Issue Category: Public Health Preparedness

Trust for America’s Health’s Statement on the Public Health Aspects of the President’s Proposed Budget

February 3, 2015

Washington, DC, February 3, 2015 – The following is a statement from Jeffrey Levi, PhD, executive director of the Trust for America’s Health (TFAH) and chair of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health.

“If adopted, the President’s budget would take a major step toward building a culture of health in the United States, as it invests in programs and policies that enable Americans to be healthier – and to be better protected from infectious diseases, foodborne illnesses and other threats.

TFAH strongly supports the President’s proposal to end sequestration. Sequestration has resulted in sharp and indiscriminate cuts to public health programs – and ending it shows a commitment to the need for a strong, effective public health system in this country.

We are pleased to see increased support for programs that can improve health in people’s daily lives – where they live, learn, work and play. Mounting evidences shows programs like the Earned Income Tax Credit, the Child Care Tax Credit, early childhood education, family home visiting and the Children’s Health Insurance Program contribute to the long-term health of children and their families and are essential building blocks to a lifetime of wellbeing.

The proposal also recognizes the need for increased resources to fight one of the country’s fastest growing, most troubling and most preventable public health epidemics – devoting more than $100 million in new investments to combat prescription drug misuse and related heroin abuse.

In addition, the budget demonstrates how important ongoing investments into a standardized set of core “foundational capabilities” for all health departments are. All Americans should be assured that their state and local health departments have the same ability to help them be healthy. To this important end, the President’s budget identifies $8 million to start down the path of this kind of assurance.

However, while this is important, it is more than offset by the zeroing out of the $160 million Preventive Services Block Grant, a mechanism that is currently used by health departments to maintain capabilities and services. We recommend restoration of the block grant funding, along with clear direction that the funding be used for foundational public health capabilities and services.

Another low-point of the budget is the proposal to significantly cut chronic disease prevention programs – including some of the most important programs that support preventing obesity, tobacco cessation and related health problems. Given the national priority to reduce healthcare costs, this is particularly ironic since we know chronic diseases are one of the biggest drivers of these costs.

Some key public health highlights in the budget include:

  • A $36 million increase to the Strategic National Stockpile, which provides medicine and medical supplies to protect the American people during a public health emergency;
  • A $264 million investment to help the Centers for Disease and Prevention (CDC) combat antibiotic resistance;
  • A $107 million increase for the Biomedical Advance Research and Development Authority (BARDA) to spark the research and development of new antibiotics, vaccines, medical treatments and medical devices;
  • The creation of a single, independent food agency to provide leadership and prevent and respond to outbreaks of foodborne illness and an increase of $109.5 million to the Food and Drug Administration to implement the Food Safety Modernization Act (though much of this increase is in the form of unauthorized user fees which Congress should enact regardless of a policy decision on user fees). The creation of a single food safety agency has been a long-standing priority for TFAH and we hope it is the start of a broader coordination of public health programs across the federal government;
  • A $31.5 million increase in programs to combat viral hepatitis, almost doubling the nation’s resources;
  • A $10 million increase for the CDC climate and health program to fund 30 additional state and local grantees, though this is offset by an $11 million cut to the National Environmental Public Health Tracking program; and
  • A $128.1 million increase in the Vaccines for Children Program, though this is offset to some degree by a $50 million cut in the discretionary immunizations program.

Some key public health low-lights include:

  • Zeroing out the $160 million Preventive Services Block Grant – which is a key mechanism state and local public health agencies use to maintain capabilities and services;
  • A $20 million cut to the Partnerships for Improving Community Health (PICH), which works to address common risk factors for chronic disease;
  • A $7.5 million cut from the Division of Nutrition, Physical Activity and Obesity for programs focused on reducing obesity in high obesity rate counties; and
  • Elimination of the Racial and Ethnic Approaches to Community Health (REACH), which helps address key chronic disease conditions in the hardest hit populations.

TFAH looks forward to working with the Administration and Congress to ensure strong and sustained funding for public health – to foster a nationwide culture of health and improve the health and wealth of the nation.”

