Issue Category: Public Health Funding

Over 110 Organizations Call on Senate to Oppose Cuts to Prevention Fund

(Washington, DC – September 20, 2023) – Trust for America’s Health, American Public Health Association, Association of Public Health Laboratories, Big Cities Health Coalition, Campaign for Tobacco-free Kids, Council of State and Territorial Epidemiologists, National Association of County and City Health Officials, and more than 100 other organizations representing public health, healthcare, research, social services, and other sectors, today released a letter to the Senate Health, Education, Labor, and Pensions (HELP) Committee opposing a committee proposal to cut $980 million from the Prevention & Public Health Fund (“the Prevention Fund”) to pay for other health legislation.

The Prevention Fund is a critical source of funding for the Centers for Disease Control and Prevention and other agencies across Health and Human Services. The Prevention Fund invests in states and communities across the nation to strengthen systems and the workforce that allow us to provide immunizations, detect and control outbreaks, and prevent illness and early deaths from tobacco and chronic diseases. It supports activities outside one’s doctor’s office – separate and distinct from individual health concerns and treatments.

In an already challenging budget environment, this would further endanger the health of Americans. These cuts would impact not only health programs, but also labor and education, as it will leave a significant gap in base appropriations for the Labor-HHS-Education spending bill that will need to be backfilled. This pay-for has far reaching consequences for all ofthe  programs that fall under the spending bill’s purview.

The letter in part reads:

“The nation can no longer afford to underfund public health…. Despite spending more than any other high-income nation on treating disease, the U.S. has substantially worse health outcomes, with life expectancy declining in recent years. Now is the time to invest in public health and prevention…

Cuts to the Prevention Fund will translate into funding shortfalls in programs that states have long relied upon to keep their residents healthy and safe. In its first 14 years (FY2010–23), the Prevention Fund has invested more than $12.3 billion in resources to states, localities, and tribal and community organizations in support of critical prevention and public health programs. These investments include the 317 immunization program that enables prevention of outbreaks, epidemiologists and public health laboratory grants in every state and territory to detect and investigate outbreaks and prevent further infections, the Preventive Health and Health Services (Prevent) Block Grant that enables states and localities to address their most pressing health concerns, supporting cancer screenings, and other critically important programs. Across the U.S. Department of Health and Human Services, the Prevention Fund supports programs such as suicide prevention, Alzheimer’s disease prevention, and chronic disease self-management.

Funding prevention not only saves lives, but it also saves money. The Prevention Fund’s Tips from Former Smokers Campaign alone saved an estimated $7.3 billion in smoking-related healthcare costs from 2012 to 2018 and helped more than one million Americans quit smoking for good. Public health funding has not kept up with the range of threats that public health must address. For many of these conditions, we know what works, but public health does not have the resources to address these growing health threats.”

The full text of the letter is linked here.

Information about the Prevention and Public Health Fund can be found here.

Organizations Joining the Letter:

ADAP Advocacy

American Academy of Pediatrics

American Association on Health and Disability

American College of Clinical Pharmacy

American College of Obstetricians and Gynecologists

American College of Physicians

American College of Preventive Medicine

American College of Sports Medicine

American Heart Association

American Lung Association

American Public Health Association

American Society for Microbiology

American Society on Aging

American Statistical Association

Association for Prevention Teaching and Research

Association for Professionals in Infection Control and Epidemiology

Association of American Medical Colleges

Association of Immunization Managers

Association of Maternal & Child Health Programs

Association of Pathology Chairs

Association of Public Health Laboratories

Association of Schools and Programs of Public Health

Association of State and Territorial Health Officials

Asthma and Allergy Foundation of America

Big Cities Health Coalition

CAEAR Coalition

Campaign for Tobacco-Free Kids

Center for Advocacy for the Rights and Interests of Elders (CARIE)

Children’s Environmental Health Network

Christian Council of Delmarva

City-County Health District

Colorado Public Health Association

Community Access National Network

Connecticut Public Health Association

Cook County Department of Public Health

Council of State and Territorial Epidemiologists

Dorchester County Health Department

Early Impact Virginia

Endocrine Society

Eta Sigma Gamma

Foundation for Healthy Generations

Futures Without Violence

GLMA: Health Professionals Advancing LGBTQ+ Equality

GO2 for Lung Cancer

Green & Healthy Homes Initiative, Inc

Health Promotion Consultants

Healthy Weight Partnership Inc.

