Issue Category: Substance Misuse and Mental Health
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
10th Anniversary of the ACA: A Time to Reflect on its Impact and Refocus Efforts on the Act’s Purpose and Goals
COVID-19 has shown how important it is to fully fund the ACA created Prevention and Public Health Fund
March 23, 2020
This tenth anniversary of the enactment of the Affordable Care Act (ACA) is an appropriate time to measure its impact and recommit to its purpose. Prior to the ACA, more than 44 million non-elderly adults were uninsured. By 2016, that rate of uninsured people reached a historic low as approximately 20 million Americans gained access to health insurance coverage under the ACA including 12 million adults who gained coverage due to Medicaid expansion.[1]
The ACA was transformative legislation in at least three ways. It offered Americans access to medical care when they were acutely ill and when they needed ongoing treatment for a chronic condition (78 percent of U.S. adults 55 and older have at least one chronic condition[2]). In addition, millions of Americans gained access to preventive care such as vaccinations and health screenings. Thirdly, it helped advance health equity by narrowing – although not eliminating – the gaps in access to high-quality care experienced by people of color due to economic disadvantage and systemic discrimination.
Prior to the ACA, Black Americans were 70 percent more likely to be uninsured than Whites and the uninsured rate for Latinos was nearly three times the uninsured rate for Whites[3]. After the ACA became law, Latinos had the largest decrease in uninsurance rates, falling from 32.6 percent to 19.1 percent between 2010 and 2016. Uninsurance rates also fell by 8 percent for Asian Americans and Black Americans during the same period.[4]
Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates among low-income individuals and within specific vulnerable populations.[5] A study by the National Bureau of Economic Research found that Medicaid expansion is associated with reduced mortality.[6] According to the study, states that expanded Medicaid had an estimated 19,200 fewer adult deaths (ages 55 to 64) between 2014 and 2017 than did states that did not expand Medicaid.[7]
Furthermore, the ACA created the Prevention and Public Health Fund (PPHF) and allocated $2 billion annually as an “expanded and sustained national investment in prevention and public health programs”. Unfortunately, much of the PPHF funding has been reallocated to other programs outside prevention and public health. On this 10th anniversary of the passage of the ACA, Congress should redouble its efforts to ensure the Prevention Fund is fully funded and that those funds are directed as intended, to prevention and public health programs.
As the COVID-19 pandemic has put in the spotlight, individual health is often linked to community health. The Prevention and Public Health Fund’s intended purpose and emphasis: sustained investment in the nation’s public health infrastructure would, if fully realized, strengthen our national readiness for health emergencies. A level of readiness that the COVID-19 pandemic has shown to be seriously inadequate.
While this 10th anniversary of the Affordable Care Act is a time to recognize and applaud its significant impact, it is also a time to shine a spotlight on the fact that over 27 million Americans remain without access to healthcare due to being uninsured. Ensuring that all Americans have access to healthcare is a priority of Trust for America’s Health and must be a national priority.
[1] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25. https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/ Google Scholar
[2] CDC, National Center for Health Statistics. Percentage of U.S. Adults over 55 with Chronic Conditions. https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm
[3] Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106(8):1416–21
[4] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25. https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/
[5] Madeline Guth, et al. The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review. March 17, 2020.
[6] Sarah Miller et al., “Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data,” National Bureau of Economic Research working paper, August 2019, https://www.nber.org/papers/w26081.
[7] Ibid
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
Nation must prepare for immediate and long-term impacts of COVID-19 on the nation’s mental health
(Washington, DC – March 20, 2020) — 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. Such consideration is especially important as the anxiety and social isolation related to the COVID-19 pandemic are likely to increase the need for mental health and substance misuse care, according to the group’s leaders.
In a letter sent to Vice President Pence and House and Senate leadership today, the group recognizes the importance of social distancing but also cites the need to proactively address the short and long-term impacts of social isolation on Americans’ mental health. Of particular concern are those people who are currently being treated for a mental health or substance misuse issue, treatment that may be interrupted by illness, stay-at-home orders, business shut-downs or the loss of income or health insurance.
