Issue Category: Substance Misuse and Mental Health

North Carolina’s Comprehensive Approach to Preventing and Reversing Drug Overdoses

Early in 2000, state public health surveillance identified a surge of deaths in North Carolina. The Centers for Disease Control and Prevention conducted an investigation into the increase, finding the main driver was unintentional drug overdoses from prescription drugs.

In 2003, the Governor created the Task Force to Prevent Deaths from Unintentional Drug Overdoses, which helped establish the North Carolina Controlled Substances Reporting System (CSRS), which was the state’s prescription drug monitoring program (PDMP).

Since then, North Carolina has implemented a variety of measures to prevent deaths from drug overdoses. With increased access to data from the PDMP and a brighter light shined on the issue, public health continued to collect data, finding, in 2007, that Wilkes County, in the northwest part of the state, had the third highest drug overdose death rate in the country.

Child Fatality Task Force

North Carolina’s Child Fatality Task Force (CFTF)—a standing committee of the general assembly that is composed of 10 legislators and numerous technical advisors—is essentially the policy component of the state’s child death review system.

CFTF provides a unique opportunity for the public health community to present data and bring in outside experts, including law enforcement and subject matter and harm reduction experts. Everyone sits in a room, discusses policies and gets on the same page. Most bills addressing the overdose epidemic since 2010 have come from CFTF, including revisions to CSRS and increasing/improving naloxone access laws.

Project Lazarus

Established in 2007, Project Lazarus— a public health model based on the twin premises that overdose deaths are preventable and that all communities are responsible for their own health—was one of the first initiatives designed to respond to the extremely high overdose mortality rates in Wilkes County.

“Project Lazarus Offers Communities & Individuals Access To:

  • Coalition formation, capacity building, & sustainability.
  • Chronic pain management.
  • Safe prescribing practices for providers.
  • Opioid overdose education, awareness, & safe medication usage materials.
  • Naloxone, the opioid overdose rescue medication.
  • Project Pill Drop, a community based medication disposal program.
  • Lazarus Recovery Services, a peer guided recovery support program.
  • Local & state data on overdose and poisoning rates.
  • Local & state funding sources for overdose prevention work.”

The University of North Carolina Injury Prevention Research Center (UNC IPRC) evaluated Project Lazarus and found an initial drop in the overdose death rate of 40 percent, which grew to a 69 percent decline in 2011. The program has since be brought statewide.

University of North Carolina Injury Prevention Research Center

The University of North Carolina Injury Prevention Research Center (UNC IPRC) is a key partner in addressing the overdose epidemic. UNC IPRC provides evaluation, research, training, and technical assistance to partners and programs working to combat the opioid epidemic.

Drug Takebacks

In 2009, Safe Kids North Carolina, located in the Office of the Chief Fire Marshall worked with the State Bureau of Investigation and a diverse group of partners to develop Operation Medicine Drop.  Since its establishment, Operation Medicine Drop has collected and safely disposed of 89.2 million pills at more than 2,000 events and established a network of permanent drop boxes that serve most counties in the state.

NC DHHS noted that drug takeback programs are a great way to get the community involved and raise public awareness of the issue—it gives everyone a little skin in the game when they realize that items in their medicine cabinet could be fueling the drug epidemic. This process helped move the conversation upstream to ensuring people knew of the problems and the steps they could take to prevent people from developing a substance use disorder.

PDMP

North Carolina has worked to improve CSRS to be a valuable tool to prescribers and dispensers to better manage pain and appropriate prescribing. In 2012, the Child Fatality Task Force convened a study group that resulted in the Revision to the CSRS Law in 2013.  They added delegate accounts, shortened the time dispensers have to report data, and enabled proactive reporting from CSRS to licensing boards and prescribers.

In 2014, the Program Evaluation Division of the General Assembly conducted an extensive evaluation of CSRS, concluding that further funding and improvements of CSRS should be included in the state budget bill of 2015.

In 2017, the STOP Act— the most comprehensive bill in the state to address the opioid epidemic—became law. The Act includes mandated use of CSRS, limits on prescribing opioids in line with CDC’s Prescribing Guidelines, expansion of naloxone distribution, and numerous other provisions to address the opioid epidemic.

To develop the Act and identify evidenced-based strategies, NC DHHS worked with UNC IPRC, CDC’s Prevention for States Program, and national experts, including Corey Davis at the Network for Public Health Law.

