Issue Category: Prevention and Public Health Policy

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.”

###

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].

Live Well San Diego

In 2010, the San Diego County Board of Supervisors adopted Live Well San Diego, a 10-year plan to advance health, safety, and well-being of the region’s more than three million residents. The County’s partners include cities and tribal governments; diverse businesses, including health care and technology; military and veterans organizations; schools; and community and faith-based organizations. The initiative has four strategic approaches: building a better service delivery system; supporting positive choices; pursuing policy and environmental changes; and improving the culture Ten indicators have been identified to capture the overall well-being of residents. The initiative now has three components: Building Better Health, Living Safely, and Thriving. Funding began in 2010 with a $16 million Communities Putting Prevention to Work (CPPW) Federal Grant Award. In 2010, Live Well San Diego also received a five-year grant from the Centers for Disease Control and Prevention National Public Health Improvement Initiative. In 2011, they received a five-year, $15 million Community Transformation Grant. To read more about this innovative program, see this brief summary [link].

Live Well Omaha

Initiated in 1995, Live Well Omaha (LWO) is a community-led collaborative created out of a shared concern that no one organization in the community has the capacity to solve health disparity issues alone. With a focus on healthy eating and active living, and an interest in obesity prevention, LWO has more than 40 active partners from a variety of sectors—public/private organizations, nonprofit, businesses, educators, health systems, and insurance companies. As a result of LWO’s work, childhood obesity rates have been held constant in the Omaha community (from 2008 to 2012); 30 municipal bike-sharing stations have been created; the employer community has embraced healthy vending; and more than $7 million of investment funding has been brought into the Omaha metro area. LWO is funded by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention Communities Putting Prevention to Work and Community Transformation Grants. To read more about this innovative program, see this brief summary [link].

HelpSteps

HelpSteps is an online assessment and referral system for families’ and individuals’ social determinants of health. It began as a research project in 2003 and became a fully implemented referral system in 2007. The online system assesses needs in 13 broad social domains and provides access to resources related to over 100 social problems that affect lower socioeconomic families, including services related to food insecurity, housing, and income resources. The system is used by a variety of social services in the Boston area, including the Boston Public Health Commission, The Mayor’s Health Line, and medical and free clinics throughout the area. HelpSteps findings include: 82 percent of families in urban clinics experience at least one type of social problem in a given year; families are interested in assessment referrals; 40 percent of individuals who selected referrals followed up with one of their selections; 52 percent said their problem had either completely or mostly resolved; and 80 percent stated they would like to use the online tool as part of an annual assessment. HelpSteps receives funding from the Boston Children’s Hospital, the Boston Public Health Commission, and small grants. To read more about this innovative program, see this brief summary [link].