Issue Category: Public Health Funding

The Nation’s Public Health System is at an Inflection Point

New Report Provides the Next Administration and Congress a Policy Roadmap for Improving the Nation’s Health, Economy, and National Security

(October 8, 2024 – Washington, DC) – The public health system—responsible for protecting and promoting health in every community— needs sustained investment, policy support, and protection from political interference, according to a new report released today by Trust for America’s Health.

The report, Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress, identifies six priority areas and includes policy recommendations that, if adopted, will improve health outcomes and bolster the nation’s economic and national security.

Americans are living longer, thanks in part to public health. Public health interventions, such as improved sanitation, enhanced vaccination access and stronger infectious disease control, improved nutrition, tobacco use prevention, and addressing preventable injury, were the largest contributing factors to life expectancy increases over the last century.

However, too many Americans are still suffering from preventable health problems. Over the last few decades, increasing rates of chronic diseases and alarming levels of substance use disorder and suicides threaten the public’s health. Furthermore, weather-related emergencies are occurring more frequently, and population-level health disparities persist.

Public health is at risk on several fronts. Underfunding has weakened the public health infrastructure and its workforce. Mis- and disinformation and politicization have contributed to distrust of public health officials and guidance. Public health’s ability to protect communities is also at risk due to proposed or enacted policies that undermine the role of public health officials or access to preventive healthcare.

“This Blueprint Report provides a roadmap for the Administration and Congress taking office in January to improve the health and well-being of the nation. We know what works in public health and that when Congress and the Administration act in support of public health, the return is improved preparedness and individual and community health and safety,” said J. Nadine Gracia, M.D. MSCE, President and CEO, Trust for America’s Health. “The next Administration and Congress will have an important opportunity to enable all Americans to enjoy optimal health.”

2024 Blueprint Priority Areas and Highlighted Recommendations

This report includes recommendations across six priority areas to protect and strengthen public health, prevention, and our nation’s health security. The following are highlighted recommendations from the report. See the report for the inclusive set of recommendations.

Priority 1: Invest in Infrastructure and Workforce to Ensure Our Public Health System Can Meet the Challenges and Opportunities of the 21st Century.

  • Congress should protect and increase overall funding for the Centers for Disease Control and Prevention (CDC).
  • Congress should ensure continuous improvement of public health infrastructure.
  • Congress should invest in public health data modernization and enact the Improving DATA in Public Health Act to better detect and contain health threats.
  • Congress and HHS agencies should support efforts to bolster recruitment, retention, and resilience of the public health workforce.

Priority 2: Strengthen Prevention, Readiness, and Response to Health Security Threats.

  • The White House should maintain coordination and leadership around public health emergencies and biodefense, and the White House and Congress should renew the nation’s Global Health Security Commitment.
  • Congress should expand public health emergency preparedness funding for state, tribal, local, and territorial jurisdictions.
  • Congress and the Administration for Strategic Preparedness and Response should strengthen the emergency readiness of the healthcare delivery system.
  • Congress should enact legislation to ensure access to vaccines for uninsured and underinsured adults.
  • Congress should support nationwide efforts to protect against environmental and climate-related health threats, including extreme heat.

Priority 3: Promote the Health and Well-being of Individuals, Families, and Communities Across the Lifespan.

  • Congress should increase funding to CDC’s National Center for Chronic Disease Prevention and Health Promotion.
  • Congress should enhance benefits in and protect access to the Supplemental Nutrition Assistance Program and should make healthy school meals for all permanent.
  • Congress should create a national standard requiring employers to provide job-protected paid sick, family, and medical leave for all employees.
  • Congress and HHS should address Adverse Childhood Experiences (ACEs) by passing the Preventing Adverse Childhood Experiences Act and increasing the investment in the CDC ACEs program.
  • Congress should fund the nationwide implementation of CDC’s Comprehensive Suicide Prevention Program and support Substance Abuse and Mental Health Services Administration’s efforts to bolster the continuum of crisis care.
  • Congress and the Administration should fund CDC’s internal capacity for healthy aging efforts and its support to build and sustain age-friendly public health systems in state, local, tribal, and territorial public health departments.

Priority 4: Advance Health Equity by Addressing Structural Discrimination.

  • Federal agencies should regularly update and report progress on agency equity plans, ensuring metrics are inclusive of and extend beyond tracking disparities.
  • Congress and the Administration should ensure accurate and complete data collection to report health-related information by race/ethnicity, age, sex, disability, language, sexual orientation, gender identity, and geography.
  • Federal health agencies should focus funding on populations at elevated risk for chronic disease and poor health outcomes due to the impact of structural discrimination and disinvestment.

