Issue Category: Public Health Funding

Nuevo Reporte: La Falta Reiterada de inversión en Salud Pública Por Parte de la Nación, Pone en Riesgo La Vida y Los Medios De Subsistencia De Los Estadounidenses

Los Fondos de Emergencia del COVID-19 fue una respuesta fundamental desde un principio, pero no lo suficiente efectiva para atender el problema que viene acarreando el país debido a la falta de inversión en la salud pública; Se necesitan $ 4.5 mil millones en fondos anuales

(Washington, DC – 28 de julio del 2022) – La insuficiencia crónica de fondos ha creado un sistema de salud pública que no logra cubrir las necesidades de seguridad de salud de la nación, las persistentes desigualdades en la salud, así como las amenazas emergentes, y fue uno de los factores que contribuyó a la respuesta inadecuada a la pandemia de COVID-19, según un informe, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2022, publicado hoy por Trust for America’s Health.

“El financiamiento de emergencia es importante pero no suficiente para llenar los vacíos de larga data en las inversiones en salud pública. El ciclo de ‘auge y caída’ de la financiación de la salud pública demuestra que el sistema no tiene las herramientas o la fuerza laboral para modernizarse y responder a las diversas amenazas que afectan a nuestras comunidades”, dijo J. Nadine Gracia, M.D., MSCE, presidente y directora ejecutiva de Trust for America’s Health.

Este informe anual examina las tendencias de financiación de la salud pública a nivel federal, estatal y local, recomendando inversiones y acciones políticas para construir un sistema de salud pública más fuerte, dándole prioridad a la prevención, abordando temas como las desigualdades sociales y económicas las cuales crean barreras para lograr un buen sistema de salud en muchas comunidades.

La falta de fondos para programas básicos de salud pública desaceleró la respuesta a la pandemia de COVID-19 y exacerbó su impacto, particularmente en las comunidades de bajos ingresos, comunidades de color y en los estadounidenses de avanzada edad los cuales son las poblaciones que representan las tasas más altas de enfermedades crónicas y tienen menos recursos para recuperarse de una emergencia. TFAH es una de las numerosas organizaciones dentro de la comunidad de salud pública que solicita una inversión anual de $4500 millones en infraestructura de salud pública a nivel estatal, local, tribus y territorial.

“A medida que atravesamos nuevas etapas de la pandemia vemos más allá, y se observa que la necesidad fundamental es que se modernice la infraestructura de datos de salud pública, que aumentemos y diversifiquemos la fuerza laboral de salud pública, que se invierta en programas de prevención y promoción de la salud, reduciendo las desigualdades en el sector de la salud. Las inversiones en salud pública son necesarias en todas las comunidades, pero deben dirigirse particularmente a aquellas comunidades que, debido a los impactos del racismo estructural, la pobreza, la discriminación sistémica y la desinversión, se encuentran en mayor riesgo durante una emergencia de salud”, dijo el Dr. Gracia.

El fondo de emergencia no es suficiente para atender las debilidades del sistema creadas por la falta de financiación crónica

Las agencias de salud pública estatales y locales manejaron dos realidades divergentes durante el 2021. La financiación a corto plazo aumentó significativamente ya que el gobierno federal proporcionó fondos de emergencia en respuesta a los estados y localidades en esfuerzo para controlar la pandemia. Pero esta financiación de dinero se realizó sola vez, y en algunos casos específicamente vinculado al COVID-19. Gran parte de este fondo de emergencia no pudo ser utilizada para abordar los déficits de larga data en el sistema de salud pública, los cuales incluían asegurar provisiones para cubrir los gastos básicos de salud pública, sustituir los sistemas desactualizados de datos y aumentar la fuerza laboral de salud pública. Un análisis de octubre del 2021 realizado por la Fundación de Beaumont y el Centro Nacional de Innovaciones de Salud Pública encontró que los departamentos estatales y locales de salud necesitan un aumento del 80 por ciento en el campo de su fuerza laboral para poder brindar servicios integrales de salud pública a sus comunidades.

