Issue Category: Sick Leave

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

Public Health’s Role in Supporting Family Caregivers

According to a September 2022 report by the National Alliance for Caregiving (NAC) and  the National Association of Chronic Disease Directors, Chronic Disease Family Caregiving Through a Public Health Lens, there are 53 million family caregivers in America-that’s nearly one i five families. Furthermore, the number of caregivers will continue to rise as people aged 65 or older are expected to almost double by the year 2060. At that time, the nation will have reached a milestone of one in four people responsible for providing care for a family member with a chronic disease, serious illness, or a disability.

The report, which was supported by a grant from the John A. Hartford Foundation, found that caregivers are taking on caregiving responsibilities for adults with increasingly complex needs due to raising rates of chronic disease, Alzheimer’s Disease and other types of memory and dementia issues.

Caregivers in Need

Providing care for an ill family member is a demanding task often made more complicated by geographically dispersed families and the need for two wage-earners.

Source: Caregiving for Family and Friends – A Public Health Issue

According to a NAC and National Association of Chronic Disease Directors Roundtable, in 2020,23 percent of caregivers reported worsening health due to caregiving. Of those caregivers, 60 percent reported difficulty when addressing their own health needs. TFAH has recommended establishing a comprehensive paid family and medical leave policy that ensures paid time off to address family health or caregiving needs for all employees.

Equity in Caregiving

Of the nation’s 53 million family caregivers, an estimated 61 percent are Non-Hispanic white, 17 percent are Hispanic, 14 percent are African American, and 5 percent are Asian American and/or Pacific Islander. As the need for care grows, the need for caregiver systems that are integrated into the community, and culturally and language appropriate is critical. Innovations in technology, such as telemedicine and translation tools, can assist in allowing both long-distance and non-English speaking caregivers have the support they need from public health programs and their communities. Culturally designed approaches and relationship building within communities will enable greater understanding of, support for, and interaction with the nation’s caregivers.

How Can the Public Health System Support Caregivers?

Support for the nation’s caregivers is a public health issue especially in light of demographic changes that will make the need for family caregiving even greater in the future. The public health system has  a critical role to play in supporting family caregivers and their ability to provide care through care coordination and assistance integrating home care with more formal healthcare services. Public health systems should work to create family caregiving support infrastructure and should team with other entities that can have a role in supporting caregivers including healthcare systems and providers, insurers, community-based organizations, faith-based organizations, and employers.

Conclusion

Caregivers are a vital part of the nation’s healthcare system and need the support of the public health sector. Policies should support the nation’s existing and growing number of caregivers to allow them to provide care while protecting their own health, well-being, and financial security.

Additional TFAH Age-Friendly Public Health Systems initiative Resources on Family Caregiving

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

Increases in Drug Overdose Death Rates Were Up Before COVID-19 and Are Continuing to Rise During the Pandemic

Trust for America’s Health and Well Being Trust Call for Renewed Focus on Preventing Deaths of Despair

DISTRICT OF COLUMBIA & OAKLAND, CA – Dec. 23, 2020 – According to data released this week by the National Center for Health Statistics, in 2019 age-adjusted drug overdose deaths increased slightly over the prior year.  Coupled with data released last week by the CDC showing increases in drug overdose deaths in early 2020, these reports demonstrate the continuing upward trajectory of drug deaths in the U.S, a trend that is being compounded by the COVID-19 pandemic.

The age-adjusted rate of drug overdose during 2019 was 21.6 per 100,000 deaths, up from the 2018 rate of 20.7 per 100,000. In 2019, 70,630 people died due to drug overdose in the United States.

Between 1999 and 2019 the rate of drug overdose deaths increased for all groups aged 15 and older, with people aged 35-44 experiencing the highest single year increase in 2019.  While rates of drug overdose deaths involving heroin, natural and semisynthetic opioids, and methadone decreased between 2018 and 2019 the rate of overdose deaths involving synthetic opioids other than methadone continued to increase.

2018 data showing only minor progress after decades of worsening trends, provisional drug overdose data showing an 18% increase over the last 12 months, and the recent CDC Health Alert Network notice on early 2020 increases in fatal drug overdoses driven by synthetic opioids all underscore the continued impact of the deaths of despair crisis and how the COVID-19 pandemic has further diminished the mental health and well-being of many Americans.