The 911 Good Samaritan Law/Naloxone Access Act

Expanding access to naloxone has been an important part of North Carolina’s strategy to address the overdose epidemic and was a founding principle of Project Lazarus. The North Carolina Harm Reduction Coalition (NC HRC) has worked with the Law Enforcement community to gain their support for enactment of a series of naloxone laws since 2013.

Since the successful passage of naloxone-related legislation, NC HRC distributed more than 41,000 overdose rescue kits and confirmed 7,408 overdose reversals in North Carolina. Working with law enforcement agencies to develop naloxone programs has resulted in 164 law enforcement agencies with officers carrying naloxone and 403 reported law enforcement reversals by naloxone.

In 2016, the Naloxone Standing Order Law—enables any pharmacy in the state to offer naloxone without a prescription under the state health director’s standing order—Became law. The Standing Order Law was developed in response to requests from the retail pharmacy industry, which wanted to easily offer naloxone in their pharmacy outlets across the state.

After passage, DHHS developed a resource web site with UNC IPRC that contains technical resources on how to use the standing order. Nearly 1,400 pharmacies in the state offer naloxone under the standing order law.

The 911 Good Samaritan Law waived prosecution for individuals experiencing or witnessing an overdose who seek help by calling 911. The law also removed civil liabilities for doctors who prescribe naloxone and bystanders who use naloxone to attempt to save someone’s life and allowed community organizations to dispense naloxone with medical provider oversight.

Syringe Exchange

In 2016, North Carolina became the first state in the south to legalize syringe exchanges with passage of House Bill 972.

The years of work on harm reduction and everyone working together broke down the historical resistance of syringe exchanges and they were able to decriminalize needles. Advocates performed demonstration projects and worked with law enforcement early to identify legislation that the law enforcement community would find acceptable and help them in their daily work.

In addition, the argument was made that needle exchanges could save the state money—DHHS noted that Medicaid charges for Hepaticas C treatment went from $3.8 million in 2011 to $85 million in 2016

Following the legalization of the syringe exchanges, DHHS developed the Safer Syringe Initiative and registered 22 syringe programs in the first year of the law—reaching 19 counties.

Initially, to pass the Bill, language was included that prohibited the use of public funds to support exchanges. When the STOP Act passed, it included provisions that only prohibited the use of “State Funds,” enabling local health departments and other governmental units to use local funds to do needle exchange.

The DHHS sees needle exchanges and drug take programs as a way for communities to take direct action in the overdose epidemic.

Colorado’s Work to Prevent Substance Misuse and Suicides

Substance Misuse Prevention

In 2012, when the full scope of the opioid epidemic begun to become apparent, Colorado officials looked to the Colorado Department of Public Health and Environment (CDPHE) to make sense of the issue.

CDPHE synthesized, streamlined and provided important data to understand the problem and convened the important stakeholders and government divisions—across many disciplines.

Initially, CDPHE operated as an integrator by identifying best practice strategies, generating surveillance reports, and facilitating a series of roundtables focused on different aspects of the issue, from prescribing to dispensing to public awareness to treatment. State agencies used the information from these important convenings to create the Colorado Plan to Reduce Prescription Drug Abuse.

To better monitor progress, state-level leadership created the Colorado Consortium for Prescription Drug Abuse Prevention (Consortium), which provides a statewide, interuniversity/interagency framework designed to facilitate collaboration and serves as the strategic lead for implementing the Plan with active participation from the Governor’s Office and various state agencies.

The Consortium is comprised of nine work groups: Data and Research, the Prescription Drug Monitoring Program (PDMP), Provider Education, Public Awareness, Treatment, Safe Disposal, Naloxone, Heroin Response, and Friends and Affected Family Members. Each work group is co-chaired by a state agency and a university representative. As a whole, the Consortium comprises over 300 local, state and federal members. The Consortium’s structure helps facilitate collaboration between state agencies and university partners, making it possible to easily apply for, receive and leverage funding.

For their part, CDPHE focuses a significant amount of attention on primary prevention, specifically prescriber education and making the state’s PDMP easier to use and better integrated into practice. In Colorado, the PDMP is located in the Department of Regulatory Agencies, which handles professional licensing. During the 2014 legislative session, Colorado legislators passed a bill that aligned Colorado’s PDMP with best practice strategies including allowing: delegated access, unsolicited reports, mandated enrollment, and access by out-of-state pharmacists. This legislation also gave CDPHE access to PDMP data as a public health surveillance tool.