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

“Outbreaks” Report Finds Gaps in Nation’s Ability to Respond to Ebola and Other Infectious Diseases; 25 States Reach Half or Fewer of Key Indicators

December 18, 2014

Washington, D.C., December 18, 2014 – A report released today by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) finds that the Ebola outbreak exposes serious underlying gaps in the nation’s ability to manage severe infectious disease threats.

Half of states and Washington, D.C. scored five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks.  Maryland, Massachusetts, Tennessee, Vermont and Virginia tied for the top score – achieving eight out of 10 indicators.  Arkansas has the lowest score at two out of 10.  The indicators are developed in consultation with leading public health experts based on data from publicly available sources or information provided by public officials.

“Over the last decade, we have seen dramatic improvements in state and local capacity to respond to outbreaks and emergencies.  But we also saw during the recent Ebola outbreak that some of the most basic infectious disease controls failed when tested,” said Jeffrey Levi, PhD, executive director of TFAH.  “The Ebola outbreak is a reminder that we cannot afford to let our guard down. We must remain vigilant in preventing and controlling emerging threats – like MERS-CoV, pandemic flu and Enterovirus – but not at the expense of ongoing, highly disruptive and dangerous diseases – seasonal flu, HIV/AIDS, antibiotic resistance and healthcare-associated infections.”

Some key findings from the Outbreaks: Protecting Americans from Infectious Diseases report include progress and gaps in the areas of:

  • Preparing for Emerging Threats:  Significant advances have been made in preparing for public health emergencies since the September 11, 2001 and the anthrax attacks, but gaps remain and have been exacerbated as resources were cut over time.
    • 47 states and Washington, D.C. reported conducting an exercise or using a real event to evaluate the time it took for sentinel laboratories to acknowledge receipt of an urgent message from the state’s laboratory.
    • Only 27 states and Washington, D.C. met a score equal to or higher than the national average for the Incident and Information Management domain of the National Health Security Preparedness Index.
  • Vaccinations:  More than 2 million preschoolers, 35 percent of seniors and a majority of adults do not receive all recommended vaccinations.
    • Only 14 states vaccinated at least half of their population against the seasonal flu (from fall 2013 to spring 2014).
    • Only 35 states and Washington, D.C. met the goal for vaccinating young children against the hepatitis B virus (Healthy People 2020 target of 90 percent of children ages 19 to 35 months receiving at least 3 doses).
  • Healthcare-Associated Infections:  While healthcare-associated infections have declined in recent years due to stronger prevention policies, around one out of every 25 people who are hospitalized each year still contracts a healthcare-associated infection.
    • Only 16 states performed better than the national standardized infection ratio for central-line-associated bloodstream infections.
    • Only 10 states reduced the number of central line-associated bloodstream infections between 2011 and 2012.
  • Sexually Transmitted Infections and Related Disease Treatment and Prevention:  The number of new HIV infections grew by 22 percent among young gay men, and 48 percent among young Black men (between 2008 and 2010); more than one-third of gonorrhea cases are now antibiotic-resistant; and nearly three million Baby Boomers are infected with hepatitis C, the majority of whom do not know they have it.
    • 37 states and Washington, D.C. require reporting of all (detectable and undetectable) CD4 and HIV viral load data, which are key strategies for classifying stage of disease, monitoring quality of care and preventing further transmission of HIV.
  • Food Safety:  Around 48 million Americans suffer from a foodborne illness each year.
    • 38 states met the national performance target of testing 90 percent of reported E.coli O157 cases within four days (in 2011).

“The best offense to fighting infectious diseases is a strong and steady defense,” said Paul Kuehnert, a Robert Wood Johnson Foundation director. “Infectious disease control requires having systems in place, continuous training and practice and sustained, sufficient funding.  As we work with communities across the nation to build a Culture of Health, we recognize that promoting and protecting health, and readiness to respond to wide-scale health threats are essential.”