Priority 5: Address the Non-Medical Drivers of Health to Improve the Nation’s Health Outcomes.

  • Congress should increase funding to $150 million for the Social Determinants of Health program at CDC and pass the Improving Social Determinants of Health Act.
  • The Administration should continue to build on the Centers for Medicare & Medicaid Services’ (CMS) efforts to support Medicaid, Medicare, and Children’s Health Insurance Program coverage of patients’ health-related social needs.
  • CMS and Congress should explore opportunities to expand the capacity of healthcare providers and payers to screen and refer individuals to social services.
  • Congress should amend tax laws to increase economic opportunity for families by expanding access to the Child Tax Credit and Earned Income Tax Credit.

Priority 6: Enhance and Protect the Scientific Integrity, Effectiveness, and Accountability of the Agencies Charged with Protecting the Health of all Americans.

  • The Administration and Congress should maintain the existing structure of federal health agencies, which have specific roles and expertise in protecting the nation’s health.
  • The Administration should protect the scientific integrity of public health agencies and leaders.
  • Congress and HHS should invest in and prioritize effective public health communications and reducing the spread of misinformation and disinformation.
  • Lawmakers and courts should reject laws that weaken or preempt public health authorities, which could threaten basic public health protections such as outbreak detection, vaccination, and response.

 

Read the full report

Trust for America’s Health is a nonprofit, nonpartisan public health research, policy, and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. 

 

 

Nuevo informe: Décadas de Infrafinanciación han Limitado la Capacidad del Sistema de Salud Pública para Proteger la Salud de los Estadounidenses y Responder a Emergencias

La financiación federal básica de la salud pública ha permanecido estancada durante la última década, mientras que la población de la nación y los riesgos para la salud han aumentado.

(Washington, DC – 21 de agosto de 2024) – La insuficiente financiación ha dejado al sistema de salud pública de la nación mal preparado para enfrentar los retos de salud pública del siglo 21st, según un nuevo informe titulado, El Impacto de la Infrafinanciación Crónica en el Sistema de Salud Pública de América 2024: Tendencias, riesgos y recomendaciones, publicado hoy por Trust for America’s Health.

Según el informe, el aumento de las tasas de enfermedades crónicas del país y la lenta respuesta a la emergencia de salud pública del COVID-19 se debieron en parte a décadas de falta de inversión en infraestructuras de salud pública y en su fuerza laboral. Otro motivo de preocupación es que los avances en seguridad sanitaria logrados cuando los legisladores aumentaron la financiación de la sanidad pública debido a la emergencia del COVID-19 están ahora en riesgo, ya que la financiación está llegando a su fin.

La mayor parte de la financiación de la salud pública es asignada por el gobierno federal, principalmente a través de los Centros para el Control y la Prevención de Enfermedades (CDC), a los estados, tribus, territorios y departamentos de salud locales. Estas entidades, a su vez, apoyan una amplia gama de actividades de salud pública fundamentales, como la detección y vigilancia de enfermedades, la seguridad de los alimentos, el agua y el medio ambiente, la promoción de la salud y la preparación para emergencias. Sin embargo, la financiación federal no ha seguido el ritmo de los crecientes retos que ha enfrentado la salud pública de la nación. El presupuesto del año fiscal actual de los CDC para el año fiscal 2024 (FY 2024) es un 3% menor que el del año fiscal 2023, cuando se toma en cuenta la inflación y solo ha aumentado un 4% en la última década después de ajustarse por la inflación.

En lo que respecta específicamente a la preparación ante emergencias, el acuerdo de cooperación de los CDC para la Preparación ante Emergencias de Salud Pública (PHEP, por sus siglas en inglés), proporciona financiación y asistencia técnica a los departamentos de salud estatales, locales y territoriales para apoyar su preparación ante emergencias, pero se ha observado una disminución de financiamiento a lo largo de las dos últimas décadas. La financiación anual actual del programa, de 735 millones de dólares, está muy por debajo de los 1,000 millones recomendados por la comunidad de salud pública.

Un segundo programa de preparación para emergencias, el programa de Preparación y Recuperación Sanitarias, administrado por la Administración para la Preparación y Respuesta Estratégicas, ha visto reducida su financiación en casi dos tercios tras ajustarla por inflación.