HIV Medicine Association

HLN Consulting, LLC

Illinois Society for the Prevention of Blindness

Immunize.org

Institute for Public Health Innovation

International WELL Building Institute

Johns Hopkins Center for Health Security

Kansas Breastfeeding Coalition

Kentucky Voices for Health

Kids and Car Safety

Lakeshore Foundation

Linn County Public Health

Maine Public Health Association

March of Dimes

Marked By Covid

MaryCatherine Jones Consulting, LLC

Mel Leaman Free Clinic

Mental Health America

Minnesota Public Health Association

NASTAD

National Alliance of Public Health Students and Alums

National Association of Chronic Disease Directors

National Association of County and City Health Officials

National Association of Social Workers

National Center for Healthy Housing

National Center on Domestic and Sexual Violence

National Network of Public Health Institutes

National Nurse-Led Care Consortium

National Prevention Science Coalition

Nemours Children’s Health

New Jersey Public Health Association

New York State Public Health Association

Oregon Coalition of Local Health Officials

Peggy Lillis Foundation

Pennsylvania Public Health Association

Population Association of America

Prevent Blindness

Prevent Blindness Georgia

Prevent Blindness Ohio

Prevent Blindness Wisconsin

Prevent Child Abuse America

Prevention Institute

Public Health Foundation

Public Health Institute

Redstone Global Center for Prevention and Wellness

Resolve to Save Lives

RiverStone Health

Safe States Alliance

Society for Healthcare Epidemiology of America

Society for Maternal-Fetal Medicine

Society for Public Health Education

Society for Women’s Health Research

Sound Generations

Sound Generations – Project Enhance

Spina Bifida Association

Task Force for Global Health

The 317 Coalition

The Foundation for Sustainable Communities

The Gerontological Society of America

Trust for America’s Health

USAging

Vaccinate Your Family

Voices for Vaccines

Washington State Association of Local Public Health Officials

Washington State Public Health Association

Well-Being and Equity in the World

Wisconsin Public Health Association

YMCA of the USA

 

 

 

At One Year Mark Data Show 988 Suicide and Crisis Lifeline Has Improved Crisis Care Access and Response, and that Sustained and Increased Funding is Needed

This month marks the one-year anniversary of the 988 Suicide and Crisis Lifeline, which replaced the previous National Suicide Prevention Lifeline with a single three-digit number for mental health, substance misuse, and crisis services. With oversight and funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) and assistance from partners like Crisis Text Line and The Trevor Project, 988 consists of independently operated and funded call and text/chat centers across the country. When individuals in crisis contact 988, trained crisis counselors at these centers listen, provide support, and share resources if necessary. Access to 988 can play a critical role in improving depressed, suicidal, or overwhelming feelings—in fact, SAMHSA estimates that 98% of individuals contacting 988 receive the crisis support they need in the moment. SAMHSA has also identified the current 988 system as a first step toward evolving crisis care to include mobile crisis units, which provide in-person responses, and stabilization centers, which provide a safe place to stay for individuals in crisis.

Even its current form, however, 988 represents a momentous advancement in the effort to connect more Americans with crisis services. In May 2023, for example, 988 answered 45% more calls, 52% more chats, and 938% texts compared to the previous lifeline in May 2022. In total, 988 answered nearly 160,000 more contacts in May 2023 compared to May 2022, and the average time to answer these contacts decreased from 140 seconds to 35 seconds. 988 has also launched specialized services for the LGBTQ+ population, and SAMHSA just announced the addition Spanish language text and chat services. Other specialized services will likely follow for hearing impaired individuals and American Indian/Alaska Native people.

 

In 2022, Congress supplemented the establishment of 988 with several pieces of legislation containing significant investments and policies to advance behavioral health. The Bipartisan Safer Communities Act (BSCA), passed in June 2022, for example, provided onetime support for 988 and increased support for the National Child Traumatic Stress Network. The BSCA also provided funding for Project AWARE at SAMHSA, which empowers education agencies through training for school personnel, increases awareness and detection of mental health issues, and connects youth and families to needed services. In addition, Congress directed the Centers for Medicare and Medicaid Services to assist schools with expanding school-based health services through Medicaid and funded initiatives at the U.S. Department of Education to hire and retain mental health professionals providing these services.