“These 2019 overdose rates and the outlook for 2020 are extremely alarming and the result of insufficient prioritization and investment in the well-being and health of Americans for decades,” said John Auerbach, President and CEO of the Trust for America’s Health. “As we work to recover from the COVID-19 pandemic, we must take a comprehensive approach that includes policies and programs that help Americans currently struggling and target upstream root causes, like childhood trauma, poverty and discrimination in order to help change the trajectory of alcohol, drug, and suicide deaths in the upcoming decades.”

Over the last five years, Trust for America’s Health (TFAH) and Well Being Trust (WBT) have released a series of reports on “deaths of despair” called Pain in the Nation: The Drug, Alcohol and Suicides Epidemics and the Need for a National Resilience Strategy, which include data analysis and recommendations for evidence-based policies and programs that federal, state, and local officials.

“If leaders don’t act now to stymie America’s mental health and addiction crises, next year’s data will easily surpass the astounding numbers we’re seeing today,” said Dr. Benjamin F. Miller, PsyD, Chief Strategy Officer at Well Being Trust. “Overdose deaths can be prevented if individuals who are struggling are able to access the appropriate services and supports – and with greater demonstrated success if the care individuals receive is rooted in their immediate communities.”

 

Drug Overdose Deaths, 1999-2019 (Rates age-adjusted)

Year Deaths Deaths per 100,000
1999 16,849 6.1
2000 17,415 6.2
2001 19,394 6.8
2002 23,518 8.2
2003 25,785 8.9
2004 27,424 9.4
2005 29,813 10.1
2006 34,425 11.5
2007 36,010 11.9
2008 36,450 11.9
2009 37,004 11.9
2010 38,329 12.3
2011 41,340 13.2
2012 41,502 13.1
2013 43,982 13.8
2014 47,055 14.7
2015 52,404 16.3
2016 63,632 19.8
2017 70,237 21.7
2018 67,367 20.7
2019 70,630 21.6

 Sources:
CDC – NCHS – National Center for Health Statistics
https://emergency.cdc.gov/han/2020/han00438.asp
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

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About Trust for America’s Health
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. Twitter: @HealthyAmerica1

 

About Well Being Trust
Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community well-being. www.wellbeingtrust.org Twitter: @WellBeingTrust

 

Policymakers and Health Systems Must Earn Trust within Communities of Color and Tribal Nations to Ensure COVID-19 Vaccine Receptivity, Say Health and Public Health Leaders

Policy brief calls for building vaccine acceptance in communities of color and tribal communities through data transparency, tailored communications via trusted messengers, ensuring ease of vaccine access and no out-of-pocket costs

(Washington, DC – Dec. 21, 2020) – A woeful history of maltreatment of communities of color and tribal nations by government and the health sector, coupled with present day marginalization of these communities by the healthcare system, are the root of vaccine distrust among those groups, according to a policy brief, Building Trust in and Access to a COVID-19 Vaccine Among People of Color and Tribal Nations released today by Trust for America’s Health (TFAH) and co-authors the National Medical Association (NMA) and UnidosUS.

This historic maltreatment, coupled with current day structural racism, has played out in COVID-19’s disproportionate impact on communities of color and tribal communities. These factors also make ensuring vaccine receptivity and access within those communities challenging and of critical importance to protecting lives and ending the pandemic.

In October 2020, TFAH, NMA and UnidosUS hosted a policy convening with 40 leading health equity, healthcare, civil rights, and public health organizations. The purpose of the convening was to advise policymakers on the barriers to vaccine receptivity within communities of color and tribal communities and how to overcome those barriers.

“Earning trust within communities of color and tribal communities will be critical to the successful administration of the COVID-19 vaccine. Doing so will require prioritizing equity, ensuring that leaders from those communities have authentic opportunities to impact vaccine distribution and administration planning, and, the resources to fully participate in supporting vaccine outreach, education and delivery in their communities,” said Dr. J. Nadine Gracia, Executive Vice President and COO of Trust for America’s Health.

The convening created recommendations for policy actions that should be taken immediately within six key areas:

Ensure the scientific fidelity of the vaccine development process.

  • HHS and vaccine developers should release all available vaccine data at frequent and regular intervals to improve transparency and increase confidence in the vaccine evaluation process. Leadership at FDA and HHS must commit to advancing any vaccine only after it has been validated based on established federal and scientific protocols. Programs to monitor for adverse events must also be in place and transparent. Any perception of bypassing safety measures or withholding information could derail a successful vaccination effort.
  • FDA should engage health and public health professional societies, particularly those representing healthcare providers of color, local public health officials, as well as other stakeholders with a role in vaccination, and allow these groups to validate all available data, review the vaccine development and approval process, and issue regular updates on data to their patients, members, and the public.