Otra área de infrafinanciación crónica se refiere a los programas dirigidos al número de estadounidenses que viven con una enfermedad crónica. Seis de cada diez adultos estadounidenses padecen una enfermedad crónica, y las enfermedades crónicas y los problemas de salud mental representan la gran mayoría del gasto sanitario del país. Con poca visión de futuro, la financiación de programas de promoción de la salud y prevención de enfermedades como la obesidad, el cáncer y el abuso de sustancias es tan baja que en muchas comunidades no existen programas probados y basados en pruebas debido a la falta de financiación. Se espera que los CDC gasten solo $1,400 millones de dólares en la prevención de enfermedades crónicas y la promoción de la salud este año fiscal, una cantidad inferior a lo que gastaron en estos programas en el año fiscal 2015 después de ajustar la inflación y una pequeña parte de los $4,5 billones de dólares que el país gasta anualmente en atención sanitaria.

Los progresos realizados en respuesta a la pandemia de COVID-19 están en peligro debido a un déficit de financiación

La respuesta a la emergencia de salud pública COVID-19 incluyó inversiones significativas en infraestructura de salud pública, mano de obra y medidas políticas para apoyar la seguridad económica y nutricional de los estadounidenses. Estas medidas fueron fundamentales para la respuesta nacional y ayudaron a que el país fuera más sano y resistente. Pero fueron asignaciones únicas y temporales y debido a que la financiación finalizó o fue rescindida, el progreso creado corre el riesgo de perderse.

Hay que actuar para salvaguardar la salud de la nación

El informe incluye medidas recomendadas a la Administración y al Congreso para proteger la salud para hacer frente a las disparidades sanitarias, reducir el gasto sanitario y mejorar la seguridad económica y nacional de la nación, entre ellas incluye:

  • Reforzar las infraestructuras de salud pública del país: Aumentar y mantener la financiación para modernizar los sistemas de datos de salud pública, apoyar a los laboratorios locales y estatales de salud pública y epidemiología, aumentando y diversificando el personal de salud pública.
  • Mejorar la seguridad sanitaria: Aumentar la financiación de programas que refuercen las defensas frente a una amplia gama de amenazas, desde enfermedades infecciosas a fenómenos meteorológicos. Apoyar la infraestructura de vacunas y garantizar la preparación del sistema sanitario.
  • Abordar las desigualdades sanitarias y los determinantes sociales de la salud: Invertir en programas y políticas que aborden las causas profundas de las disparidades sanitarias, incluidos los factores sociales y estructurales de la salud.
  • Promover la salud y prevenir las enfermedades crónicas a lo largo de toda la vida: Asignar recursos para intervenciones basadas en pruebas que promuevan comportamientos saludables y prevengan enfermedades crónicas en todas las etapas de la vida.
  • Dar prioridad a la prevención primaria de los problemas de salud conductual y las muertes por desesperación: Invertir en programas integrales de prevención del suicidio y los trastornos por consumo de sustancias, haciendo hincapié en las intervenciones tempranas y la identificación oportuna de las personas en situación de riesgo.
  • Prepararse y mitigar las consecuencias sanitarias del cambio climático y las amenazas medioambientales: Aumentar la financiación para hacer frente a las consecuencias sanitarias del cambio climático, los fenómenos meteorológicos extremos y otros peligros medioambientales para la salud.

Trust for America’s Health es una organización sin fines de lucro, no partidista, dedicada a la protección, investigación y la defensa de políticas de salud pública, promoviendo una salud óptima para todas las personas y comunidades, haciendo que la  prevención de enfermedades y lesiones sea una prioridad nacional.

Racial and Ethnic Approaches to Community Health (REACH) Program’s 25th Anniversary

Trust for America’s Health hosted a virtual Congressional briefing and national webinar honoring the 25th anniversary of the Centers for Disease Control and Prevention (CDC) Racial and Ethnic Approaches to Community Health (REACH) program. REACH aims to improve health, prevent chronic diseases, and reduce health disparities among racial and ethnic populations with the highest risk, or burden of chronic disease. Since 1999, the program has empowered communities to develop and share effective solutions, fostering a healthier future for all.

A panel of subject matter experts discussed the history, achievements, and future of the REACH program.

Ready or Not 2024: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism

The Ready or Not 2024: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report identifies gaps in national and state preparedness to protect residents’ health during emergencies and makes recommendations to strengthen the nation’s public health system and improve emergency readiness. As the nation experiences an increasing number of infectious disease outbreaks and extreme weather events, the report found that while emergency preparedness has improved in some areas, policymakers not heeding the lessons of past emergencies, funding cuts, and health misinformation put decades of progress at risk.