Otro desafío para los departamentos de salud a nivel estatal y local es que los fondos de emergencias, si bien es una gran ayuda durante la emergencia, es demasiado tarde para trabajar en un plan de preparación y prevención, ya que estos programas deben implementarse antes de una emergencia para proteger vidas. Para estar adecuadamente preparado para la próxima emergencia de salud pública, la nación debe mantener los niveles de fondos más altos respecto a la salud pública y proveer una financiación flexible.

Los fondos de dos programas clave de preparación y respuesta de emergencias se han visto drásticamente reducidos en las últimas dos décadas:

  • Los Centros para el Control y la Prevención de Enfermedades (CDC) de EE. UU. son la principal agencia de salud pública del país y la principal fuente de financiación para los departamentos de salud estatales, locales, tribales y territoriales. La financiación anual de los CDC para los programas de preparación para emergencias de salud pública (PHEP, por sus siglas en inglés) aumentó ligeramente entre el año fiscal 2021 y el año fiscal 2022, de $840 millones a $862 millones, pero ha reducido un poco más de una quinta parte desde el año fiscal 2002, ó aproximadamente a la mitad cuando se ajusta por inflación.
  • El Programa de Preparación Hospitalaria, administrado por la Oficina del Subsecretario de Preparación y Respuesta del Departamento de Salud y Servicios Humanos de EE. UU., es la fuente principal de financiamiento federal para ayudar a los sistemas de atención médica a prepararse para emergencias. El programa ha sufrido una reducción de casi dos tercios en las últimas dos décadas cuando se ajusta a la inflación.

Los fondos para la promoción de la salud, la prevención y la equidad también necesita un crecimiento sostenido

Como nación, gastamos $4,1 billones en salud en 2020, pero solo el 5,4 % de ese gasto se destinó a la salud pública y la prevención. Notablemente, casi se duplicó la cifra del año pasado en comparación con el 2019. Esto se debe a la respuesta de fondos implementados a corto plazo en respuesta al COVID-19. Sin embargo, esta cifra sigue siendo insuficiente y muy probable que regrese a los niveles en los que se encontraba antes de la pandemia, si el patrón histórico de aumento de fondos para la salud pública aumenta durante otra emergencia, volveremos a estar en la misma situación.  La financiación inadecuada significa que los programas efectivos de salud pública, como aquellos para prevenir el suicidio, la obesidad y las amenazas ambientales para la salud, solo llegan a una fracción de los estados. Esta negligencia de larga data contribuye a las altas tasas de enfermedades crónicas y a las persistentes desigualdades en el ámbito de la salud.

“Debemos romper el patrón de invertir solo en el sistema de salud pública durante una emergencia, ya que no permite trabajar en la preparación y prevención. Es muy importante invertir en salud pública y equidad sanitaria de manera continua, incluso en tiempos que no sean de emergencia, para lograr salvar vidas, reduciendo los costos económicos para nuestra nación durante y entre emergencias”, dijo la Dra. Gracia.

Los impactos del racismo estructural, la pobreza, la discriminación y la desinversión son temas que deben de igual manera abordarse mediante inversiones a través de programas que aseguren que cada comunidad tenga acceso a alimentos saludables, vivienda segura, atención médica, transporte, educación y empleo, ya que todos estos factores afectan la salud de las personas.

Recomendaciones para tomar medidas de acción:

El informe exige la adopción de medidas de acción por parte de la administración, el Congreso y funcionarios tanto estatales como locales en cuatro áreas:

Aumentar sustancialmente los fondos básicos para fortalecer la infraestructura de salud pública y desarrollar su fuerza laboral, incluyendo el aumento de la asignación básica de los CDC y la modernización de los sistemas de seguimiento de enfermedades y datos de salud pública de la nación.