 

In the Consolidated Appropriations Act (CAA), enacted in December 2022, Congress built on these accomplishments by reauthorizing the Garrett Lee Smith Suicide Prevention Program, which funds mental health programs for college-age students, as well as several programs to improve the behavioral health workforce. The CAA also bolstered crisis-intervention programs by directing guidance and funding to providers and improving payment for their services.

 

The U.S. Department of Health and Human Services (HHS) also acted throughout 2022 to expand access to community-based mental health services. In partnership with the Department of Education, for example, HHS has worked to facilitate the use of Medicaid and Children’s Health Insurance Program funds to support school-based behavioral health services. SAMHSA also launched the Mental Health Crisis Response Partnership Pilot Program to improve access to mobile crisis services in high-need areas.

988 is part of a series of investments to address Americans’ mental health needs

Despite this progress, significant challenges remain in the effort to strengthen 988 and connect individuals in crisis to behavioral health services. For example, although state governments carry the responsibility for funding and operating 988 call centers, only a handful of states have passed legislation to secure long-term financial support for the lifeline through telecommunications fees. A recent study, moreover, found that only around half of states have earmarked sufficient funding to meet increased 988 center costs. Due in part to insufficient funding, call centers can also struggle to hire and retain qualified staff and answer rates can vary significantly by state. Improved data collection and analysis concerning 988 services is also necessary to help identify gaps in crisis care and improve lifeline implementation.

On the federal level, ongoing negotiations in Congress could result in cuts to appropriations for 988, which is an alarming prospect given that SAMHSA estimates outreach to the lifeline will increase by up to 50%—to a total of around 9 million contacts—in FY 2024. States will also require additional federal support to develop and implement mobile responses and stabilization units and publicize the full range of 988 services. A recent survey by the Pew Charitable Trusts, for example, found that only 13% of U.S. adults knew about the existence and purpose of 988; awareness was higher among white adults and individuals with a college education compared to Black adults and individuals with a high school degree or less.

Trust for America’s Health (TFAH) will continue to advocate for additional funding and resources to bolster the 988 lifeline and transform the behavioral health crisis system more broadly. Continued bipartisan support is necessary not only to ensure access to existing services, but also to build the next generation of care to meet the growing demand from Americans in crisis.

Recommendations for addressing Americans’ mental health needs and other issues are available in TFAH’s 2023 Pain in the Nation report.

 

 

 

New Report: Under-Investment in Public Health Leaves Nation Less Prepared for Current and Future Health Risks

COVID-19 Emergency Funding Helped Control the Pandemic, but Did Not Address Structural Weaknesses in the Nation’s Public Health System

(Washington, DC – June 14, 2023) – Decades of underfunding have left the nation’s public health system ill-equipped to protect the health of Americans, according to a new report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2023, being released today by Trust for America’s Health.

Insufficient funding for public health programs has been a long-standing problem. The COVID-19 crisis illuminated weaknesses in the nation’s public health infrastructure, including antiquated data systems, insufficient public health laboratory capacity, an under-resourced public health workforce, and the need for improved public health communications. These foundational public health capacities require increased, flexible, and sustained funding.

While pandemic response emergency funding was critical for addressing the crisis, it represented one-time funding and was often limited to COVID-19-specific spending, i.e., it could not be spent on underlying infrastructure needs. Furthermore, in most instances, this funding has now ended or was rescinded in the recent debt limit agreement. The nation is therefore at risk of returning to a boom-and-bust pattern of sporadic funding increases for public health during emergencies followed by insufficient funding in non-emergency periods.

The U.S. Centers for Disease Control and Prevention (CDC), the primary source of public health funding for state, local, tribal, and territorial health departments, is itself reliant on the annual federal appropriations process. Over the past two decades (FY 2014 – 2023), the CDC’s budget has increased by just 6 percent after adjusting for inflation, leading to insufficient funding in key program areas such as emergency preparedness and chronic disease prevention.