 

Resource:

Ready or Not 2024: State-by-State Factsheets

TFAH Celebrates National Public Health Week

April 1-7, 2024 is National Public Health Week. This year’s theme is Protecting, Connecting and Thriving: We Are All Public Health and TFAH is proud to celebrate and recognize all of the individuals, organizations, and agencies that work to protect health, advance equity, and promote well-being in communities nationwide.

Public health workers are on the front lines helping communities prevent chronic diseases and substance misuse, defending against disease outbreaks, protecting our water supply, and preparing for and responding to natural and human-caused disasters. Their work is constant and critically important to improving and protecting the health and safety of all communities.

Examples of the contributions of the public health system to advancing Americans’ health are many, including:

  • Increasing life expectancy – Americans’ life expectancy steadily increased during the 20th century and through 2009 the first decade of the 21st century, was flat between 2010 and 2018 the next decade, and declined during the COVID-19 pandemic. The latest available data, for 2022, showed a slight rebound in the life expectancy trendline.
  • Delivering vaccines – the 20th and beginning of the 21st centuries saw substantial decreases in vaccine preventable diseases such as measles and polio thanks in part to public health programs to ensure vaccine access, particularly in underserved communities.
  • Promoting maternal and infant health – programs to support pregnant people have created improved access to prenatal, post-partum, and infant healthcare, but more work needs to be done to address racial and ethnic disparities in maternal and postpartum health outcomes.
  • Helping people who smoke quit – the initial phase of the Centers for Disease Control’s Tips from Former Smokers campaign (2012 – 2018) helped more than one million people successfully stop smoking, which has prevented an estimated 129,000 early deaths and saved approximately $7.3 billion in smoking-related healthcare costs.
  • Protecting health during extreme heat – extreme heat threatens the public’s health. Several U.S. jurisdictions have heat response plans, and others are working on creating such plans. Heat response plans outline actions to mitigate the impact of the increasing number and intensity of heatwaves.

“Public health practitioners work tirelessly to prevent disease, prepare for and respond to disasters, address health disparities, and create healthy communities. This vital work deserves support and requires investment to fully fund the public health infrastructure and its workforce,” said Dr. J. Nadine Gracia, M.D. MSCE, President and CEO of Trust for America’s Health.

Most of the money spent on healthcare in the U.S. goes toward preventable illnesses and injuries. Increased and sustained funding for public health would be an investment in prevention and would help to reduce healthcare spending over time. TFAH has called for $4.5 billion annually to adequately fund public health infrastructure across the country.  As the White House and Congress work on FY 2025 appropriations, lawmakers should support the full range of work the CDC and health departments do every day to keep communities safe and healthy.

A different public health theme is highlighted each day during National Public Health Week. Visit the American Public Health Association and to access information and resources on each topic.

New Report Measures States’ Emergency Preparedness and Recommends Policy Actions to Strengthen the Nation’s Public Health System and Emergency Preparedness

Special Section Examines Health Impacts of Extreme Heat and the Disproportionate Risks for Certain Population Groups

(Washington, DC – March 14, 2024) – Ready or Not 2024: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, released today by Trust for America’s Health, identifies key gaps in national and state preparedness to protect residents’ health during emergencies and makes recommendations to strengthen the nation’s public health system and improve emergency readiness.

As the nation experiences an increasing number of infectious disease outbreaks and extreme weather events, the report found that while emergency preparedness has improved in some areas, policymakers not heeding the lessons of past emergencies, funding cuts, and health misinformation are putting decades of progress in public health preparedness at risk.

Based on nine indicators, the report tiers states, and the District of Columbia, into three readiness levels: high, middle, and low. This year’s report placed 21 states and DC in the high-performance tier, 13 states in the middle-performance tier, and 16 states in the low-performance tier.

High Tier – 21 states & DC

AL, AZ, CO, CT, DC, FL, GA, KS, MA, ME, MS, NC, NE, NJ, OH, PA, RI, SC, TN, VA, VT, WA

Middle Tier – 13 states

AR, DE, IA, ID, IL, MD, MO, MT, NH, NM, OK, UT, WI

Low Tier – 16 states

AK, CA, HI, IN, KY, LA, MI, MN, ND, NV, NY, OR, SD, TX, WV, WY

The report is designed to give policymakers actionable data and benchmarks to improve their jurisdiction’s readiness through new and sustained investment in public health infrastructure, modern data systems, a larger and more diverse public health workforce, and collaboration between public health and healthcare systems, and both systems’ ability to surge capacity in response to emergencies. Additional areas of responsibility for the public health system are enhancing vaccine access and monitoring municipal water systems safety.