Invertir en la seguridad de la salud de la nación, aumentando los fondos de salud pública para la preparación de emergencias de sanidad, mejorando la infraestructura de inmunización y tomando en cuenta los impactos del cambio climático.

Abordar las desigualdades de la salud y su impacto como causas principal de  enfermedades abordando los factores sociales de la salud que tienen un impacto descomunal en temas de salud pública.

Proteger y mejorar la salud a través del tiempo en vida. Muchos programas que promuevan la salud y prevengan las principales causas de enfermedad, discapacidad y muerte se han descuidado durante mucho tiempo, además de no estar disponibles en todos los estados ni a las poblaciones que se encuentran en mayor riesgo. Es de vital importancia, activar los programas que frenan las enfermedades crónicas, apoyar a niños y familias para prevenir el uso indebido de sustancias y colocar como máxima prioridad el suicidio.

 

Lea el reporte completo en: The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2022

 

Trust for America’s Health es una organización no partidista sin fines de lucro que promueve la salud óptima para cada persona y comunidad a través de la acción política y trabaja para hacer de la prevención de enfermedades y lesiones una prioridad nacional.

 

 

 

 

 

 

Public Health Leaders Discuss the Importance of Sustained Public Health Funding in the Post COVID-19 Landscape

Trust for America’s Health (TFAH) President & CEO J. Nadine Gracia, and Coalition for Health Funding’s (CHF) Executive Director Erin Will Morton issued the following statement regarding the June 22nd Beyond Emergency Funding: Sustaining Public Health Funding in the Post-COVID Landscape discussion.

(Washington, DC) — Trust for America’s Health and the Coalition for Health Funding are proud to have hosted the Beyond Emergency Funding: Sustaining Public Health Funding in the Post-COVID Landscape discussion on June 22, 2022. This discussion included three expert panelists; Dr. Gracia, Trust for America’s Health, Lisa Macon Harrison, MPH, Health Director, Granville Vance Public Health (North Carolina), and the current President of the National Association of County and City Health Officials, and Dr. Michael Fraser, Chief Executive Officer, the Association of State and Territorial Health Officials. CHF’s president, Mila Becker, moderated the event.

According to the panelists, the COVID-19 pandemic demonstrated a clear need for a well-funded, broad-based public health infrastructure and workforce at all levels. Our organizations urge lawmakers to increase annual funding to achieve these goals and create a sustainable, long-term funding strategy for public health beyond emergency supplemental funding.

The panelists emphasized the following issues during the session:

  • The public health system our country needs cannot be built on the boom-and-bust cycle of emergency funding.
  • The system needs long-term, flexible funding. Short term and inflexible funding lines for public health make investing in essential infrastructure, workforce, and cross-cutting approaches to prevention, including addressing the social determinants of health, impossible.
  • Public health emergency response is more expensive than funding core public health infrastructure. Billions of dollars spent in the years before the COVID-19 pandemic could have saved the trillions of dollars spent in response to the crisis and would have saved lives.
  • We must invest in the public health programs and workforce needed to prevent illness and injury. Doing so would decrease the amount of money now spent on treating preventable disease.
  • We must be nimbler and better prepared in order to save lives during the next public health emergency. Core public health services most in need of sustained investment are:
  • Modernized data systems that provide real-time data for decision-making.
  • Sustained funding for recruitment and retention of a larger and more diverse public health workforce.
  • Programs to achieve health equity – during the pandemic many health departments increased their engagement with community leaders and organizations. Those partnerships and networks should be sustained and grown.
  • We are approaching a COVID “funding cliff” – emergency funding has been spent or is expiring, but core public health services still need to be provided, particularly in those communities where health inequities were exacerbated by the pandemic.

Listen to the full session at: https://www.tfah.org/webinars-briefings/beyond-emergency-funding/

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About TFAH
Trust for America’s Health is a non-partisan public health policy, research and advocacy organization that envisions a nation that values the health and well-being of all and where prevention and health equity are foundational to policymaking at all levels of society.

