied ceramic decoration on glass bottles, a 2008 amendment banned such uses if the lead content exceeds 600 ppm.

California passed a law in 2013 that made it the first state to require the use of only lead-free ammunition be used for hunting with a firearm in California. The regulations, which began to phase in in 2015, will be fully implemented in 2019. Lead ammunition for hunting waterfowl was banned nationally in 1991, but the California law extends the ban to hunting for all wildlife. The main purpose of the law is to protect endangered wildlife, including the California condor, from lead exposure. However the legislation should have the added benefit of reducing lead exposure for the families of hunters.

Results

The number of children from 0 to under 21 years who have been identified with blood lead levels at and above 4.5 mcg/dL has been decreasing significantly. In 2013, 1.7 percent of tested children had blood lead levels in this range. In 2007, 6.5 percent tested above 4.5 mcg/dL.

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The case study does not attempt to to capture everything a location is doing on lead, but aims to highlight some of the important work.

Graham-Cassidy is Legislative Malpractice – It Would Greatly Harm the Nation’s Health

Joint Statement from American Public Health Association, Prevention Institute, Public Health Institute, and Trust for America’s Health

Washington, D.C., September 25, 2017 – Below is a statement from American Public Health Association, Prevention Institute, Public Health Institute, and Trust for America’s Health on Graham-Cassidy, which would cause millions to lose healthcare coverage, decrease access to clinical preventive services, and eliminate the Prevention and Public Health Fund.

“Graham-Cassidy would do untold damage to the nation’s health, unraveling the progress we’ve made to expand access to quality, affordable healthcare, reorient our healthcare system to value prevention and equity, and invest in a healthier future for all Americans.

Graham-Cassidy upends efforts to improve the nation’s health in the future by threatening to strip people of access to preventive care and zeroing out the Prevention and Public Health Fund. Over the next five years alone, states and communities stand to lose more than $3 billion in funding to prevent chronic disease, stop the spread of infectious diseases, and invest in resources that support health and equity. The Prevention and Public Health Fund also provides 12 percent of the Centers for Disease Control and Prevention’s annual budget. Losing this much funding—about $900 million a year—would irreparably damage our public health infrastructure, including our ability to respond to disasters and emerging epidemics. These short-term cuts will lead to more chronic conditions and exact a heavy burden of preventable illness and death – as well as higher healthcare expenditures for worse health outcomes – down the line.

Investing in public health makes the difference between health and illness, safety and injury, and life and death. The deep cuts this bill proposes – to Medicaid, to public health and prevention – would touch every community, especially those communities that are struggling most with longstanding inequities in health and safety.

Passing Graham-Cassidy is tantamount to legislative malpractice. The undersigned groups find this approach unacceptable and strongly urge Congress to work in a bipartisan manner to improve the nation’s public health and healthcare systems.”

TFAH Statement on the ACA and the Prevention and Public Health Fund

Washington, D.C., July 28, 2017 – The below is a statement from John Auerbach, president and CEO, Trust for America’s Health (TFAH).

“TFAH is thankful that healthcare coverage will continue to be available for millions of Americans. We applaud the decision by the majority of senators to avoid the damaging repeal of the Affordable Care Act (ACA). As a result, millions can breathe a sigh of relief that their coverage will not be cut, their benefits reduced and/or their premiums become unaffordable.

That said, there is a need for continued support to increase and sustain access to affordable, high-quality healthcare, covering the range of needs from life- and cost-saving preventive care to comprehensive treatment.

And, importantly, efforts must ensure the Prevention and Public Health Fund remains intact. The Prevention Fund is one of the most important and biggest sources of funding for prevention-focused efforts, comprising 12 percent of the budget for the Centers for Disease Control and Prevention (CDC).

The Fund supports essential work at CDC and provides more than $600 million a year directly to states and communities to address their leading health concerns using the best public health approaches available. Without these funds, we are putting Americans across the country at unnecessary risk for health problems that could be prevented.”

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Public Health Groups Decry Potential Elimination of the Prevention and Public Health Fund in Senate Bills

Joint Statement from American Public Health Association, Prevention Institute, Public Health Institute, Society of Public Health Education, and Trust for America’s Health

July 27, 2017

WASHINGTON, D.C. – The Senate is expected to soon vote on a ‘skinny’ repeal bill that would target key components of the Affordable Care Act – including potentially eliminating the Prevention and Public Health Fund.

