State Category: North Dakota

The Number of People in the U.S. Serving as Informal Caregivers is Growing, Yet Support and Assistance for Them is Shrinking, According to New Policy Brief

Public health agencies can play vital role in supporting caregivers

(Washington, DC – September 30, 2025) – As the percentage of older adults continues to grow in the United States, so do the number of people providing informal caregiving to them. A new policy brief highlighting the role of caregivers, published by Trust for America’s Health (TFAH) today, finds that many people who provide unpaid, informal caregiving are experiencing increasing levels of economic, emotional, and physical hardships as a result. The brief highlights the many roles that public health agencies can play in supporting caregivers and that more federal and state interventions are needed to support this growing segment of the population.

The brief, Public Health’s Roles in Supporting Informal and Family Caregivers, reports that 41.8 million people served as a caregiver to an adult over the age of 50 in 2020, an increase of over 7 million people who provided unpaid care to a family member or friend in 2015.

“The prevalence of caregiving in the U.S. has grown exponentially more complex,” said Megan Wolfe, senior policy development manager at TFAH who leads its Age-Friendly Public Health Systems initiative. “As more jurisdictions work to be age-friendly communities, having a nuanced understanding of the role and challenges facing caregivers will allow public health organizations to work with community partners to advocate for and provide the support caregivers need.”

The caregiving population is a diverse one, with about 40 percent of caregivers being individuals of color (17 percent Hispanic or Latino, 14 percent non-Hispanic Black, 5 percent Asian American and Pacific Islander, and 3 percent some other race/ethnicity, including those who identified as multiracial), according to the brief.

Women that serve as caregivers and caregivers of color face greater financial stress and physical demands that can impact their health, including experiencing depressive symptoms and feeling ignored or difficulty navigating healthcare systems.

TFAH’s Age-Friendly Public Health Systems (AFPHS) provides guidance for public health practitioners on the policy and systems changes that are needed to advance healthy aging and build supportive communities. This includes programs and activities that support caregivers, including better availability and easier navigation of caregivers’ supports.

The brief provides recommendations for the roles of public health that are aligned with the AFPHS Framework, including:

  • Advocate for changes to the workplace to create supports for caregivers including leave policies and employment protections.
  • Help create cross sector initiatives that support older adult and caregiver needs.
  • Work with the healthcare sector to ensure that healthcare providers understand and can refer caregivers to non-clinical support resources in their communities.
  • Collect data on the experience of caregivers and help communities design programs that meet their needs.
  • Model the use of culturally appropriate communication strategies that recognize the diversity of the caregiving population.
  • Create programs that provide caregivers with the tools they need to care for themselves and their care recipients.

TFAH’s Age-Friendly Public Health Systems initiative is made possible with generous support from The John A. Hartford Foundation.

To learn more about the Age-Friendly Public Health Systems initiative, visit Age-Friendly Public Health Systems – Trust for America’s Health (afphs.org)

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Trust for America’s Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and works to make the prevention of illness and injury a national priority.

The John A. Hartford Foundation, based in New York City, is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The leader in the field of aging and health, the Foundation has three areas of emphasis: creating age-friendly health systems, supporting family caregivers and improving serious illness and end-of-life care. https://www.johnahartford.org/

Nuevo análisis El presupuesto de los CDC se reduciría en un 53 % si se adopta el presupuesto propuesto por la Administración para el año fiscal 2026; más de sesenta programas de los CDC quedarían eliminados

Los programas estatales y locales de salud pública y preparación se verán considerablemente afectados

(Washington, DC – 18 de septiembre de 2025) – Los departamentos de salud en estados y localidades de todo el país están enfrentando severas reducciones presupuestarias debido a los recortes federales, recaptura de fondos, despidos y congelamiento de contrataciones, y reorganizaciones, tanto actuales como propuestos. Estas acciones debilitarán considerablemente el sistema sanitario y la preparación y respuesta ante emergencias de la nación y pondrá en peligro la salud y la seguridad económica del país. Estas son las conclusiones de un nuevo informe, Public Health Infrastructure in Crisis: HHS Workforce Cuts, Reorganizations, and Funding Reductions: Impacts and Solutions (“La infraestructura sanitaria en crisis: Recortes de personal del HHS, reorganizaciones y reducciones de financiamiento: impactos y soluciones”) publicado hoy por Trust for America’s Health (TFAH), una organización sin fines de lucro y apartidaria dedicada a la investigación y las políticas en materia de salud pública.