“This report underscores the need for comprehensive investment in public health infrastructure and preparedness and highlights the importance of addressing the disproportionate effects of underinvestment in public health on communities of color and other groups that have been underserved or marginalized,” said Dr. J. Nadine Gracia, President and CEO of Trust for America’s Health. “Recent public health emergencies, from wildfires to infectious disease outbreaks, not only reveal the imperative for a modernized public health system they also highlight the intrinsic link between the overall health of a community and its ability to be resilient during an emergency. Focusing on eliminating health disparities, advancing health equity, and stemming the rise in chronic diseases is essential for enhancing the nation’s emergency preparedness.”

The report’s special section discusses the increasing health risks from extreme heat, including for particular population groups: people who live in under-resourced communities, people living in urban heat islands or without air conditioning, people who work outdoors, people with chronic diseases, pregnant individuals, infants, children, and older adults. In 2022, more people died in the U.S. due to extreme heat than from any other single type of weather event.

The report’s findings showed both areas of strength in the nation’s health emergency preparedness and areas that need attention.

Areas of strong performance include:

  • A majority of states have made preparations to expand healthcare and public health laboratory capacity in an emergency. As of the end of 2023, 39 states participate in the Nurse Licensure Compact, which helps facilitate emergency response efforts by allowing nurses to work in multiple member states, both in person and via telehealth, without the need for additional state licenses. Additionally, 46 states and the District of Columbia have written plans for the expansion of public health laboratory services during health emergencies.
  • Most states (43) and the District of Columbia are accredited in the areas of public health or emergency management, with many accredited in both.
  • A majority of states (at least 37) and the District of Columbia either maintained or increased their public health funding during fiscal year 2023. State investment in public health is particularly important because most federal funding in response to the COVID-19 pandemic was temporary, one-time funding.

Areas that need attention include:

  • Too few people are vaccinated against seasonal flu. During the 2022-2023 flu season, only 49 percent of the population (ages 6 months and older) was vaccinated against the flu, well short of the 70 percent goal established by Healthy People 2030. There is concern among public health experts that misinformation about the COVID-19 vaccine could be impacting the uptake of other vaccines.
  • On average, only 25 percent of acute care hospitals in states earned a top-quality patient safety grade in fall 2023. Hospital safety scores measure performance on issues such as healthcare-associated infection rates, intensive-care capacity, and an overall culture of error prevention – all critical for performing at their best during health emergencies.
  • On average, only 55 percent of U.S. workers used paid time off during the period from March 2018 to March 2023. Access to paid time off is an important readiness measure because workers who go to work sick risk spreading infections in the workforce and throughout the community.

Policy action is needed:

The report contains recommendations for policy actions across both public and private sectors that would create stronger public health preparedness, including:

  • Congress should enhance and modernize public health infrastructure by investing $4.5 billion per year to support foundational public health capabilities at the federal, state, tribal, local, and territorial levels, including investments in data systems and the public health workforce.
  • Congress should empower CDC to collect public health data in a timely and coordinated manner, and the U.S. Department of Health and Human Services (HHS) and all jurisdictions should ensure timely, complete, and disaggregated data collection and reporting. Together, these will enable faster and more effective detection and response to health emergencies.
  • Policymakers should prioritize rebuilding trust in public health agencies and leaders. Public health policy decisions should always be based on the best available science and free from political considerations, and federal agencies should be equipped to provide timely and clear public health guidance.
  • Congress should provide at least $1.1 billion per year to support vaccine infrastructure and equitable delivery of vaccines. States should minimize vaccine exemptions for schoolchildren, and healthcare facilities should increase vaccination rates among healthcare workers.
  • Congress should significantly increase investments in public health initiatives to prevent, detect, and contain antimicrobial resistance.
  • Congress and states should provide job-protected paid leave to contain the spread of outbreaks and protect health.
  • Congress should provide significant funding for medical countermeasures and should work with the private sector to plan for their distribution and dispensing when needed.
  • Congress, HHS, and healthcare leaders should strengthen healthcare readiness and recovery, and state and local emergency planners should work with the healthcare sector to integrate healthcare delivery into emergency preparedness and response.
  • Congress should increase investments in programs that identify and mitigate the health impacts of climate change, environmental hazards, and extreme weather.

Read the report

Trust for America’s Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.