About CHF
The Coalition for Health Funding works to preserve public health investments in the interest of all Americans. Our 81 member organizations together represent more than 100 million patients and consumers, health providers, professionals, and researchers. Coalition for Health Funding (publichealthfunding.org)

Beyond Emergency Funding: Sustaining Public Health Funding in the Post-COVID Landscape

With Congress having spent billions of dollars fighting COVID-19 since early 2020, why should we increase annual funding for public health when we have so many other competing priorities?

TFAH and the Coalition for Health Funding convened experts in public health policy and funding to clearly explain the need for robust, sustainable public health funding and how it must be considered separately from the COVID-19 emergency.

 

 

U.S. Experienced Highest Ever Combined Rates of Deaths Due to Alcohol, Drugs, and Suicide During the COVID-19 Pandemic

Deaths spanned ages, racial and ethnic groups, and geography but disproportionally harmed young people and people of color

Solutions are known and must be implemented

(Washington, DC – May 24, 2022) – Deaths associated with alcohol, drugs, and suicide took the lives of 186,763 Americans in 2020, a 20 percent one year increase in the combined death rate and the highest number of substance misuse deaths ever recorded for a single year, according to a report released today by Trust for America’s Health (TFAH) and Well Being Trust.  In addition, provisional data from the Centers for Disease Control and Prevention show drug overdose deaths continued to increase in 2021.

While alcohol, drug, and suicide deaths have been increasing for decades, the 2020 increase was unprecedented and driven by a 30 percent increase in the rate of drug-induced deaths and a 27 percent increase in the rate of alcohol-induced deaths.  Combined rates of alcohol, drug, and suicide deaths increased in all 50 states except New Hampshire, and for the first time two states – West Virginia and New Mexico – surpassed 100 deaths per 100,000 state residents from alcohol, drugs, and suicide combined in a single year.

  • The overall drug-induced death rate increased by 30 percent, largely driven by increases in deaths due to use of synthetic opioids and psychostimulants. The rate of drug-induced death rose for all but one population group – those over 75 years of age. There were particularly large increases in communities of color, among youth (17 years old and younger) and young adults (18-34 years of age) and in the South and West regions of the country.
  • Alcohol-induced death rates increased by 27 percent, and the increase spanned demographic groups and parts of the country, including in all 50 states and the District of Columbia. Increases were particularly high among young adults, American Indians/Alaska Native and Asian communities, and for those living in the Midwest.
  • Overall suicide rates declined by 3 percent but that trend was not universal. The decline occurred among white people but suicide deaths for the year increased among American Indian, Black, and Latino people. Suicide rates for adults ages 35-74, declined, but rates for youth and young adults increased.

“With the trends continuing to go in the wrong direction we must ask ourselves, what will it take to move to robust and comprehensive action? The story behind these data is beyond devastating and heartbreaking to those families who have suffered loss,” said Dr. Benjamin F. Miller, President, Well Being Trust. “Let’s begin to address this crisis with the urgency it deserves by bringing care to where people are. From schools to primary care to our workplaces, let’s ensure that all places are equipped to address mental health and substance misuse. This is not just the responsibility of the mental health and addiction field – but all our responsibility.”

TFAH and Well Being Trust have been reporting alcohol-induced, drug-induced and suicide deaths as part of their Pain in the Nation initiative since 2017.  In the initiative’s inaugural 2017 report, alcohol, drug and suicide deaths accounted for 55,403 deaths per year, as compared to the 186,763 deaths associated with alcohol, drugs or suicide in this year’s report. According to the report authors and other experts, the stunning increase in alcohol and drug deaths in 2020 was exacerbated by: a continued rise in synthetic opioid and psychostimulant overdoses and the anxiety, stress, grief, disruption to substance misuse recovery programs, and financial hardship many individuals and families experienced during the COVID-19 pandemic.