 Equip trusted community organizations and networks within communities of color and tribal nations to participate in vaccination planning, education, delivery and administration.  Ensure their meaningful engagement and participation by providing funding.

  • Congress should fund CDC and its state, local, tribal, and territorial partners to provide training, support, and financial resources for community-based organizations to join in vaccination planning and implementation, including community outreach, training of providers, and participation in vaccination clinics. State, local, tribal, and territorial authorities should authentically engage and immediately begin vaccination planning with community-based organizations, community health workers/promotores de salud, faith leaders, educators, civic and tribal leaders, and other trusted organizations outside the clinical healthcare setting as key, funded partners.

Provide communities the information they need to understand the vaccine, make informed decisions, and deliver messages through trusted messengers and pathways.

  • Congress should provide at least $500 million to CDC for outreach, communication, and educational efforts to reach priority populations in order to increase vaccine confidence and combat misinformation. All communications must be culturally and linguistically appropriate and tailored as much as possible to reach diverse populations as well as generations within groups.
  • FDA and CDC should initiate early engagement with diverse national organizations and provide funding and guidance for state, local, tribal, and territorial planners to help shape messaging and engage locally with healthcare providers in communities of color and tribal communities, such as nurses, pharmacists, promotores de salud, community health workers, and others to ensure they have the information they need to feel comfortable recommending the vaccine to their patients. Congress and HHS should provide funding for training and engagement of trusted non-healthcare communicators to help shape messaging and to train informal networks, civic and lay leaders, and other trusted community leaders and community-based organizations to answer questions and encourage vaccination.
  • All messaging about the vaccine must be appropriate for all levels of health literacy. Communication should be realistic and clear about timelines and priority groups (and the rationale for these decisions), vaccine effectiveness, types of vaccines, the number of doses, costs, and the need for ongoing public health protections. Planners must provide information that meets people where they are (e.g., barber shops, bodegas, grocery stores, places of worship, etc.) and ensure that trusted messengers in those places have the information they need to be credible and authentic spokespeople.

 

Ensure that it is as easy as possible for people to be vaccinated. Vaccines must be delivered in community settings that are trusted, safe and accessible.

  • We urge the administration and Congress to appropriate the resources necessary to expand and strengthen federal, state, local, territorial, and tribal capacity for a timely, comprehensive, and equitable COVID-19 vaccination planning, communications, distribution, and administration campaign, including funding to support vaccine distribution at the local level and by community-based organizations.
  • Congress and HHS should allocate funding to increase access to vaccination services to ensure that people seeking to be vaccinated do not experience undue increased exposure to the virus as they travel to, move through, and return home from vaccination sites. Flexibility in funding is needed to enable transport of people to vaccination sites, increase accessibility to people without cars, and promote safety and minimize exposure at vaccination locations. Funding should also be provided to health and community-based agencies to assist those for whom transportation or childcare costs are an obstacle to receipt of the vaccine.
  • Planners should ensure that vaccination sites are located in areas that have borne a disproportionate burden of COVID-19, especially leveraging community-based organizations such as Federally Qualified Health Centers, community health centers, rural health centers, schools and places of worship. Mobile services will be particularly important in rural areas. Planners should prioritize congregate living facilities, such as long-term care, prisons, and homeless shelters. In addition, some families, displaced by the COVID economic fallout, may be living with relatives. Planners should ensure vaccination sites have services that meet the Americans with Disabilities Act (ADA) and HHS Office for Civil Rights (OCR) standards for disability and language access.
  • Federal state, local, tribal, and territorial officials must guarantee and communicate with the public that immigration status is not a factor in people’s ability to receive the vaccine and that immigration status is not collected or reported by vaccination sites/providers. Similarly, the presence of law enforcement officers or military personnel could be a deterrent for vaccination at locations, so planners should consider other means of securing sites.
  • In the initial phase, as communities vaccinate healthcare workers, planners must be sure to prioritize home health, long-term care, and other non-hospital-based healthcare workers, who are more likely to be people of color. Other essential workers that comprise large numbers of workers who are people of color and should be treated as within the vaccination priority groups are the food service industry, farmworkers and public transportation employees.