With the data in hand and important partners via the Consortium, CDPHE is using funds from the Centers for Disease Control and Prevention to implement and evaluate several pilot projects aimed at improving use of and access to the PDMP, including: integrating the PDMP with the state’s two health information exchanges; connecting electronic health records and the PDMP at eight outpatient clinics; and linking the PDMP to a software application that will allow improved access to the PDMP and better assess provider adherence to prescribing guidelines.

In addition to work on the PDMP, the Consortium encouraged multiple sectors to advocate for the purchase of naloxone—which the Attorney General decided to fund as a pilot in the 16 counties with the highest overdose rates.  In conjunction, another member of the Consortium developed an app to track reversals from using naloxone. CDPHE is conducting an evaluation of the project. But, after just 2 months of data collection, there were nearly 150 reported overdose reversals. As the data continues to be collected, the results should make the case that there is a positive return on investment and that law enforcement is willing to use it.

Suicide Prevention

In July 2012, the Office of Suicide Prevention at CDPHE, Cactus Marketing Communications and the Carson J Spencer Foundation partnered to launch www.ManTherapy.org. The website aims to reach working-age men, who account for the highest number of suicide deaths in Colorado annually.

The three goals of Man Therapy are: 1) to change the way men think and talk about suicide and mental health; 2) to provide men (and their loved ones) with tools to empower them to take control of their overall wellness; and, 3) long-term, to reduce the number and rate of suicide deaths among men. Man Therapy removes traditional mental health language from the conversation and uses humor to help men feel welcome and at ease while visiting the site. The website provides information on depression and suicide, substance use, anger and anxiety, and includes statewide resources specific to finding support and services related to each issue.

In 2015, the Office of Suicide Prevention and the Commission identified Zero Suicide as a priority to better align, integrate and emphasize suicide prevention in Colorado’s health systems. In 2016, Colorado became the first state to pass legislation encouraging healthcare organizations and systems to adopt the Zero Suicide framework, which works to train primary healthcare staff to provide better treatment to individuals who might be contemplating suicide.

Additionally, the Office of Suicide Prevention partnered with Children’s Hospital Colorado, the Colorado School of Public Health, and the Harvard Injury Control Research Center to develop the Emergency Department Counseling on Access to Lethal Means (ED-CALM), which teaches emergency department providers how to educate parents/guardians of suicidal youth about the techniques and importance of restricting access to lethal means in the home.

Going Upstream

CDPHE has a number of efforts dedicated to upstream approaches to preventing youth substance misuse, violence and suicide. For example, CDPHE is currently funding 48 Colorado communities to implement Communities That Care, an evidence-based public health framework that encourages communities to take part in looking at their data, identify evidence-based strategies to address community problems, and implement those strategies to address those issues. The experience uncovered the connections between substance misuse and suicide rates and shown that efforts to prevent substance use work well on preventing suicides and violence.

To help youth even more, CDPHE implemented the Sources of Strength program, a school-based youth initiative focused on redefining school level social norms that has been shown to build positive feelings of connectedness between youth and their peers and communities.

In the program, youth advisors are carefully handpicked from different segments from the school to create leaders from all the peer groups. Those leaders are then educated on suicide prevention basics and are tasked with coming up with positive campaigns that are upbeat and engaging. Because they are peers, the activities are better positioned to get a wider population involved in activities—and research shows that kids involved in activities who are connected to their community are much less likely to commit suicide.

In addition to preventing suicides, building these protective factors extends to preventing sexual violence prevention, bullying and other dangerous and/or risky behaviors. Through the pilot programs, Colorado has begun to see reductions in sexual violence and bullying. CDPHE is currently partnering with researchers at the University of Florida and the University of Rochester to do a rigorous evaluation of Sources of Strength at 24 Colorado high schools to measure the impact the program has on preventing the perpetration of sexual violence, bullying and suicide.

TFAH Statement: Strongly Opposed to the House Obamacare Replacement Bill

Washington, D.C., March 7, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH).

“We are strongly opposed to the House Obamacare Replacement bill, which would repeal significant portions of the Affordable Care Act (ACA), including the Prevention and Public Health Fund.

Under this plan, millions of people could lose health insurance—a devastating blow to the health of many of our nation’s most vulnerable individuals and families. Without affordable insurance coverage we will see increased levels of preventable illnesses, injuries and deaths.

In addition, eliminating the Prevention Fund would erase 12 percent of the Centers for Disease Control and Prevention’s (CDC) budget. Of that investment, $625 million directly supports state and local public health efforts to fight preventable diseases such as diabetes, heart disease and cancer.