This short-sighted move would cause long-term damage to our nation’s health. If the Prevention and Public Health Fund is eliminated, the pain of these cuts will be felt across the country, reverberating in every state and community. Over the next five years alone, states stand to lose over $3 billion in funding they rely on to prevent chronic disease, halt the spread of infections and epidemics, and invest in the community resources that support health and equity. It would cut the budget of the Centers for Disease Control and Prevention by 12 percent.

In the lives of individuals and communities, strong public health infrastructure makes the difference between health and illness, safety and injury, life and death. Slashing public health and prevention funding would increase preventable suffering and death, make the poorest and sickest communities fall even further behind, and leave our country far less prepared for and capable of responding to public health emergencies. The undersigned groups find this vision of the future unacceptable, and stand for prevention and public health.

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The Senate’s Latest Obamacare Replacement Effort will not improve the Nation’s Health, Affordable Care Act

Washington, D.C., July 25, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH) on the Senate’s motion to proceed.

“Each new iteration of Obamacare repeal legislation has failed to do what a health bill should: improve the nation’s health.

We know—according to the Congressional Budget Office’s scores on any number of the attempted bills—that tens of millions of people will quickly lose access to health insurance and the preventive services and programs which keep them from developing debilitating and costly chronic diseases.

That is, simply, the opposite of what a bill—intended to improve the nation’s health—should do.

Continued attempts to eliminate the Prevention and Public Health Fund would irreparably harm the nation’s health. States and communities rely on the hundreds of millions of dollars they receive annually to work on the critical health issues—including the opioid epidemic, lead poisoning, obesity, tobacco use and vaccine-preventable illnesses—facing their citizens.

To date, any funding included in repeal legislation for the opioid crisis has been nowhere near enough to solve the problem and will not make up for the substantially larger cuts to Medicaid and the Prevention Fund.

Estimates have found that the total coverage cost for people receiving treatment for substance misuse disorders could reach $220 billion over the next decade. And, people with substance misuse disorders often suffer from additional health problems – for example, mental illness and chronic conditions such as heart disease or diabetes – and need the routine access to care and services provided by Medicaid. As such, substance misuse treatment must remain part of the Medicaid integrated care system.

TFAH encourages the Administration and Congress to start over and create a true healthcare bill that will improve upon Obamacare, keep people covered and safeguard the nation’s health.”

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The Senate’s Better Care Reconciliation Act is Irredeemable, would eliminate 12 Percent of CDC’s Budget for Fiscal Year 2018

Washington, D.C., June 22, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH) on the Senate’s Better Care Reconciliation Act.

“The Senate version is no better than what the House proposed and in no way improves upon the Affordable Care Act (ACA). In reality, this Act is irredeemable.

If the Better Care Reconciliation Act becomes law, tens of millions will lose insurance. A critical part of what they’ll lose is access to the care they need to prevent or manage chronic conditions in a life- and cost-saving way. More than 80 percent of the $3 trillion dollars we spend every year on healthcare goes to individuals with one or more chronic conditions—with better preventive care and well managed chronic disease clinical services we can reduce costs and improve health outcomes.

A better way for Congress to cut healthcare costs and keep Americans healthy would be to create legislation that increases investments in preventive services and programs and ensures people have access to clinical care before they develop costly conditions.

This bill does the absolute opposite.

In addition to millions losing insurance, the Senate bill would eliminate the Prevention and Public Health Fund beginning next fiscal year, which supplies 12 percent of the budget (or close to $900 million) for the Centers for Disease Control and Prevention (CDC). And, $625 million of that goes directly to states and communities to address their most pressing health needs, including drug misuse, infectious diseases, lead poisoning, obesity, diabetes, hypertension, cancer and tobacco use.

In addition, with the phasing out of Medicaid expansion and possible loss of guaranteed essential health benefits, effective preventive services—including vaccines and screenings for cancer—will no longer be required of insurers.

If the Better Care Reconciliation Act becomes law, the American people will be sicker and poorer. We will likely see more overdoses and untreated STDs, rises in infant mortality and increases in innumerable other preventable health issues, all of which add up to ever-increasing healthcare costs.

We strongly urge the United States Congress to start over and create a true healthcare bill that will actually improve the ACA and the nation’s health.”