Issue Category: Prevention and Public Health Policy

CDC to Lose More than $5 Billion, States to Lose More than $3 Billion to Fight Health Epidemics over Five Years, if the ACA and Prevention and Public Health Fund are Repealed

Washington, D.C., January 17, 2017 – The U.S. Centers for Disease Control and Prevention (CDC) would lose 12 percent of its annual budget if the Prevention and Public Health Fund, part of the Affordable Care Act (ACA), were repealed, according to an analysis by the Trust for America’s Health (TFAH).

States would end up losing more than $3 billion over the next five years – from grants and programs supported by the Prevention Fund.

“CDC is the world’s leading public health authority and the front line against major threats to the health and well-being of the American people—such as disease outbreaks, prescription drug  misuse and diabetes,” said John Auerbach, President and CEO of TFAH. “Losing the Prevention Fund would result in diminished support for public health in every state, undermining their ability to fight epidemics and keep people safe. The costs of these vital public health efforts will either be passed along to states or the efforts will be eliminated—resulting in more people becoming sick and higher healthcare costs.”

The $890 million gap in CDC’s annual funding created by eliminating the Prevention Fund could not be filled under current laws without drawing funds away from other Department of Labor, Education and Health and Human Services programs. Among activities supported directly by the Prevention Fund are grants to states for infectious disease control, resources through the Preventive Health and Health Services Block Grant and other core public health programs which, if cut, would increase illness, injuries and preventable deaths.

If the Prevention Fund is eliminated, the impact will be felt at the local, state and federal levels as public health organizations respond to several major health crises that are on the rise, such as:

  • Health Security Funds for Disease Outbreaks, Disasters and Bioterrorism:  With the exception of the one-time-only funding for Ebola and Zika, the core funding for preparedness and response to health emergencies has been cut by more than one-third in the past decade. CDC has responded to more than 750 health emergencies in the past two years. Infectious diseases cost the country more than $120 billion per year, and that cost grows exponentially when major new diseases strike.
  • Prescription Painkiller and Heroin Use: Deaths from opioids have more than quadrupled in the past 15 years. Nationally, more than 2 million Americans misuse prescription drugs, and nearly a half million are addicted to heroin, costing the country more than $55 billion a year in healthcare, workplace and criminal justice spending. CDC plays a critical role by providing support to states and healthcare providers to monitor and control the inappropriate prescribing of opioids.
  • Obesity and Diabetes: Nearly 38 percent of adults are obese and more than one-third of children are overweight or obese, contributing to more than $200 billion in direct health costs. One in three children could develop diabetes in their lifetime, and one in four are not healthy enough to serve in the military by the ages of 17 to 24.
  • Declining Life Expectancy:  Life expectancy in the United States has declined for the first time in two decades. While death rates are higher among Blacks and other people of color, death rates have increased the fastest (by 10 percent since 1999) among middle-aged White men and women (ages 45 to 54). Increasing death rates among middle-aged Whites are the highest in West Virginia, Mississippi, Oklahoma, Tennessee, Kentucky, Alabama and Arkansas. Amounts each state stands to lose over the next 5 years if the Prevention Fund was repealed (based on fiscal year 2016 grants to state)

State

Potential Five Year PPHF Loss, Based on FY 2016 Funding

Alabama

$44,867,115

Alaska

$22,312,985

Arizona

$46,840,075

Arkansas

$29,599,945

California

$307,768,530

Colorado

$44,671,845

Connecticut

$36,728,860

Delaware

$12,462,820

District of Columbia

$51,533,080

Florida

$101,864,250

Georgia

$100,421,755

Hawaii

$40,025,880

Idaho

$22,428,585

Illinois

$93,084,850

Indiana

$41,381,450

Iowa

$35,630,210

Kansas

$45,329,065

Kentucky

$40,687,570

Louisiana

$45,111,030

Maine

$27,588,000

Maryland

$84,876,045

Massachusetts

$88,112,505

Michigan

$110,739,075

Minnesota

$80,759,870

Mississippi

$31,276,855

Missouri

$53,853,865

Montana

$24,831,145

Nebraska

$47,957,625

Nevada

$19,174,580

New Hampshire

$24,967,020

New Jersey

$60,558,365

New Mexico

$43,257,135

New York

$207,587,230

North Carolina

$85,917,320

North Dakota

$14,975,550

Ohio

$114,951,125

Oklahoma

$46,585,755

Oregon

$46,462,400

Pennsylvania

$111,991,355

Rhode Island

$40,238,960

South Carolina

$56,576,525

South Dakota

$18,732,825

Tennessee

$67,537,910

Texas

$147,214,850

Utah

$49,396,510

Vermont

$14,637,565

Virginia

$77,104,520

Washington

$70,060,890

West Virginia

$22,669,320

Wisconsin

$64,120,145

Wyoming

$11,024,970

 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. 