Access to mental health and substance misuse treatment is an ongoing concern, likely to be exacerbated by the COVID-19 crisis. Currently, 112 million Americans live in a mental health professional shortage area. Furthermore, loneliness and social isolation are already a daily reality for many Americans and is estimated to shorten a person’s life by 15 years – the equivalent impact of having obesity or smoking 15 cigarettes a day. This problem will only increase as further social distancing requirements are put in place.
The cross-sector group is calling for immediate action to address Americans’ mental health and substance misuse needs during the COVID-19 response. And, for the longer term, strengthening the nation’s mental health and substance misuse treatment system so it meets the needs of all Americans, regardless of their socioeconomic status, their employment status or where they live.
The group is following for the following action steps: The Administration and/or Congress should:
Immediately implement measures to ensure access and continuation of mental health and substance use services to all individuals during the COVID-19 response and during future public health emergencies including:
- HHS should issue guidance clarifying that mental health and substance use clinicians and professionals are included in priority testing for COVID-19as well as targets of emergency medical supplies including masks, respirators, ventilators, and other needed resources for health care professionals during this crisis.
- CMS should issue guidance for various care contingencies should substance use treatment providers become sick or unable to work and affect required quotas for reimbursement.
- SAMHSA should issue guidance to support remote recovery support groups.
- Congress should pass S. 2244/H.R. 4131, the Improving Access to Remote Behavioral Health Treatment Act, to clarify the eligibility of community mental health and addiction treatment centers to prescribe controlled substances for opioid use disorder via telemedicine. HHS recently waived the Ryan Haight restrictions for this pandemic, but this ends once the national emergency ends which could create treatment gaps.
- HHS should launch a special enrollment period for commercial health insurance in the healthcare.gov marketplace during this crisis and future public health crises.
- Congress should ensure that all government health plans provide extended supplies and/or mail order refills of prescriptions.
- Congress should allow for all current discretionary and block grant funds for mental health and substance use programs, including prevention, intervention, treatment, and recovery support, across all relevant agencies across the federal government that cannot be spent this fiscal year due to the pandemic to be automatically extended into Fiscal Year 2021.
Pass, implement, and/or appropriate funding to strengthen crisis services and surveillance including:
- S. 2661/H.R. 4194, the National Suicide Hotline Designation Act, which would formally designate a three-digit number for the Lifeline.
- H.R. 4564, The Suicide Prevention Lifeline Improvement Act, which would implement a set of quality metrics to ensure resources are effective and evidence-based.
- H.R. 4585, the Campaign to Prevent Suicide Act, which establishes an educational campaign to advertise the National Suicide Prevention Lifeline and suicide prevention resources.
- H.R. 1329, Medicaid Reentry Act, which would allow Medicaid-eligible incarcerated individuals to restart their benefits 30 days pre-release.
- Increase funding for the Disaster Distress Helpline.
- Increase funding to serve people who are homeless and to divert people who are at immediate risk of becoming homeless during this crisis.
Pass and implement reforms to ensure long-term availability of care, especially for populations at higher risk of self-harm or substance misuse, including:
- S. 824/H.R. 1767, the Excellence in Mental Health and Addiction Treatment Expansion Act, which would expand the Certified Community Behavioral Health Clinic Program.
- S. 1122/H.R. 1109, the Mental Health Services for Students Act which expands SAMHSA’s Project AWARE State Educational Agency Grant Program to support the provision of mental health services.
- S. 2492/H.R. 2599, the Suicide Training and Awareness Nationally Delivered for Universal Prevention (STANDUP) Act, which would create and implement suicide prevention training policies in states, tribes, and school districts.
- Enforce mental health parity and pass S. 1737/H.R. 3165, the Mental Health Parity Compliance Act and S. 1576/H.R. 2874, the Behavioral Health Transparency Act.
- Expand HRSA’s NHSC Substance Use Disorder Workforce Loan Repayment Program H.R. 2431, the Mental Health Professionals Workforce Shortage Loan Repayment Act, which would establish a loan repayment program for mental health professionals working in shortage areas.