Losing this funding would wreak havoc on our efforts to reduce chronic disease rates, immunize our children, stop the prescription drug and opioid epidemic and prepare the public health system to prevent infectious disease outbreaks.

We know how to prevent many chronic and infectious illnesses—which make up a significant portion of the $3 trillion the nation spends yearly on healthcare.  If we lose access to health care coverage and to the Prevention Fund, our children, families and communities will suffer and ultimately costs will rise.

The bottom line? This Bill would make untold numbers of the American people less healthy.”

 

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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.

TFAH Statement on the Draft House Republican Obamacare Replacement Bill: Our Nation’s Health Will Suffer

Washington, D.C., February 24, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH).

“The draft House Republican Obamacare replacement bill—which would eliminate the Prevention and Public Health Fund—would threaten the health of American children, families and communities.

Thanks to the Prevention Fund, hundreds of thousands of Americans benefit from increased access to vaccines and other preventive health services. Quite simply, more people are getting and remaining healthy because of the Prevention Fund.

Yet, the proposed replacement bill would eliminate this important Fund and 12 percent of the U.S. Centers for Disease Control and Prevention’s (CDC) budget along with it.

And, without the Prevention Fund, states will lose substantial sums of money—totaling as much as $3 billion over the next 5 years—which fight growing epidemics and emerging diseases.

Every year, we spend $3 trillion on healthcare, yet millions suffer from chronic diseases and death rates among Blacks and other people of color remain too high. At the same time, death rates among white middle-aged Americans increased for the first time in decades, mainly due to preventable conditions.

Time and again research shows that the vast majority of these conditions—heart disease, diabetes and others—can be prevented by investing in addressing the root causes. Yet, the country has repeatedly failed to do so.

The nation cannot afford to trade away our single best investment in preventing disease, preparing for and responding to infectious disease outbreaks, reducing rates of chronic illness, and saving lives and money.

If this draft becomes law, our nation’s health will suffer—and it will be exponentially harder to fight growing epidemics, like the rise in prescription drug and heroin overdoses.”

 

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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.

Survey Finds 73 Percent Support Investments to Improve Health; Obesity, Future Health of Children Top Concerns

Washington, D.C., January 19, 2017 —A new national survey of registered voters has found that nearly three-quarters (73 percent) of Americans support increasing investments to improve the health of communities.  Support spans across party lines (57 percent of Republicans, 87 percent of Democrats and 70 percent of Independents) and regionally across the country (75 percent in the Northeast, 71 percent in the Central U.S., 72 percent in the South, and 75 percent in the West).  Women are the strongest proponents of supporting health improvement efforts (62 percent of Republican women, 87 percent of Democratic women and 80 percent of Independent women).

The survey, released today by the Robert Wood Johnson Foundation and the Trust for America’s Health, was conducted by Greenberg Quinlan Rosner Research, in consultation with Bellweather Research, on September 8-9, 2016 of a nationwide sample of 1302 registered voters across the country.

A majority (51 percent) believe that today’s children will be less healthy than previous generations when they reach adulthood.  The groups who hold this belief most strongly include: Republicans (55 percent); rural residents (60 percent); Southerners (57 percent); Independent women (62 percent); and Black women (68 percent).  Most registered voters with children under age 18, however, believe their own children are very healthy (92 percent give an 8-10 rating on a 10-point scale); this is the case for parents of all ideologies, incomes, education levels, and ethnicities.

Additionally, 64 percent believe that the number of health issues facing the country has grown in recent years. Obesity is the top health concern (41 percent), cancer ranked second (33 percent), followed by heart disease and stroke (14 percent) and diabetes and substance misuse (both at 11 percent).

Americans also rate their own health better than the health of the community where they live (66 percent rate their own health as 8-10 (very good) on a 10 point scale, but only 36 percent rank their community’s health as very good).  There are differences based on income, age, education and area of the country on how people rank their health.  For instance:

  • 73 percent of college-educated Whites rank their health as very good compared to 57 percent of Whites without college degrees; and
  • 72 percent of individuals with a household income above $50,000 per year rank their health as very good compared to 59 percent of those with incomes below $50,000.