The report includes recommendations for steps the federal, state, and local governments should take to begin to reverse the deaths of despair crisis.  They include:

Invest in programs that promote health and prevent substance misuse and suicide:

  • Support in-school programs focused on students’ mental health and preventing substance use.
  • Strengthen trauma-informed and culturally competent and linguistically appropriate programs within all youth-serving agencies, including the juvenile justice system.
  • Strengthen the continuum of crisis intervention programs with a focus on the newly established “988” lifeline.
  • Expand CDC comprehensive suicide-prevention efforts, including measures to strengthen economic supports, promote connectedness, and create protective environments.
  • Build programs that address the social determinants of health and promote resilience in children, families and communities including those focused on the prevention of adverse childhood experiences.

Address the substance misuse and overdose crises:

  • Promote harm-reduction policies to reduce overdose and blood-borne infections, including increasing access to syringe service programs, naloxone, and fentanyl test strips.
  • Preserve and extend programs that create more flexible access to substance use disorder treatment during the pandemic.
  • Direct funding from the opioid litigation settlement to primary prevention of youth substance misuse.
  • Lower excessive alcohol use through policies that limit where and when alcohol can be served/purchased and by the use of alcohol excise taxes.

Transform the mental health and substance abuse prevention system

  • Increase access to mental health and substance use treatment through full enforcement of the Mental Health Parity and Addiction Equity Act.
  • Combat stigma about mental health issues and access to service.
  • Modernize physical and mental health services by aligning service delivery, provider payment, quality measures, and training toward the whole health of individuals and integrated care.
  • Build grassroots community capacity for early identification and intervention for individuals with mental health and substance use disorders, including through community-based or non-traditional settings.

“It is imperative that officials at every level of government act on the recommended policies in this report.  The data are shockingly clear – lives are at risk in every community due to alcohol, drugs, and suicide and communities that experience disadvantage because of long-standing social, economic and environmental inequities suffer a disproportionate impact. There is an urgent need for action in order to save lives,” said J. Nadine Gracia, M.D., MSCE, President and CEO of the Trust for America’s Health.

Read the full report

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

Well Being Trust is an impact philanthropy dedicated to advancing the mental, social, and spiritual health of the nation.

TFAH’s Portal of COVID-19 Resources

The following is a list of TFAH resources and documents related to the novel coronavirus read of COVID-19 and better equip the nation’s public health system to deal with this and future health emergencies.

Press Releases and Statements

20 Public Health Organizations Condemn Herd Immunity Scheme for Controlling Spread of SARS-CoV-2   The virus that causes COVID-19 has infected at least 7.8 million people in the United States and 38 million worldwide. It has led to over 215,000 deaths domestically, and more than 1 million globally – with deaths continuing to climb… read more (October 14, 2020)

Newly Announced Order for Hospitals to Bypass CDC and Send Coronavirus Patient Information Directly to Washington Database Likely to Worsen Pandemic Response Rather than Improve It  The U.S. Centers for Disease Control and Prevention (CDC), as the nation’s lead public health agency, is uniquely qualified to collect, analyze and disseminate information regarding infectious diseases… read more (July 16, 2020)

Nearly 350 Public Health Organizations Implore HHS Secretary Azar to Support CDC’s Critical Role in the COVID-19 Pandemic Response  The expertise of the U.S. Centers for Disease Control and Prevention (CDC) and all public health agencies is critical to protecting Americans’ health during the COVID-19 crisis, said a letter to Health and Human Services Secretary Alex Azar from 347 health and public health organizations released today… read more (July 7, 2020)

Public Health Needs Our Support “As our nation’s struggles to manage the continued surge of COVID-19 cases, we need to strengthen the public health response… read more (June 23, 2020)

Summary of CDC Morbidity and Mortality Weekly Report on COVID-19 Impact Patterns This is the first data reported on U.S. patients and is consistent with findings from other countries. Key takeaways… read more (March 31, 2020)