Trust for America’s Health Announces New President and CEO, John Auerbach

Washington, D.C., October 7, 2016–Today, Trust for America’s Health (TFAH) announced the selection of John Auerbach, MBA, as its new President and CEO.

Auerbach brings more than 35 years of experience as a leader in the public health field – including serving as the Commissioner of the Massachusetts Department of Health, Executive Director of the Boston Public Health Commission, and, most recently, Associate Director for Policy and Acting Director of the Office for State, Tribal, Local and Territorial Support at the Centers for Disease Control and Prevention (CDC).

“John is a true innovator in public health and we cannot be more pleased to have him as the new head of TFAH,” said Gail Christopher, board chair of TFAH and vice president for policy and senior advisor at the W.K. Kellogg Foundation. “His work embodies a transformative approach to improving health – thinking beyond medical care to support opportunities for better health in our daily lives. We share a vision where every American has the chance to be as healthy as they can be.”

At CDC, Auerbach has focused on promotion of public health and prevention as components of healthcare and payment reform and health system transformation. He also oversees key activities and technical assistance that support the nation’s health departments and the public health system.

Previously, he was, from 2012 to 2014, a distinguished professor of practice in health sciences and director of the Institute on Urban Health Research and Practice at Northeastern University.  From 2007 to 2012, he was the commissioner of public health for the Commonwealth of Massachusetts. Under his leadership, the department developed innovative programs to address racial and ethnic disparities, promote wellness, combat chronic disease, and support the successful implementation of the state’s early healthcare reform initiative.  He served as the President of the Association of State and Territorial Health Officials (ASTHO) in 2010-2011.

Prior to that, Auerbach was the executive director of the Boston Public Health Commission for nine years during which health equity, emergency preparedness, and tobacco prevention became priorities. In addition to Boston’s public health programs, he oversaw its emergency medical, homeless, and substance abuse services.  Throughout his tenure as the city commissioner, Auerbach served as a member of the Board of Directors at the National Association of County and City Health Officials (NACCHO).

Earlier in his career Auerbach worked at the state health department for a decade, first as chief of staff and later as an assistant commissioner overseeing the HIV/AIDS Bureau during the early years of the epidemic.  He was a founding member and the second president of the National Association of State and Territorial AIDS Directors (NASTAD).

“I’ve had a lifelong commitment to health and social justice, from the start of my career as a community health worker in one of the earliest community health centers to having the privilege of managing city, state and federal efforts,” said Auerbach.  “We’re in a unique moment to define the next generation of health and healthcare – and I am excited to be joining TFAH and being at the leading edge of efforts to advance the mission of creating a healthier America.”

Auerbach will start in his role January 1, 2017.  TFAH’s previous executive director, Jeffrey Levi, PhD, is now serving as Professor of Health Policy and Management at the Milken Institute School of Public Health at the George Washington University.

Richard Hamburg, who has been Interim President and CEO at TFAH, will be assuming the position of Executive Vice President and Chief Operating Officer.

 

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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.

Outbreaks

«state» Scored «score_upper» Out of 10 on Key Indicators Related to Preventing, Detecting, Diagnosing and Responding to Outbreaks

Report Finds Major Gaps in Country’s Ability to Prevent and Control Infectious Disease Outbreaks

Washington, D.C., December 17, 2015 – A new report released today by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) finds «state» scored «score_lower» out of 10 on key indicators related to preventing, detecting, diagnosing and responding to outbreaks.

Twenty-eight states and Washington, D.C. scored 5 or lower out of 10 key indicators. Five states—Delaware, Kentucky, Maine, New York and Virginia—tied for the top score, achieving eight out of 10 indicators. Seven states — Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah — tied for the lowest score at three out of 10.

The report, Outbreaks: Protecting Americans from Infectious Diseases, concluded that the United States must redouble efforts to better protect Americans from new infectious disease threats such as MERS-CoV and antibiotic-resistant Superbugs and resurging illnesses like whooping cough, tuberculosis and gonorrhea.

“The overuse of antibiotics and underuse of vaccinations along with unstable and insufficient funding have left major gaps in our country’s ability to prepare for infectious disease threats,” said Jeffrey Levi, PhD, executive director of TFAH. “We cannot afford to continue to be complacent. Infectious diseases – which are largely preventable – disrupt the lives of millions of Americans and contribute to billions of dollars in unnecessary healthcare costs each year.”