- S. 2772/H.R. 884, the Medicare Mental Health Access Act, which would allow expanding the definition of “physician” under Medicare, allowing psychologists to practice to the full extent of their state licensure without physician oversight of Medicare facilities.
HHS should consider the mental health and substance use effects of future pandemics and national emergencies including:
- Establishing an interagency taskforce or advisory committee on disaster mental health and substance use to ensure future responses take proper measures to coordinate care, allocate resources, and take appropriate measures to ensure recovery.
- Convening a working group to review current research and funding on disaster mental health through NIH, AHRQ, CDC, SAMHSA, HRSA, FDA, and the Department of Justice, and other relevant agencies and identify gaps in knowledge, areas of recent progress, and necessary priorities.
Signing on to the letter were:
2020 Mom, AAMFT Research & Education Foundation, Active Minds, Addiction Connections Resource, Advocates for Opioid Recovery, African American Health Alliance, American Academy of Addiction Psychiatry, American Art Therapy Association, American Association for Marriage and Family Therapy, American Association for Psychoanalysis in Clinical Social Work, American Association of Suicidology, American Counseling Association, American Dance Therapy Association American Foundation for Suicide Prevention American Group Psychotherapy Association, American Mental Health Counselors Association, American Psychological Association, American Public Health Association, Anxiety and Depression Association of America, California Pan-Ethnic Health Network Center for Law and Social Policy (CLASP)Centerstone, Children and Adults with Attention-Deficit/Hyperactivity Disorder, Clean Slate Medical Group -Addiction Treatment, Clinical Social Work Association, Coalition to End Social
Isolation & Loneliness, College of Psychiatric and Neurologic Pharmacists (CPNP )Colorado Children’s Campaign Columbia Psychiatry, Community Anti-Drug Coalitions of America (CADCA, )Community Care Alliance Davis Direction Foundation, Depression and Bipolar Support Alliance, Easterseals, Eating Disorders Coalition, Families USA, Flawless Foundation, Foundation for Recovery, Global Alliance for Behavioral Health and Social Justice, Greater Philadelphia Business Coalition on Health, Health Resources in Action, Hogg Foundation for Mental Health, InnovaTel, Telepsychiatry International, OCD Foundation,
Mental Health America, NAADAC, the Association for Addiction Professionals, National Association of County Behavioral Health and Developmental Disability Directors, National Association for Rural Mental Health (NARMH), National Alliance on Mental Illness, National Association for Children of Addiction (NACoA, )National Association of Community Health Workers, National Association of Counties, National Association of Social Workers, National Association of Social Workers -Texas Chapter, National Association of Social Workers at the University of Southern California, National Association of State Mental Health Program Directors, National Council for Behavioral Health, National Eating Disorders Association, National Federation of Families for Children’s Mental Health, National Organization on Fetal Alcohol Syndrome, National Register of Health Service Psychologists, Network of Jewish Human Service Agencies, Neurofeedback Advocacy Project, New Jersey Association of Mental Health and Addiction Agencies, Inc., O’Neill Institute for National and Global Health Law, Postpartum Support International, Prevention Institute, Public Health Foundation, Residential Eating Disorders Consortium, Robert Graham Center, San Francisco AIDS Foundation, San Juan County Behavioral Health Department, Sandy Hook Promise SMART Recovery, Staten Island Partnership for Community Wellness, Suicide Awareness Voices of Education, Texans Care for Children, The Confederation of Independent Psychoanalytic Societies (CIPS), The Gerontological Society of America, The Institute for Innovation & Implementation at UMBSSW, The Jed Foundation, The National Alliance to Advance Adolescent Health, The Trevor Project, The Voices Project, Trust for America’s Health, United States of Care, University of Southern California, Well Being Trust.