Ensure complete coverage of the costs associated with the vaccine incurred by individuals, providers of the vaccine, and state/local/tribal/territorial governments responsible for administering the vaccine and communicating with their communities about it.

  • Congress, the Centers for Medicare and Medicaid Services, and private payers must guarantee that people receiving the vaccine have zero out-of-pocket costs for the vaccine, related health care visits, or any adverse events related to the vaccine, regardless of their health insurance status.
  • HHS, with emergency funding from Congress, should provide funding so that state, local, tribal, and territorial governments do not bear any cost of vaccine communication efforts, working with their communities, organizing sites, training their staff, and providing personal protective equipment (PPE).

 Congress must provide additional funding and require disaggregated data collection and reporting by age, race, ethnicity, gender identity, primary language, disability status, and other demographic factors on vaccine trust and acceptance, access, vaccination rates, adverse experiences, and ongoing health outcomes.

  • CDC, and state, local, tribal, and territorial authorities should include leaders from communities of color and tribal communities and to plan on-going data collection on vaccination efforts, interpret data, add cultural context, share data with communities, and determine implications and next steps.
  • CDC, and state, local, tribal, and territorial authorities should use these data to inform ongoing prioritization of vaccine distribution and rapidly address gaps in vaccination that may arise among subpopulations by race, ethnicity, neighborhood, or housing setting.

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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. Twitter: @healthyamerica1

 

COVID-19 School Closures Put 30 Million Children at Risk of Hunger

Many States with High COVID-19 Infection Rates Also Have Highest School-Meal Programs Participation Rates

(Washington, DC – July 16, 2020) – As COVID-19 infection rates continue to increase in states across the country, many of those jurisdictions are facing the complex dilemma of high infections rates complicating school re-openings and thereby limiting students’ access to school-based meal programs. Among the states with spiking infection rates and a high percentage of students participating in school-based meal programs are Arizona, Florida, Louisiana, Mississippi and South Carolina.

In March schools across the country began closing to stop the spread of the COVID-19 virus. In response, and recognizing the important source of nutrition school-based meals were to millions of American children, the U.S. Department of Agriculture’s Food and Nutrition Service began approving nationwide waivers to provide school systems flexibility in how meals were provided to students.  For example, these waivers enable schools to serve meals in non-congregate settings and outside of standard mealtimes, serve afterschool snacks and meals outside of structured environments, and waive requirements that students be present when meals are picked up.

Over half of all students in elementary and secondary schools across the country depend on the National School Lunch Program, and 12.5 million of those students also participate in the School Breakfast Program. As the COVID-19 pandemic closed schools this spring, these students were placed at risk of not having enough to eat.

A new policy brief, Beyond School Walls: How Federal, State and Local Entities are Adapting Policies to Ensure Student Access to Healthy Meals During the COVID-19 Pandemic, released today by Trust for America’s Health, reviews steps the federal and state governments have taken to ensure students’ access to healthy meals when schools are closed and what needs to be done to ensure continued meal access as all school systems face uncertainties about how to safely reopen for the 2020-2021 school year.

“School meal programs are the most important source of nutritious food for millions of American children. To the degree possible, school systems, with financial and regulatory relief from the federal government,  should continue to be innovative about how to deliver meals to students and should strive to meet or exceed federal nutrition standards for these meals despite product shortages created by the pandemic,” said Adam Lustig, Project Manager at Trust for America’s Health and the brief’s author.

Due to the economic impact the pandemic has had on millions of American families and the numerous uncertainties about how to safely re-open schools, the currently in place program waivers should be extended through the summer and may need to be kept in place during the 2020–2021 school year, the brief says.

Many of the states hardest hit by COVID also have highest school meal programs participation rates

States with some of the highest rates of COVID-19 infections also have high percentages of students who depend on school meals for much of their nutrition. States in which both COVID-19 infection rates are above national medians and school meals program enrollment is high include Arizona, Florida, Georgia, Louisiana, Mississippi, and South Carolina.