Two CDC programs focused on public health preparedness and response, the Public Health Emergency Preparedness Program (PHEP) and the Healthcare Readiness and Recovery Program, have both experienced major budget cuts over the past two decades. After adjusting for inflation, PHEP funding has been reduced by about half since 2003, and the budget for the Healthcare Readiness and Recovery Program has decreased by nearly two-thirds during the same period.

In addition to the risks associated with health emergencies, the country faces a growing number of people living with chronic diseases and the associated healthcare costs. Today, roughly 60 percent of the U.S. adult population has at least one chronic disease, such as obesity, diabetes, or heart disease. Treating these chronic diseases, along with mental health conditions, accounts for the vast majority of U.S. healthcare spending. While evidence-based public health programs that help prevent chronic disease are doing important work, insufficient funding has limited their accessibility and impact in many communities.

“We must address the serious mismatch between the nation’s public health needs and its public health investment,” said J. Nadine Gracia, M.D. MSCE, President and CEO of Trust for America’s Health. “Public health and prevention represent only a small fraction of the more than $4 trillion in annual health spending in our nation. Increased and sustained investment in public health would not only better prepare us for future public health emergencies, it would also help address the root causes of poor health and health disparities.”

TFAH is calling for annual funding for CDC of at least $11.581 billion in FY 2024, the level requested in the President’s FY 24 budget (FY 2023 CDC funding is $9.2 billion).

Other policy recommendations within the report include:

  • Increase and sustain disease-agnostic funding to strengthen public health infrastructure. Public health experts estimate an annual shortfall of $4.5 billion in necessary funding for state and local health departments to provide comprehensive public health services in their communities.
  • Strengthen public health emergency preparedness, including within the healthcare system. Investments should include the restoration of funding to the Public Health Emergency Preparedness Cooperative Agreement, the Healthcare Readiness and Recovery Program, and programs designed to support vaccine infrastructure as well as prevent, detect, and contain antimicrobial-resistant infections.
  • Modernize the public health data system to ensure comprehensive and real-time data sharing during public health emergencies. Public health experts estimate that at least $7.84 billion is needed over the next five years for CDC’s Data Modernization Initiative to strengthen public health data collection and reporting at the state and local levels. Congress should also provide sustained funding for CDC’s new Center for Forecasting and Outbreak Analytics.
  • Bolster the recruitment and retention of the public health workforce. In 2021, it was estimated that state and local public health departments needed to hire an additional 80,000 employees to be able to deliver a minimum set of public health services. The one-time nature of short-term emergency funding means that health departments will continue to experience understaffing.
  • Address health disparities and the root causes of disease by addressing the social determinants of health and investing in chronic disease prevention.
  • Invest in programs to prepare for and mitigate the impacts of climate change.

Read the full report

 

 

 

Shortchanged: The Impact of Chronic Underinvestment in Public Health

Policymakers are asking: With the United States spending far more on healthcare compared to other high-income nations, why does our nation still yield substantially worse health outcomes and what funding and policy actions must we take to see better results?

To shed light on that important question, Trust for America’s Health (TFAH) and the Coalition for Health Funding (CHF) are gathering experts in public health policy and funding on June 20th to discuss the critical need for increased, sustainable, and flexible funding that specifically targets public health and prevention. The discussion will focus on how to address the longstanding gaps in public health capacity resulting from chronic underfunding.

Resources:

Ready or Not 2023: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism

This briefing explores the findings from TFAH’s recent report, Ready or Not 2023: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism.

The past year alone saw the U.S. surpassing 1 million deaths due to COVID-19, decreasing rates of routine vaccinations, and increasing prevalence of health misinformation. In addition, last year the U.S. experienced 10 or more billion-dollar weather-related disasters for the eighth consecutive year. The webinar will review TFAH’s 2023 Ready or Not report which measures states’ degree of preparedness to respond to a wide spectrum of health emergencies and to provide ongoing public health services.

Subject matter experts discussed the nation’s readiness for public health emergencies, examine the findings of the report, and discuss key recommendations for policymakers.

Resources:

Trust for America’s Health

Children’s National Hospital