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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
88 Organizations Call for Attention to Mental Health and Substance Misuse Treatment as Part of COVID-19 Response (March 2020)
New National Data Present a Mixed Picture: Some Drug Overdoses Down but Others are Up, and Suicides Rates are Increasing
(Washington, DC – January 30, 2020) Newly released mortality data from 2018 show the first increase in Americans’ life expectancy since 2014, and the first decline in the rate of drug overdose deaths, including opioid overdoses, since 2012. The year also saw an increase in suicide and in overdose deaths involving synthetic opioids, cocaine, and psychostimulants (a category that includes drugs like methamphetamine, amphetamine, and methylphenidate). The topline trends on mortality and opioids—released by the National Center for Health Statistics on January 30—are heartening after years of alarming trends, but suicides continue to rise, and drug overdoses remain a major public health issue that requires vigilance from policymakers to ensure sustained gains.
Key findings from today’s reports:
- Life expectancy: American’s life expectancy was 78.7 years in 2018, compared with 78.6 years in 2017. Life expectancy in the United States peaked in 2014 at 78.9 years.
- Suicide deaths: 48,344 Americans died from suicide in 2018, a rate of 14.2 deaths per 100,000. That’s a rate 2 percent higher than 2017 when 47,173 Americans died from suicide (14.0 deaths per 100,000).
- Overall drug overdoses deaths: 67,367 Americans died from drug overdoses in 2018, a rate of 20.7 deaths per 100,000. This is a rate 5 percent lower than over 2017 when 70,237 Americans died of drug overdoses (21.7 deaths per 100,000). Even with the decline, the 2018 rate of drug overdoses is still 74 percent higher than 2008.
- Opioid overdose deaths: 46,802 Americans died from opioid overdoses in 2018, a rate of 14.6 deaths per 100,000. That’s a rate 2 percent lower than 2017 when 47,600 Americans died of opioid overdoses (14.9 deaths per 100,000). Even with the decline, the rate of opioid overdose deaths has more than doubled in the last decade.
- Synthetic opioid overdose deaths: 31,335 Americans died from synthetic opioid overdoses in 2018, a rate of 9.9 deaths per 100,000. That’s a rate 10 percent higher than 2017 when 28,466 Americans died of synthetic opioids overdoses (9.0 deaths per 100,000). The rate of synthetic opioid overdose deaths has increased almost 900 percent over the last five years.
- Cocaine overdose deaths: 14,666 Americans died from cocaine overdoses in 2018, a rate of 4.5 deaths per 100,000. That rate is 5 percent higher than 2017, when 13,942 Americans died of cocaine overdoses (4.3 deaths per 100,000). The rate of cocaine overdose deaths has increased by almost three-fold over the past five years.
- Psychostimulant overdose deaths: 12,676 Americans died from psychostimulants in 2018, a rate of 3.9 deaths per 100,000. That’s a rate 22 percent higher than 2017, when 10,333 Americans died from psychostimulant overdoses (3.2 deaths per 100,000). The rate of psychostimulants overdose death has increased by more than three-fold over the past five years.Additional annual data (1999-2018) and state-level data on drug overdose death can be found below.“While we have some cause for celebration, now is not the time to become complacent,” said Benjamin F. Miller, PsyD, chief strategy officer, Well Being Trust. “It’s been important to focus on harm reduction and saving lives—but policy and investments must go further to reduce what’s driving despair and prevent substance misuse issues and suicidal ideation from developing in the first place. No one policy will solve this crisis we’re facing as a country—what is need is a comprehensive, actionable framework for policy makers.”“These new data suggest efforts to reduce opioid deaths are starting to take hold, particularly by reducing inappropriate opioid prescribing and expanding treatment options,” said John Auerbach, President and CEO of the Trust for America’s Health. “These data show we can make a positive difference when we adopt evidence-based approaches and expand the available resources. But we need to expand that approach to prevent suicides and address all forms of substance misuse. That requires a comprehensive approach that pays attention to the upstream root causes, like childhood trauma, poverty and discrimination,”Over the last four years, Trust for America’s Health (TFAH) and Well Being Trust (WBT) have released as 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.