States in which more than half of students are enrolled in school-meals programs are:

Percentage of students enrolled in school meal programs

D.C.                                        76.4%

Mississippi                           75.0%

New Mexico                         71.4%

South Carolina                    67.0%

Arkansas                              63.6%

Louisiana                             63.0%

Oklahoma                            62.5%

Georgia                                62.0%

Nevada                                60.8%

Kentucky                             58.7%

California                            58.1%

Florida                                 58.1%

Arizona                                57.0%

Missouri                              52.7%

New York                            52.6%

Illinois                                 50.2%

Alabama                              51.6%

Oregon                                 50.5%

Hunger, poor nutrition and food insecurity can increase a child’s risk of developing a range of physical, mental, behavioral, emotional, and learning problems. Hungry children also get sick more often and are more likely to be hospitalized. Maintaining children’s access to nutritious meals despite school closures not only ensure they do not go hungry, but also promotes children’s health.

“State and federal guidelines waivers have allowed school systems to provide meals to students during the pandemic response, keeping them in place this summer and into the 2020-2021 school year will be the difference between kids who have enough to eat and kids who go hungry,” Lustig said.

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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. Twitter:@HealthyAmerica1

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

(Washington, DC – July 15, 2020) — 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. It has been serving in that role since its creation and, in close collaboration with U.S. healthcare facilities nationwide, has developed a health statistics infrastructure that is the gold standard worldwide.

The problems with regard to the COVID-19 data collection have largely been a result of the decentralized and fragmented nature of both healthcare and public health in the United States. Furthermore, hospital data is only one aspect of what we need to know to fight the pandemic. A key role of health departments at all levels of government is to aggregate data to produce a detailed picture of a health problem at the national, state and local levels. Inadequate funding for data infrastructure, at CDC and at the local, state, tribal and territorial levels, is also a contributing factor.  That underfunding should be corrected rather than bypassed.

In the midst of the worst public health crisis in a century, it is counter-productive to create a new mechanism which will be extremely complicated to build and implement.  Another area of concern is that the planning for this new approach did not substantively involve officials at the local, state, tribal and/or territorial levels.  This is a time to support the public health system not take actions which may undermine its authority and critical role.

Americans must have confidence in the integrity of health data and its insulation from even the suggestion of political interference.  Sending these sensitive data to a newly created entity overseen directly by the White House will not eliminate such concerns, it will increase them.

John Auerbach, President and CEO, Trust for America’s Health

Dr. Tom Frieden, President and CEO, Resolve to Save Lives

Lori T. Freeman, Chief Executive Officer, National Association of County and City Health Officials

Dr. Georges C. Benjamin, Executive Director, American Public Health Association

Thomas M. File, Jr., M.D., MSc, FIDSA; President, Infectious Disease Society of America

Chrissie Juliano, MPP, Executive Director, Big Cities Health Coalition

William H. Dietz, MD, PhD, Chair, Redstone Center for Prevention and Wellness, George Washington University

Nuevo informe muestra que la respuesta de COVID-19 fue años de fabricación

El financiamiento para los programas de preparación y respuesta de salud pública perdió terreno en el año fiscal 2020 y durante la última década

(Washington, DC – 16 de abril de 2020) – La falta de fondos crónica de los sistemas de preparación para emergencias y salud pública del país ha hecho que el país sea vulnerable a los riesgos de seguridad de la salud, incluida la nueva pandemia de coronavirus, según un nuevo informe publicado hoy por Trust for America’s Health.

El informe, El impacto de la falta de fondos crónica en el sistema de salud pública de Estados Unidos: Tendencias, riesgos y recomendaciones, 2020, examina las tendencias federales, estatales y locales de financiamiento de salud pública y recomienda inversiones y acciones políticas para construir un sistema más sólido, priorizar la prevención y efectivamente abordar los riesgos para la salud del siglo XXI.

“COVID-19 ha puesto de relieve la dura falta de preparación del país para hacer frente a las amenazas al bienestar de los estadounidenses”, dijo John Auerbach, presidente y CEO de Trust for America’s Health. “Años de recortar fondos para programas de salud pública y preparación para emergencias han dejado a la nación con una fuerza laboral de salud pública más pequeña de lo necesario, capacidad de prueba limitada, una reserva nacional insuficiente y sistemas de seguimiento de enfermedades arcaicas – en resumen, herramientas del siglo XX para lidiando con los desafíos del siglo XXI “.

Imagen mixta para la financiación de los CDC para el año fiscal 2020

Los Centros para el Control y la Prevención de Enfermedades (CDC) de los Estados Unidos. Son la agencia de salud pública líder del país. El presupuesto general de los CDC para el año fiscal 2020 es de $ 7.92 mil millones: un aumento de $ 645 millones, 9 por ciento sobre el financiamiento de los CDC para el año fiscal 2019, 7 por ciento en dólares ajustados por inflación. El mayor aumento del año fiscal 2020 fue una inversión única en edificios e instalaciones (+ $ 225 millones). Otros aumentos incluyeron fondos para la iniciativa Ending HIV (+ $ 140 millones) y pequeños aumentos para programas de prevención de suicidio y enfermedades crónicas.