The Outbreaks report recommends that it is time to rethink and modernize the health system to better match existing and emerging global disease threats.  Priority improvements should include:

  • Core Abilities:  Every state should be able to meet a set of core capabilities and there must be sufficient, sustained funding to support these capabilities.  Some basic capabilities include: investigative expertise, including surveillance systems that can identify and track threats and communicate across the health system and strong laboratory capacity; containment strategies, including vaccines and medicines; continued training and testing for hospitals and health departments for infection control and emergency preparedness; risk communications capabilities that inform the public without creating unnecessary fear; and maintaining a strong research capacity to develop new vaccines and medical treatments;
  • Healthcare and Public Health Integration:  Systems must be improved so the healthcare system, hospitals and public health agencies work better together toward the common goals of protecting patients, healthcare workers and the public; and
  • Leadership and Accountability:  Stronger leadership is needed for a government-wide approach to health threats at the federal, state and local levels, and there must be increased support for integration and flexibility of programs in exchange for demonstration of capabilities and accountability.

The report and state-by-state materials was supported by a grant from RWJF.

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.  Zero is the lowest possible overall score, 10 is the highest.  The data for the indicators are from publicly available sources or were provided from public officials.

8 out of 10: Maryland, Massachusetts, Tennessee, Vermont and Virginia

7 out of 10: California, Delaware, Nebraska, New Hampshire, North Dakota, Pennsylvania and Wisconsin

6 out of 10: Colorado, Connecticut, Florida, Hawaii, Illinois, Iowa, Minnesota, New York, North Carolina, Rhode Island, South Carolina, South Dakota and Texas

5 out of 10: Alabama, D.C., Georgia, Indiana, Michigan, New Mexico, Oklahoma, Oregon, Utah and West Virginia

4 out of 10: Alaska, Arizona, Maine, Mississippi, Missouri, Montana, Nevada and Washington

3 out of 10: Idaho, Kansas, Kentucky, Louisiana, New Jersey, Ohio and Wyoming

2 out of 10: Arkansas

 

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.

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 Releases “The Truth about the Prevention Fund”

June 6, 2013

Washington, DC, June 6, 2013 – Trust for America’s Health (TFAH), today, released a new report of key facts about the Prevention and Public Health Fund, which was created by the Affordable Care Act (ACA).

The Truth about the Prevention Fund includes an overview of the Fund, which is the nation’s largest single investment in prevention, using evidence-based and innovative partnership approaches to improve the health of Americans.  The Fund provides more than $14.5 billion in mandatory appropriations over 10 years to improve health and prevent chronic illnesses by expanding preventive care and supporting proven community-based programs that reduce obesity, tobacco use and other preventable conditions.

Currently, more than half of Americans suffer from chronic diseases, such as type 2 diabetes and heart disease.  Two thirds of Americans are currently obese or overweight and nearly 20 percent of Americans smoke.  Obesity costs the country $147 billion and tobacco use $96 billion in direct healthcare costs each year.  A 2012 TFAH study found that if obesity rates continue on their current trajectory, half of Americans could be obese by 2030, and the rise in obesity-related healthcare costs could reach between $196 billion and $213 billion in direct medical costs.

“Today’s kids could become the first in American history to live shorter, less healthy lives than their parents,” said Jeffrey Levi, PhD, executive director of TFAH.  “We can resign our kids to that fate – or invest in proven, effective programs to reduce obesity, tobacco use and the prevalence of preventable chronic conditions.  The Prevention Fund is the best and most targeted effort the nation has made toward getting the health of this country back on track.”

The Prevention Fund invests in programs that are proven and effective.  Oversight and evaluation is a key component of every Fund-sponsored program, and strict performance measures ensure accountability before federal dollars are spent.   The Fund supports community-driven prevention efforts targeted at reducing tobacco use, increasing physical activity, improving nutrition, expanding mental health and injury prevention programs and improving prevention activities.