Some key «state» findings include:

No. Indicator «state» Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Public Health Funding: State increased or maintained funding for public health between FY 2013 to 2014 and FY 2014 to 2015. «metric1» 34 and Washington, D.C.
2 Flu Vaccination Rates: State vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2014 to Spring 2015. The rate was «flu_vaccine_rate» in «state», the national average is 47.1 percent. «metric2» 18
3 Childhood Immunization School Requirement Policies: State law either excludes philosophical exemptions entirely or requires a parental notarization or affidavit to achieve a religious or philosophical exemption for school attendance. In 2014, there were more than 600 cases of measles and nearly 33,000 cases of whooping cough reported. While more than 90 percent of U.S. kindergarteners receive all recommended vaccinations, rates are lower in a number of communities and states. More than 28 percent of preschoolers do not receive all recommended vaccinations. «metric3» 20
4 HIV/AIDS Surveillance: State requires reporting of all (detectable and undetectable) CD4 cell count (a type of white blood cell) and HIV viral load data to their state HIV surveillance program. Of the more than 1.2 million Americans are living with HIV, almost one in eight do not know they are infected. (As of July 2013.) «metric4» 43 and Washington, D.C.
5 Syringe Exchange Programs: State explicitly authorizes syringe exchange programs (SEP). Hepatitis C infections—related to a rise in heroin and injection drug use from people transitioning from prescription painkillers—increased by more than 150 percent nationally from 2010 to 2013. «metric5» 16 and Washington, D.C.
6 Climate Change and Infectious Disease: State currently has climate change adaptation plans completed. «metric6» 15
7 Central Line-Associated Bloodstream Infections (CLABSI): State reduced the standard infection rate (SIR) for CLABSI between 2012 and 2013. «state» has a CLABSI SIR of «clabsi_2013_sir». The national CLABSI SIR is 0.5. Around one out of every 25 people who are hospitalized each year contracts some form of healthcare-associated infection leading to around 75,000 deaths a year. «metric7» 9
8 Public Health Laboratories: State laboratories reported having a biosafety professional from July 1, 2014 to June 30, 2015. «metric8» 36
9 Public Health Laboratories: State laboratories provided biosafety training and/or information about courses for sentinel clinical labs in their jurisdiction from July 1, 2014 to June 30, 2015. «metric9» 35
10 Food Safety: State met the national performance target of testing 90 percent of reported E.coli O157 cases within four days (in 2013). Around 48 million Americans get sick from a foodborne illness each year. «metric10» 39 and Washington, D.C.
Total «score_upper»

“America’s investments in infectious disease prevention ebb and flow leaving our nation challenged to sufficiently address persistent problems,” said Paul Kuehnert, a Robert Wood Johnson Foundation director. “We need to reboot our approach so we support the health of every community by being ready when new infectious threats emerge.”

The Outbreaks report features priority recommendations, including:

  • Increase resources to ensure every state can maintain and modernize basic capabilities – such as epidemiology and laboratory abilities – that are needed to respond to new and ongoing outbreaks;
  • Update disease surveillance to be real-time and interoperable across communities and health systems to better detect, track and contain disease threats;
  • Incentivize the development of new medicines and vaccines, and ensure systems are in place to effectively distribute them when needed;
  • Decrease antibiotic overuse and increase vaccination rates;
  • Improve and maintain the ability of the health system to be prepared for a range of potential threats – such as an influx of patients during a widespread outbreak or the containment of a novel, highly infectious organism that requires specialty care;
  • Strengthen efforts and policies to reduce healthcare-associated infections;
  • Take strong measures to contain the rising hepatitis C epidemic and other sexually transmitted infections, particularly among young adults; and
  • Adopt modern strategies to end AIDS in every state and city.

The indicators represent examples of important capabilities, policies and trends, and were selected in consultation with leading public health and healthcare officials. The report and state-by-state materials are available on TFAH’s website at www.healthyamericans.org.

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s website. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator, with zero the lowest possible overall score and 10 the highest. The data for the indicators are from publicly available sources or were provided from public officials.

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

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

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

TFAH Opposes any Attempts to Defer or Transfer any portion of the Prevention and Public Health Fund

Washington, D.C., December 10, 2015 – Trust for America’s Health (TFAH) strongly opposes cutting, deferring or transferring any portion of the Prevention and Public Health Fund. The following is a statement from Jeffrey Levi, PhD, executive director of TFAH.

“It is important to help Puerto Rico, but eliminating any funding for the Prevention and Public Health Fund would be a tremendous setback for public health.