El informe, que incluye un análisis original de TFAH, calcula los impactos de las reducciones presupuestarias y de personal y las reorganizaciones hasta la fecha, así como también los cambios adicionales propuestos, y resalta las siguientes conclusiones:

  • El presupuesto plateado por el Presidente para el año fiscal 2026 para los Centros para el Control y la Prevención de Enfermedades (CDC) asciende al 53 % de reducción en comparación con el año fiscal 2024. Esta cifra refleja los recortes propuestos para los CDC y su hermana, la Agencia para Sustancias Tóxicas y el Registro de Enfermedades (ATSDR). Estas reducciones están pendientes de acción en el Congreso.
  • Además, dentro del recorte total propuesto, el Programa de Preparación ante Emergencias de Salud Pública de los CDC enfrenta una reducción de fondos del 52 %.
  • En total, el presupuesto presentado recorta poco más de la mitad del financiamiento para los CDC y la ATSDR y restaura alrededor de un cuarto de los fondos perdidos hacia dos divisiones del HHS recientemente creadas: la Administración para una América Sana y la Oficina de Estrategias.
  • Más de 100 programas de salud pública y líneas de financiamiento serían eliminadas bajo el presupuesto presentado por el Presidente para el año fiscal 2026, incluidos 61 programas de los CDC y 40 programas de la Administración de Salud Mental y Abuso de Sustancias. Entre los programas en riesgo de eliminación están los de prevención de cáncer, diabetes, enfermedad coronaria y accidente cerebrovascular; los de prevención de la obesidad; los de prevención del VIH/SIDA, tanto nacionales como internacionales; los de inmunización global; y los de recuperación y prevención del uso de opiáceos y otras sustancias.
  • La reorganización propuesta para las agencias del Departamento de Salud y Servicios Humanos de los Estados Unidos (HHS) reduciría en un 16 % la cantidad de personal que trabaja en programas de salud pública, incluso contando la creación de la Administración para una América Sana que se ha propuesto.
  • Este año la rescisión de fondos ya aprobados recapturó 12 000 millones de USD en subvenciones de la época de la covid-19; fondos que además de apoyar la respuesta a la pandemia estaban destinados a reforzar la infraestructura de salud pública más allá de las necesidades creadas por la pandemia, como el monitoreo de enfermedades infecciosas, la capacidad de laboratorio, la preparación ante emergencias y los servicios de salud mental.

El informe se concentra en los cambios en los CDC y otras agencias del HHS debido a su rol central en el apoyo de los programas de salud pública y la respuesta a crisis a nivel estatal y local. Alrededor del 80 % del presupuesto interno de los CDC va hacia estados, localidades, tribus y organizaciones tribales, sistemas de salud y actores comunitarios para apoyar iniciativas de salud pública estatales y locales. Los fondos federales representan cerca de la mitad de los presupuestos de los departamentos de salud estatales y locales, por lo que los recortes en el gasto federal son recortes en los presupuestos de salud pública.

“Los grandes cambios que ocurren en las agencias federales de salud pública afectan a todas las comunidades y tienen impacto sobre la vida de toda la ciudadanía. Los departamentos sanitarios estatales y locales, que están en la primera línea de protección de la salud de sus residentes, dependen del gobierno federal, en particular de los CDC, para obtener financiamiento de la salud pública, experticia y asistencia técnica. Con la pérdida de fondos, personal y programas, nuestro país estará menos preparado para futuras emergencias sanitarias, la salud de la ciudadanía sufrirá y aumentarán los costos de la salud”, dijo J. Nadine Gracia, M.D., MSCE, presidenta y directora ejecutiva de Trust for America’s Health.

El informe incluye entrevistas con dos responsables de oficinas de salud pública —el Dr. Scott Harris, Responsable de la Oficina de Salud Estatal de Alabama, y la Dra. Katherine Wells, Directora de Salud Pública de la ciudad de Lubbock, Texas—, quienes describen los impactos y los desafíos creados en el territorio por las acciones federales, tanto las que están en curso como las que se proponen. Ambas oficinas están luchando con reducciones presupuestarias de por lo menos la mitad de su presupuesto anual como resultado de los recortes federales.