Drug Overdose Deaths, 1999-2018 (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 |
Source National Vital Statistics System, National Center for Health Statistics
2018 Drug Overdose Deaths by State
| State | Deaths | Deaths per 100,000 |
| Alabama | 775 | 16.6 |
| Alaska | 110 | 14.6 |
| Arizona | 1670 | 23.8 |
| Arkansas | 444 | 15.7 |
| California | 5348 | 12.8 |
| Colorado | 995 | 16.8 |
| Connecticut | 1069 | 30.7 |
| Delaware | 401 | 43.8 |
| DC | 254 | 35.4 |
| Florida | 4698 | 22.8 |
| Georgia | 1404 | 13.2 |
| Hawaii | 213 | 14.3 |
| Idaho | 250 | 14.6 |
| Illinois | 2722 | 21.3 |
| Indiana | 1629 | 25.6 |
| Iowa | 287 | 9.6 |
| Kansas | 345 | 12.4 |
| Kentucky | 1315 | 30.9 |
| Louisiana | 1140 | 25.4 |
| Maine | 345 | 27.9 |
| Maryland | 2324 | 37.2 |
| Massachusetts | 2241 | 32.8 |
| Michigan | 2591 | 26.6 |
| Minnesota | 636 | 11.5 |
| Mississippi | 310 | 10.8 |
| Missouri | 1610 | 27.5 |
| Montana | 125 | 12.2 |
| Nebraska | 138 | 7.4 |
| Nevada | 688 | 21.2 |
| New Hampshire | 452 | 35.8 |
| New Jersey | 2900 | 33.1 |
| New Mexico | 537 | 26.7 |
| New York | 3697 | 18.4 |
| North Carolina | 2259 | 22.4 |
| North Dakota | 70 | 10.2 |
| Ohio | 3980 | 35.9 |
| Oklahoma | 716 | 18.4 |
| Oregon | 547 | 12.6 |
| Pennsylvania | 4415 | 36.1 |
| Rhode Island | 317 | 30.1 |
| South Carolina | 1125 | 22.6 |
| South Dakota | 57 | 6.9 |
| Tennessee | 1823 | 27.5 |
| Texas | 3005 | 10.4 |
| Utah | 624 | 21.2 |
| Vermont | 153 | 26.6 |
| Virginia | 1448 | 17.1 |
| Washington | 1164 | 14.8 |
| West Virginia | 856 | 51.5 |
| Wisconsin | 1079 | 19.2 |
| Wyoming | 66 | 11.1 |
Source National Vital Statistics System, National Center for Health Statistics
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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. @HealthyAmerica1
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 @WellBeingTrust
New Maps Track Laws Related to Tobacco Pricing Strategies and Syringe Service Programs in US
(Philadelphia, Pa – Novermber 19, 2019) Two new maps published to LawAtlas.org today — syringe service programs (SSPs) and tobacco pricing strategies — offer a comprehensive look at US laws that address tobacco pricing strategies and access to clean syringes through syringe service programs.
“States have a vital role to play in promoting the health and well-being of their residents. These datasets, along with other resources produced under the Promoting Health and Cost Control (PHACCS) in States initiative, will provide decisionmakers, advocates, and other key stakeholders with the evidence and business case for the adoption of policies that have been shown to improve community health,” said Adam Lustig, MS, Manager and Co-Principal Investigator of the PHACCS initiative.
The maps are the first two legal data resources in a new series created and maintained by the Center for Public Health Law Research at Temple University’s Beasley School of Law (CPHLR) with the Trust for America’s Health (TFAH).
Researchers from the Center used the scientific policy surveillance process in collaboration with experts from TFAH to provide states with detailed information about the current state of US laws that could be used to improve community health through cost-saving policy changes.
“You must first measure a policy to understand its impact on health and cost. These maps give policymakers, advocates, practitioners and other stakeholders a comprehensive look into what these laws say and how the nuanced characteristics differ across the US,” said Lindsay Cloud, JD, Director of the Policy Surveillance Program at CPHLR. “The policy surveillance process we use is the gold standard for legal research because it creates objective, detailed legal data that can be used for evaluation and provides a clear visual to identifying gaps and areas for policy improvement.”