A majority of American registered voters also strongly support (rating 8-10 out of a 10 point scale) a range of priorities and strategies for improving health, including:

  • 74 percent of people highly support providing enough time — during the school day and afterschool – for kids’ physical education, physical activity or community sports;
  • 74 percent also highly support creating partnerships among farmers, food suppliers and community health groups to bring fresh produce trucks or mobile markets to communities that lack access to grocery stores;
  • 65 percent highly support providing kids with more information on making healthy food choices and being physically active;
  • 63 percent highly support investing more in preventing obesity and chronic diseases like heart disease, diabetes and stroke;
  • 62 percent highly support increasing early childhood health programs, including home visit programs, mobile health screenings and treatment for diseases like asthma;
  • 61 percent highly support investing more in preventing the spread of infectious diseases like the Zika virus, bird flu and hepatitis;
  • 60 percent highly support treating substance use, including addiction to prescription painkillers and heroin, like a disease, not a crime;
  • 60 percent highly support planning for building more parks, walking and biking trails and other recreation areas for people to be physically active in all communities;
  • 60 percent highly support increasing access to safe and affordable housing and routinely testing for things that create health problems in homes, like lead in water and paint, carbon monoxide, and harmful chemicals in the air;
  • 59 percent highly support increasing incentives that encourage business owners to open grocery stores in communities that lack access to healthy food options; and
  • 58 percent highly support building local partnerships across businesses, health systems, schools and community organizations to address specific health problems in communities.

Methodology:  On behalf of the Robert Wood Johnson Foundation and the Trust for America’s Health, Greenberg Quinlan Rosner Research, in consultation with Bellwether Research, conducted a survey among 1,320 registered voters nationwide (1,019 weighted). The survey was conducted between September 8th and 19th, 2016. Voters were randomly selected from a list of registered voters and reached on a landline or cell phone depending on the number they designated on their voter registration. Interviews were conducted by live telephone interviewers; 50 percent were reached on a cell phone. Included in the sample were three oversamples: 100 Black voters, 100 Hispanic voters, and 100 White non-college voters. Upon completion of the survey, the results were weighted to bring the three oversamples into line with the racial and ethnic composition of registered voters nationwide. The data was weighted to reflect the total population of registered voters, taking into account regional and demographic characteristics according to known census estimates and voter file projections. The data are subject to a margin of error of +/- 3.1 percentage points.  Full survey and topline results are available upon request.

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 atwww.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook. 

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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.

Trust for America’s Health: Deeply Disappointed Congress Utilized the Prevention Fund as a 21st Century Cures Offset

Washington, D.C., December 7, 2016 – The below is a statement from Rich Hamburg, interim president and CEO, of Trust for America’s Health (TFAH) on the 21st Century Cures legislative package.

“TFAH is deeply disappointed Congress will utilize the Prevention and Public Health Fund as an offset for the legislative package known as 21st Century Cures. Cutting the Prevention Fund will limit the nation’s ability to improve health and quality of life and prevent disease.

While TFAH supports aspects of this legislative package, including the much-needed funds to address the opioid epidemic, we remain opposed to using the Prevention Fund to offset the cost of this legislation.

The Prevention Fund is inextricably tied to the nation’s future ability to reign in healthcare costs. This is the nation’s first and only substantial investment in moving from our current “sick care” system to a true preventive health system. The Prevention Fund should be dedicated to its intended purpose: helping all Americans stay healthy.

Despite the exponentially growing burden of largely preventable diseases, federal disease prevention and public health programs remain critically underfunded. Public health spending is still below pre-recession levels, having remained relatively flat for years. Today, more than 12 percent of the CDC budget is supplied through Prevention Fund investments, including the 317 immunization program, epidemiology and laboratory capacity grants and the entire Preventive Health and Health Services Block Grant program—all critical to preparing for and responding to public health emergencies.

The United States spends $3 trillion annually on healthcare without much to show for it: Millions of Americans suffer from chronic diseases, which are responsible for seven out of 10 deaths and $1.3 trillion in treatment costs and lost productivity every year.

And, two-thirds of Americans are overweight or obese and nearly 20 percent of Americans smoke. Obesity costs the country $147 billion and tobacco use leads to another $130 billion in healthcare spending each year.

Time and again research shows that the vast majority of these chronic diseases can be prevented by investing in addressing the root causes. Yet, the country has repeatedly failed to do so.

The nation cannot afford to trade away our single best investment in preventing disease, preparing for and responding to infectious disease outbreaks, reducing rates of chronic illness, and saving lives and money.”

 

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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.

Trust for America’s Health Releases “Blueprint for a Healthier America” Report Featuring High-Impact Policies for the Next Administration and Congress

Washington, D.C., October 19, 2016 – Today, the Trust for America’s Health (TFAH) released Blueprint for a Healthier America 2016: Policy Priorities for the Next Administration and Congress which calls for a new approach to health – prioritizing improving health and addressing major epidemics in the United States.