Financiamiento de preparación para emergencias este año y por más de una década

Los fondos para los programas de preparación y respuesta de salud pública de los CDC disminuyeron entre los presupuestos del año fiscal 2019 y el año fiscal 2020, de $ 858 millones en el año fiscal 2019 a $ 850 millones en el año fiscal 2020. Los fondos del programa de los CDC para la preparación para emergencias en el año fiscal 2020 ($ 7.92 mil millones) son menores que fue en el año fiscal 2011 ($ 7.99 mil millones en dólares del año fiscal 2020), después de ajustar por inflación.

Los fondos para los programas de preparación y respuesta ante emergencias de salud pública estatales y locales también se han reducido, en aproximadamente un tercio desde 2003. Y, de gran preocupación ahora, los fondos para el Programa de Preparación Hospitalaria, la única fuente federal de fondos para ayudar a la prestación de atención médica. El sistema de preparación y respuesta ante emergencias se ha reducido a la mitad desde 2003.

La acción federal para promulgar tres paquetes de fondos suplementarios para apoyar la respuesta a la pandemia COVID-19 fue crítica. Pero son ajustes a corto plazo que no fortalecen la capacidad central a largo plazo del sistema de salud pública, según los autores del informe. Se necesitan incrementos sostenidos de fondos anuales para garantizar que nuestros sistemas de seguridad de salud e infraestructura de salud pública estén a la altura de la tarea de proteger a todas las comunidades.

El descuido habitual de la salud pública en la nación, excepto durante emergencias, es un problema de larga data. “Las emergencias que amenazan la salud y el bienestar de los estadounidenses son cada vez más frecuentes y más graves. Estos incluyen incendios forestales e inundaciones, la crisis de opioides, el aumento de la obesidad y las enfermedades crónicas, y este año un brote de sarampión, lesiones pulmonares graves debido al vapeo y la peor pandemia en un siglo. Debemos comenzar a hacer inversiones año tras año en salud pública”, dijo Auerbach.

Además de apoyar las actividades federales, los fondos federales también son la fuente principal de financiamiento para la mayoría de los programas de salud pública locales y estatales. Durante el año fiscal 2018, el 55 por ciento de los gastos de salud pública de los estados, en promedio, fueron financiados por fuentes federales. Por lo tanto, los recortes en el gasto federal tienen un grave efecto de goteo en los programas estatales y locales. Entre el año fiscal 2016 y el año fiscal 2018, los gastos estatales de dinero federal para actividades de salud pública disminuyeron de $ 16.3 mil millones a $ 12.8 mil millones. Además de los recortes federales, algunos estados también han reducido los fondos de salud pública. Más del 20 por ciento de los estados (once) recortaron sus fondos de salud pública entre 2018 y 2019.

Estos recortes de fondos han llevado a reducciones significativas de la fuerza laboral en los departamentos de salud pública estatales y locales. En el 2017, el 51 por ciento de los grandes departamentos locales de salud pública informaron pérdidas de empleos. Algunas de las posiciones pérdidas fueron en el personal de salud pública de primera línea que habría sido movilizado para combatir la pandemia de COVID-19.

El informe incluye 28 recomendaciones de políticas para mejorar la preparación para emergencias del país en cuatro áreas prioritarias:

  • mayor financiamiento para fortalecer la infraestructura de salud pública y la fuerza laboral, incluida la modernización de los sistemas de datos y las capacidades de vigilancia.
  • mejorar la preparación para emergencias, incluida la preparación para eventos relacionados con el clima y brotes de enfermedades infecciosas.
  • salvaguardar y mejorar la salud de los estadounidenses invirtiendo en la prevención de enfermedades crónicas y la prevención del abuso de sustancias y el suicidio.
  • abordar los determinantes sociales de la salud y avanzar en la equidad en salud.

El informe también respalda el llamado de más de 100 organizaciones de salud pública para que el Congreso aumente el presupuesto de los CDC en un 22 por ciento para el año fiscal 2022.