The project will include 13 datasets on a variety of public health topics through the end of 2020, ranging from universal pre-kindergarten and school nutrition standards, to housing and economic policies like the Earned Income Tax Credit and paid sick and family leave laws. The laws displayed were in effect as of August 1, 2019.
The two datasets released today, on syringe service programs and tobacco pricing strategies, represent two of the harm reduction-focused datasets in the series.
Syringe Service Programs
Syringe service program (SSP) policies authorize the legal sale and exchange of sterile syringes, and are one of the most effective and scientifically-based methods for reducing the spread of HIV and Hepatitis. This legal map identifies where SSPs have been explicitly authorized by the law, legal exemptions for individuals who access SSPs if they’re in possession of paraphernalia if stopped by law enforcement, and additional services an SSP must provide directly or through referrals.
Some key findings from this dataset include:
- 31 states have passed laws that explicitly authorize SSPs. This number has nearly doubled since 2014 (18 states as of August 1, 2014).
- In four of the 31 states – Delaware, Florida, Hawaii, and Maine – the law requires a one-for-one exchange of syringes.
- In three states – Colorado, Georgia and Ohio – SSPs are also required to provide HIV and Hepatitis screenings.
Tobacco Pricing Strategies
Tobacco use and exposure to second-hand smoke are leading causes of preventable death in the US. One strategy to decrease tobacco use and promote quitting is to increase the price of tobacco products. This legal map details US laws that apply taxes or set pricing limits for tobacco products, like traditional cigarettes, e-cigarettes, and others.
Some key findings from this dataset include:
- All 50 states and the District of Columbia tax cigarettes.
- All 50 states and the District of Columbia have taxes on non-cigarette tobacco products.
- 14 states and the District of Columbia also tax e-cigarettes, either by taxing the device, the liquid, or both.
- 31 states and the District of Columbia prohibit selling cigarettes, non-cigarette tobacco products, or both below cost.
- 32 states preempt local taxation of tobacco, either through explicit prohibitions on local tobacco taxation or through general limitations on the power of local governments to impose their own excise taxes.
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. Learn more at www.tfah.org
The Center for Public Health Law Research at the Temple University Beasley School of Law supports the widespread adoption of scientific tools and methods for mapping and evaluating the impact of law on health. Learn more at http://phlr.org
Addressing a Crisis: Cross-Sector Strategies to Prevent Adolescent Substance Use and Suicide
Adolescent Suicide Up 87 Percent Over Last Decade; LGBT and American Indian/Alaskan Native Teens at Highest Risk
Vaping among teens also increasing at an alarming rate.
(Washington, DC and Oakland, CA – October 29, 2019) – Adolescent suicides have spiked over the last decade and substance misuse including vaping is exacting a heavy toll on teens according to a report released today by Trust for America’s Health (TFAH) and Well Being Trust (WBT).
The report, Addressing a Crisis: Cross-Sector Strategies to Prevent Adolescent Substance Misuse and Suicide finds that, while progress has been made in reducing some risky behaviors, adolescent suicide and substance misuse rates remain high and in some cases are climbing. The report calls for the expansion of evidence-based and cross-sector strategies in order to save lives.
Suicide rates among 12- to 19-year-olds have increased 87 percent between 2007 and 2017 (when the most recent data is available) – making suicide the second leading cause of death among adolescents. In 2017, 7.4 percent of high schoolers nationwide attempted suicide within the preceding 12 months – a 17 percent increase from the previous year. Nearly 3,000 12- to 19-year-olds died by suicide in 2017.
“We know strategies that are proven to work and can improve mental health and well-being among our young people,” said Benjamin F. Miller, PsyD, chief strategy officer, WBT. “From Zero Suicide to Youth Mental Health First Aid to LifeSkills Training programs and dozens of other initiatives, there are solutions out there – why this is not the first question of every Presidential debate, prioritized in Congress, and in every state legislature is beyond me. Our country has failed to devote the time, energy, and resources to our youth.”