For instance, for one component of the Fund – the Community Transformation Grants (CTGs) – grantees are required within five years to reduce by 5 percent death and disability due to tobacco use; the rate of obesity (through nutrition and physical activity approaches); and death and disability due to heart disease and stroke.  States and local communities have the flexibility to decide what problems are most pressing for them to address and decide which approaches to use as long as they are evidence based.  All grantees are expressly forbidden from using any funds for lobbying.  U.S. Centers for Disease Control and Prevention (CDC) has initiated extra controls to ensure grantees are restricted from ever using funds on prohibited lobbying activities and has mechanisms in place to identify any violations.  No such violations have been confirmed.

“Obesity, tobacco-use and other preventable health problems are crippling this nation.  The Prevention Fund provides states and communities with the flexibility to address their most pressing health challenges. We will never be successful unless we invest in programs and approaches we know work,” said Levi.

The full report also profiles examples of how communities are effectively using Prevention Fund support – The Truth about the Prevention Fund is available on TFAH’s web site.

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

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Examples of CTG Efforts in Communities:

  • West Virginia is supporting local health departments to address top challenges facing their community and develop solutions.  The West Virginia Department of Health is using CTG support to help local health departments in every county in the state implement targeted initiatives including:  safe places in communities to work and play, Farm-to-School Initiatives to improve nutrition in school settings, Child and Day Care Center Nutrition Programs to educate and empower children to choose healthy lifestyles through physical activity and healthy food choices, and community coordinated care systems that link and build referral networks between the clinical system and community-based lifestyle programs so people can manage their health.

  • Oklahoma is using a CTG to work with a range of sectors to make healthier choices easier in the state.  Nearly 70 percent of Oklahoma County’s premature deaths are largely preventable, arising from an unhealthy lifestyle, poor diet or the use of tobacco, alcohol or other substances.  The county spends about $920 million every year to treat chronic disease. In September 2011, Oklahoma City was awarded a $3.5 million CTG.  Using a portion of those funds, the Oklahoma City-County Health Department (OCCHD) expanded the use of community health workers to ensure more people access the “My Heart, My Health, My Family” program, which provides prevention programs and services, specifically focused on cardiovascular disease.  The program includes lesson plans on healthy living (e.g. portion control and the benefits of substituting water for sugar sweetened beverages) and participants receive access to free regular clinical checkups four times a year and free medication. The CTG money will also support other obesity-specific initiatives, including expanded walking and biking trails, a push to help schools offer healthy menu options and a physical education coordinator for city schools.

  • An Accountable Care Community (ACC) in Akron, Ohio – a CTG recipient – has brought together 70 community partners to coordinate healthcare and support inside and outside the doctor’s office for patients with type 2 diabetes.  In just 18 months, the ACC has reduced the average cost per month of care for individuals with type 2 diabetes by more than 10 percent per month with an estimated program savings of $3,185 per person per year. This initiative also led to a decrease in diabetes-related emergency department visits.
  • The Iowa Department of Public Health (IDPH) is providing local communities with resources to better address obesity and other health risk factors.  Utilizing a $3 million/year CTG, one key element is the Iowa Community Referral Project. The project will help ensure Iowans follow through with healthy lifestyle behaviors as a result of referral system changes between health providers and community agencies. The two components of the project include 1) A partnership with the Iowa Primary Care Association (IPCA) and selected communities where intensive training and technical assistance are provided to promote a seamless referral system, and 2) Implementation of local referral projects in the Iowa CTG intervention counties.
  • A CTG awarded to Broward Regional Health Planning Council’s Transforming Our Community’s Health (TOUCH) initiative is serving 1.7 million residents of Broward County, Florida to improve health, including by working with a range of partners to alleviate childhood obesity.  TOUCH has brought together community-based organizations, multidisciplinary strategies and diverse communities to address the most recognizable factors contributing to childhood obesity.  It is anticipated that these system, environmental and policy enhancements will positively impact the health, well-being and longevity of children.
  • Additional highlights of CTG program efforts in 2011 are available at: http://www.cdc.gov/communitytransformation/accomplishments/index.htm.