Trust for America’s Health Statement in Response to Congressional Passage of the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”)
“Congress took an important step today to begin giving public health the resources it needs now to respond to the COVID-19 pandemic. We are seeing in real-time the impact of the chipping away at public health budgets over the past 15 years… read more (March 27, 2020)

Cross-Sector Group of Eighty-eight Organizations Calls on Congress to Address Americans’ Mental Health and Substance Misuse Treatment Needs as Part of COVID-19 Response
A cross-sector group of 88 organizations from the mental health and substance misuse, public health and patient-advocacy sectors are jointly calling on the Trump Administration and Congress to address the immediate and long term mental health and substance misuse treatment needs of all Americans as part of their COVID-19 response… read more (March 20, 2020)

55 Organizations Call for Passage and Fast Implementation of Paid Sick Leave for all Workers as a Critical Part of COVID-19 Response
A cross-sector group of 55 public health, health, labor, business, and social policy organizations are jointly calling on the Trump Administration and Congress to pass and quickly implement a federal paid sick leave law that provides 14 days of such leave to all workers, available immediately… read more (March 13, 2020)

TFAH Applauds Passage of Supplemental Funding for COVID-19 Response: Now Funding Must Move Quickly to States and Other Entities
TFAH applauds Congress’ fast action in approving the Coronavirus Preparedness and Response Supplemental Appropriations Act (H.R 6074). We now call on the tasked federal agencies to move quickly to send the appropriated monies to the agencies and localities working at the frontlines of the COVID-19 crisis… read more (March 5, 2020)

TFAH Statement on COVID-19 Preparations
Now that the U.S. has transitioned from the planning phase to the response phase of the COVID-19 outbreak, the Federal Executive Branch and Congress as well as state and local governments and other stakeholders should prioritize… read more (March 3, 2020)

Congressional Testimony and Sign-on Letters

Commentaries and Op-Eds

Additional News Coverage We Recommend

Coronavirus in the U.S.: Latest Map and Case Count

as compiled by the New York Times

 

 

CDC COVID-19 Information Resources

COVID-19 and Response: Webinars and Briefings

Related Reports

TFAH Recognizes National Minority Health Month

Trust for America’s Health (TFAH) is proud to support National Minority Health Month (NMHM) 2022 and its critical focus on addressing health inequities. This year’s NMHM theme Give Your Community a Boost! notes the importance of ensuring that everyone eligible to receive the COVID-19 vaccine is vaccinated, including all eligible booster doses. Being vaccinated is the best way to protect yourself and your loved ones against severe illness from COVID-19.

“Ensuring that communities of color have equitable access to and reliable sources of information about the COVID-19 vaccine is vital to promoting and protecting the health and well-being of the community,” said TFAH President and CEO, Dr. J. Nadine Gracia. “People of color have been disproportionately impacted by the pandemic, due to longstanding social, economic, and health inequities that led to higher rates of job loss, less access to essential resources for remote learning, and higher rates of infections, hospitalizations, and deaths. We need to focus on two priorities: protecting everyone from COVID-19 now and ensuring that no community is at heightened risk during the next public health emergency. ”

Additional Readings:

TFAH’s 2020 policy brief Building Trust in and Access to a COVID-19 Vaccine Within Communities of Color and Tribal Nations reports on challenges to building vaccine trust and access in communities of color and tribal communities and recommends solutions.

TFAH’s 2022 Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism reports on state-level public health emergency readiness and the connection between health equity and emergency preparedness.

TFAH’s Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity recommends policy action that if adopted will address the social determinants of health that currently drive poor health in many communities.

Read more about TFAH’s policy recommendations to rebuild the nation’s public health system and invest in the social determinants of health and health equity in our Blueprint report: The Promise of Good Health for All: Transforming Public Health in America. A Blueprint for the 2021 Administration and Congress.