An additional area of concern threatening youth well-being is vaping—with rates of use among adolescents climbing dramatically. In just one year, 2017 to 2018, e-cigarette use by high school students increased by 78 percent and by 48 percent among middle school students. More teens are also reporting vaping marijuana.
While there is some good news – rates of illicit or injection and prescription drug use among adolescents have declined or held steady among 12- to 17-year-olds since 2002 – but those rates are still too high and cause serious harm and disruption to young lives. In 2017, 5,455 young people between the ages of 15 to 24 died due to a drug overdose.
Alcohol use among adolescents has also declined. Past month alcohol use among 12- to 17-year-olds declined from 18 percent in 2002 to 10 percent in 2017 and lifetime alcohol use among high school students has declined from 82 percent in 1991 to 60 percent in 2017.
Substance misuse and suicide disproportionately affect adolescents from certain population groups
Of additional concern are large disparities in substance misuse rates and suicide based on teens’ race, ethnicity, socioeconomic status, sexual orientation/gender identification or where they live. Most striking is the high risk for substance misuse and suicide-related behaviors among gay, lesbian and bisexual adolescents. Forty-eight percent of gay, lesbian and bisexual adolescents report considering or attempting suicide as compared to 13 percent of their heterosexual peers. These high rates of suicide risk for sexual minority teens are likely due to stressors they experience including discrimination, bullying, violence and family rejection, according to the report.
American Indian/Alaskan Native teens experience the highest rates of suicide among any race and ethnicity in the United States: 16 suicides per 100,000 15- to 19-years-olds in 2016 – a rate 60 percent higher than the national average for all teens. The high rates of substance misuse and suicide among American Indian/Alaskan Native teens are likely associated with the historical and intergenerational trauma experienced by their community as well as the lack of education and economic opportunities typically available to them.
Solutions do exist and need implementation
Adolescence is a critical juncture in teens’ lives. This report highlights the many opportunities to set youth on healthy pathways be increasing the life circumstances that protect them from harm.
The report highlights dozens of evidence-based programs in place in communities across the country that help reduce risk and build protective factors in teens’ lives by strengthening families, providing counseling and mentorship, teaching social and emotional skills, fostering connectedness, particularly in schools, and working across sectors. Most importantly, addressing the factors that create or reduce risk for substance misuse or mental health issues will not only reduce negative impact on teens’ health, it will also improve outcomes in other sectors such as high school graduation rates or involvement with the juvenile justice system.
“Adolescence is a challenging time when the impact of poverty, discrimination, bullying and isolation can be intense,” said John Auerbach, President and CEO of Trust for America’s Health. ” Fortunately, there are policies and programs that can reduce some of these circumstances and the risks associated with them by strengthening teens’ coping and emotional skills – skills that can improve their health and lead to their succeeding in school.”
Recommendations for programs and policy actions
The report includes recommendations for policy actions at the federal, state and local level.
Among the specific recommendations are:
- The federal government and state legislatures should create and/or scale up policies that support families including increases to federal and state earned income tax credits and programs that provide access to health insurance and affordable housing.
- Congress should increase funding for substance misuse and suicide prevention including Project AWARE and the Garrett Lee Smith State/Tribal Youth Suicide Prevention and Early Intervention Grant program.
- States should expand Medicaid services in schools using flexible models such as school-employed providers, school-based health centers and telehealth.
- Congress should increase investments in the Centers for Disease Control and Prevention’s Division of Adolescent and School Health.
- All youth-serving systems should adopt trauma-informed and culturally competent policies and practices and should engage youth leaders in program development.
- Federal, state and local efforts to improve school safety should include strategies to prevent school violence by investing in safe and supportive school environments and mental health services.
- Public and private funders should incentivize strategies that address common risk/protective factors across all adolescent serving sectors.
The report is part of the TFAH/WBT Pain in the Nation publication series, launched in 2017 and examining substance misuse and suicide trends and evidence-based policies and programs in an effort to promote a comprehensive approach to solving the nation’s deaths of despair crisis. The report series is designed to focus attention on the need for national resilience strategy.
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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
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.