 

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Trust for America’s Health es una organización sin fines de lucro y no partidista que promueve la salud óptima para cada persona y comunidad y hace de la prevención de enfermedades y lesiones una prioridad nacional. Twitter: @healthyamerica1

New Report Shows Hamstrung COVID-19 Response was Years in the Making

Funding for public health preparedness and response programs lost ground in FY 2020 and over the past decade.

(Washington, DC – April 16, 2020) – Chronic underfunding of the nation’s public health and emergency preparedness systems has made the nation vulnerable to health security risks, including the novel coronavirus pandemic, according to a new report released today by Trust for America’s Health.

The report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2020, examines federal, state, and local public health funding trends and recommends investments and policy actions to build a stronger system, prioritize prevention, and effectively address twenty-first-century health risks.

“COVID-19 has shined a harsh spotlight on the country’s lack of preparedness for dealing with threats to Americans’ well-being,” said John Auerbach, President and CEO of Trust for America’s Health. “Years of cutting funding for public health and emergency preparedness programs has left the nation with a smaller-than-necessary public health workforce, limited testing capacity, an insufficient national stockpile, and archaic disease tracking systems – in summary, twentieth-century tools for dealing with twenty-first-century challenges.”

Mixed Picture for CDC FY 2020 Funding

The U.S. Centers for Disease Control and Prevention (CDC) is the nation’s leading public health agency. The CDC’s overall budget for FY 2020 is $7.92 billion – a $645 million increase, 9 percent over FY 2019 CDC funding, 7 percent in inflation-adjusted dollars. The largest FY 2020 increase was a onetime investment in buildings and facilities (+$225 million). Other increases included funding for the Ending HIV initiative (+$140 million) and small increases for suicide and chronic disease prevention programs.

Emergency Preparedness Funding Down This Year and For Over a Decade

Funding for CDC’s public health preparedness and response programs decreased between the FY 2019 and FY 2020 budgets – down from $858 million in FY 2019 to $850 million in FY 2020.  CDC’s program funding for emergency preparedness in FY 2020 ($7.92 billion) is less than it was in FY 2011 ($7.99 billion in FY 2020 dollars), after adjusting for inflation.

Funding for state and local public health emergency preparedness and response programs has also been reduced, by approximately one-third since 2003. And, of critical concern now, funding for the Hospital Preparedness Program, the only federal source of funding to help the healthcare delivery system prepare for and respond to emergencies, has been cut by half since 2003.

Federal action to enact three supplemental funding packages to support the COVID-19 pandemic response was critical. But they are short-term adjustments that do not strengthen the core, long-term capacity of the public health system, according to the report’s authors.  Sustained annual funding increases are needed to ensure that our health security systems and public health infrastructure are up to the task of protecting all communities.

The nation’s habitual neglect of public health, except during emergencies, is a longstanding problem. “Emergencies that threaten Americans’ health and well-being are becoming more frequent and more severe. These include wildfires and flooding, the opioid crisis, the increase in obesity and chronic illness, and this year a measles outbreak, serious lung injuries due to vaping, and the worst pandemic in a century. We must begin making year-in and year-out investments in public health,” Auerbach said.

In addition to supporting federal activities, federal monies are also the primary source of funding for most state and local public health programs. During FY 2018, 55 percent of states’ public health expenditures, on average, were funded from federal sources. Therefore, federal spending cuts have a serious trickle-down effect on state and local programs. Between FY 2016 and FY 2018, state expenditures of federal monies for public health activities decreased from $16.3 billion to $12.8 billion.   On top of federal cuts, some states have also reduced public health funding.  More than 20 percent of states (eleven) cut their public health funding between 2018 and 2019.

These funding cuts have led to significant workforce reductions in state and local public health departments. In 2017, 51 percent of large local public health departments reported job losses.  Some of the positions lost were frontline public health staff who would have been mobilized to combat the COVID-19 pandemic.

The report includes 28 policy recommendations to improve the country’s emergency preparedness in four priority areas:

  • increased funding to strengthen the public health infrastructure and workforce, including modernizing data systems and surveillance capacities.
  • improving emergency preparedness, including preparation for weather-related events and infectious disease outbreaks.
  • safeguarding and improving Americans’ health by investing in chronic disease prevention and the prevention of substance misuse and suicide.
  • addressing the social determinants of health and advancing health equity.

The report also endorses the call by more than 100 public health organizations for Congress to increase CDC’s budget by 22 percent by FY 2022.

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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. Twitter: @healthyamerica1