For the past six years, the Prevention Fund has provided nearly $5.25 billion in resources to states, communities, territories (including Puerto Rico), and tribal and community organizations to support community-based prevention, including tobacco use prevention, healthy eating and active living, childhood immunizations and clinical prevention. In total, the Fund has:

  • Doubled the Preventive Health and Health Services Block Grant, which provides all 50 states, the District of Columbia, two American Indian tribes, and eight U.S. territories with flexible funding to address their unique public health issues at the state and community level;
  • Expanded access to cancer screenings;
  • Supported the successful Tips from Former Smokers campaign, which has inspired more than 1.6 million people to try to quit smoking, with more than 100,000 smokers have quit for good; and
  • Increased funding for the section 317 childhood immunization program, which has been vital to preventing and responding to measles outbreaks.

Lastly, Puerto Rico has received more than $431 million through the Fund to prevent tobacco use, improve lab capacity, strengthen surveillance systems, and to address their unique public health needs.

Clearly, cutting even a portion of the Prevention Fund would dramatically impede efforts underway to improve health across the nation and in Puerto Rico, as noted by the more than 900 national, state and local organizations, including the Puerto Rico Department of Health, that have pledged their support for the Fund.

We urge Congress to find a realistic source of funding to provide the assistance Puerto Rico needs.”

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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. 

Visiting Nurse Service of New York Population Health Management

The Visiting Nurse Service of New York (VNSNY) is the largest free-standing home and community-based nonprofit health system in the country. VNSNY has established a population health division to provide care coordination to at-risk populations, employing strategies such as transitions of care, health coaching, caregiver support, community-based peer workers, hot-spotting, motivational interviewing, and behavior activation. The Institute for Healthcare Improvement (IHI)/Rockaways Wellness Partnership with VNSNY is an innovative, community-based intervention for improving the health of “at-risk” populations through proactive client engagement and self-empowerment. To read more about this innovative program, see this brief summary [link].

New York State Prevention Agenda 2013–2017

The New York State Public Health and Health Planning Council—a group made up of more than 140 organizations across New York—developed the New York State Prevention Agenda 2013–2017 at the request of the Department of Health. The Council, a collaboration of health departments, state agencies, providers, health plans, community-based organizations, academia, advocacy groups, schools, and employers, developed this plan to demonstrate how communities across the state can work together to improve health and quality of life. The Prevention Agenda serves as a guide to local health departments and hospitals as they develop their community health assessments. Statewide and local planning organizations provide technical support to local communities that are collaborating to assess needs and develop local implementation plans, with support from the Robert Wood Johnson Foundation. The New York State Health Foundation provides grants to organizations that help local health departments and their partners advance the goals of the Prevention Agenda. To read more about this innovative program, see this brief summary [link].

New York City Macroscope

In 2013, the New York City Department of Health and Mental Hygiene launched NYC Macroscope, a program that uses aggregate data from primary care providers to estimate the prevalence of selected health conditions in New York City. Using data from electronic health records, the goal is for estimates to efficiently and cost-effectively characterize the burden of disease in New York City and changes in that burden over time. The Department of Health and Mental Hygiene, in partnership with the City University of New York School of Public Health is gathering the data from over 700 ambulatory care practices across the city. This program is funded by the deBeaumont Foundation; the Robert Wood Johnson Foundation; the Robin Hood Foundation; the Doris Duke Foundation; the New York State Health Foundation; and the Centers for Disease Control and Prevention. To read more about this innovative program, see this brief summary [link].

Nemours Children’s Health System

Nemours is an integrated pediatric health system committed to improving the health of children. Established in Delaware in 2004, Nemours Health & Prevention Services were first created to help children grow up healthy by integrating treatment and prevention of illness. They work with community partners to influence policies and practices to improve children’s health. Through family-centered care in children’s hospitals and clinics in Delaware, New Jersey, Pennsylvania, and Florida, as well as world-changing research, education, population health, and advocacy, Nemours fulfills the promise of a healthier tomorrow for all children — even those who may never enter the doors. The work is financed by Nemours operating budget and with limited external grants. To read more about this innovative program, see this brief two-page summary [link].

Maryland Model for Hospital Payment

In 2014, Maryland and the Center for Medicare & Medicare Innovation (CMMI) negotiated a waiver that established a per capita expenditure rate for Medicare hospital services and a limit on the growth of inpatient and outpatient hospital costs for all payers to 3.58 percent. The waiver projects Medicare savings over five years to be $330 million. To implement the model, the state rate-setting commission will replace fee-for-service models with population-based payment models that reward providers for improving health outcomes, enhancing quality, and controlling costs. Although the new model has just been introduced, several early adoptees of the new payment models have observed significant reductions in preventable hospitalizations. With these new incentives, hospitals are expected to form more creative partnerships with public health agencies, community health organizations, and long-term care providers. To read more about this innovative program, see this brief summary [link].