“It’s time for a sea change from our current sick care system to a true health system, where we focus on preventing disease and improving quality of life,” said Richard Hamburg, Interim CEO and President of TFAH.  “In the Blueprint, we highlight high-impact policies that could help spare millions of Americans from preventable health problems and save billions in avoidable healthcare costs – if we make them a priority.” 

The report highlights pressing crises and how investments could yield positive returns on investment by adopting proven health strategies.  For instance:

  • Investing $1 in substance use prevention to realize as much as $34 in return.  Deaths from prescription painkiller use have more than quadrupled in the last 15 years and deaths from heroin have tripled since 2010, contributing to higher death rates among middle-aged Whites.  Five of the strongest school-based substance use prevention strategies have returns on investment ranging from $3.8:1 to $34:1.
  • Saving more than $16 billion through a more active and healthy population. One in three children will develop type 2 diabetes in their lifetime and one in four young adults are not healthy enough to join the military.  An investment of $10 per person in proven, evidence-based community prevention programs to increase physical activity, improve nutrition and reduce tobacco use could save the country more than $16 billion annually – a $5.60:1 return.
  • Connecting health and social services to cut billions in costs.  Health and social service coordinating systems that address gaps between medical care and effective social service programs – by connecting patients in need with programs ranging from supportive housing to food assistance – could yield between $15 billion and $72 billion in healthcare savings a year within 10 years, according to a new analysis by TFAH and Healthsperien.
  • Reducing the $120 billion spent annually on preventable infectious diseases.  Fifteen years after 9/11 and 11 years after Hurricane Katrina, when health crises such as new infectious diseases arise, the country still scrambles to implement emergency plans and secure funding.  Preventable infectious diseases cost the country more than $120 billion annually – and that cost is exponentially compounded when new diseases emerge.
  • Realizing a 7-10 percent annual return by investing in early childhood education. More than half of U.S. children – across the economic spectrum – experience adverse experiences, such as physical or sexual abuse, and more than 20 percent live below the poverty line, which increases their risk for “toxic stress” – living under a constant state of stressful conditions – that can contribute to a range of physical, mental and behavioral health issues.  Investments in early childhood education can help mitigate against impact of these risks and increase resilience, while also providing an annual return of 7 to 10 percent per year, and supportive nurse-family home visits for high-risk families show a return of $5.70:1. 

The Blueprint highlights leading evidence-based strategies for improving health and policy – and models to help bring them to scale across the country. These include:

  • Supporting Better Health in Every Community:  Federal, state and local public health programs and policies should support place-based health improvement partnerships. Doing so will help identify and elevate a local community’s top priorities and bring key partners and assets together – from public health, healthcare, social services, philanthropies, education, businesses and faith and community groups – for a greater collective impact.  A network of expert institutes in each state should provide technical assistance to these multisector collaborative partnerships.  In addition, the Prevention and Public Health Fund and other community-based health improvement programs should be protected and fully funded.
  • Modernizing the Public Health System to Be Prepared for Emergencies:  The public health system must be modernized – and sufficiently funded – so that it can handle ongoing threats and new emergencies. Too often the country has been caught off guard when a new crisis emerges, diverting attention and resources.  There should be 1) greater investment to improve baseline foundational capabilities in communities around the country; 2) a standing Public Health Emergency Fund to provide additional surge funds when needed; 3) improved federal leadership, such as through a Special Assistant to the President for Health Security; and 4) upgrades to out-of-date technology and surveillance systems.
  • Incentivizing Health Care vs. Sick Care:  There should be increased incentives and mechanisms for healthcare insurers, nonprofit hospital community benefit programs and social investment funds to support health improvement strategies.  Efforts such as healthcare investment in community-wide health improvement programs, “navigator plus support” health and social service integration (such as Accountable Health Communities), Community Development Financial Institutions for Health (strategic planning and financing intermediaries) and pay-for-outcome approaches should be expanded.

The report also includes a set of policy recommendations to address priority health problems that require urgent action, some highlight areas include:

  • Stopping the Prescription Painkiller and Heroin Epidemics
  • Renewing Efforts to Prevent Obesity, Diabetes and Tobacco Use
  • Highlighting Prevention in the National Cancer Moonshot Initiative
  • Ending the HIV/AIDS Epidemic
  • Stopping Superbugs and Antibiotic Resistance
  • Lowering the Rising Death Rates Among Middle-Aged Whites
  • Achieving Health Equity

The Blueprint was supported by grants from the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation, The California Endowment and The Kresge Foundation.

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.

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