El informe también reconoce que el sistema de salud pública tiene áreas por mejorar. Necesita modernizarse y fortalecerse para satisfacer los desafíos sanitarios tanto actuales como emergentes de la población. El informe hace un llamamiento a la colaboración entre la administración, el Congreso y las oficinas de salud pública para reforzar el sistema con acciones basadas en datos. Algunas de las acciones que recomienda son:

  • El Congreso y la administración deberían restaurar las agencias federales de salud, los fondos y el personal que se recortaron en 2025.
  • La administración y el Congreso deberían mantener y reforzar la estructura y las capacidades de las agencias federales de salud, que tienen roles específicos, complementarios y distintos y cuentan con experticia en la protección de la salud de la nación.
  • El Congreso, en colaboración con agencias federales y especialistas y actores externos, debería llevar adelante un proceso deliberativo bipartidista de revisión de propuestas para la reestructuración de las agencias federales de salud o el desarrollo de nuevas agencias.
  • El Congreso y la administración deberían fortalecer el CDC como una agencia de salud pública integral nacional con responsabilidades en materia de detección, prevención y mitigación de las principales causas de muerte prevenible, enfermedades y lesiones.
  • Las agencias federales deben gastar todos los fondos asignados por el Congreso, conforme a la ley, y la Oficina de Administración y Presupuesto debería liberar hacia las agencias fondos para todo el año luego de la promulgación de la ley de asignación.
  • El Congreso debería garantizar el mejoramiento continuo de las capacidades de salud pública y los servicios esenciales de la nación, como el personal, los laboratorios y los sistemas de datos en todos los niveles.
  • El Congreso debería restaurar el Fondo de Prevención y Salud Pública, un fuente crucial de fondos sostenidos para la prevención de enfermedades y actividades de promoción de la salud en cada estado y territorio, así como también en localidades y comunidades tribales, y prevenir futuros recortes.

El informe completo puede leerse en: https://www.tfah.org/report-details/funding-report-2025

 

New Analysis: CDC’s Budget Would be Reduced by 53 Percent if the Administration’s Proposed FY 2026 Budget is Adopted; Over Sixty CDC Programs Would be Eliminated

State and local public health and preparedness programs will be significantly impacted

(Washington, DC – September 18, 2025) – Health departments in states and localities nationwide are facing severe budget reductions due to current and proposed federal cuts, funding clawbacks, layoffs and hiring freezes, and agency reorganizations. These actions will weaken the nation’s public health system and emergency readiness and response and will put the country’s health and economic security at risk. So concludes a new report, Public Health Infrastructure in Crisis: HHS Workforce Cuts, Reorganizations, and Funding Reductions: Impacts and Solutions released today by Trust for America’s Health (TFAH), a non-partisan, non-profit organization focused on public health research and policy.

The report, which includes original analysis by TFAH, tallies the impacts of budget and staff reductions and proposed agency reorganizations to date as well as additional proposed changes and highlights the following findings:

  • The President’s proposed FY 2026 budget for the Centers for Disease Control and Prevention (CDC) amounts to a 53 percent reduction in funding as compared to FY 2024. This figure reflects proposed cuts to CDC and its sister agency, the Agency for Toxic Substances and Disease Registry (ATSDR). These reductions are pending Congressional action.
  • In addition, within the total proposed cut, CDC’s Public Health Emergency Preparedness program faces a 52 percent funding reduction.
  • Overall, the proposed budget cuts CDC and ATSDR funding by slightly more than half and then restores about one-quarter of the lost funding to two newly proposed HHS divisions: the Administration for a Healthy America and the Office of Strategy.
  • Over 100 public health programs and funding lines would be eliminated under the President’s proposed FY 2026 budget including 61 programs at CDC and 40 programs at the Substance Abuse and Mental Health Services Administration. Programs facing elimination include cancer, diabetes, heart disease, and stroke prevention programs, obesity prevention programs, global and domestic HIV/AIDS prevention programs, global immunization programs, and opioid and other substance use prevention and recovery programs.
  • The proposed reorganization of U.S. Department of Health and Human Services (HHS) agencies would reduce the number of staff positions working on public health programs by 16 percent, even when accounting for the creation of the proposed Administration for a Healthy America.
  • This year’s termination of already-approved funds clawed back over $12 billion in COVID-19 era grants – funding that in addition to supporting the pandemic response was intended to strengthen public health infrastructure beyond the needs created by the pandemic, including infectious disease monitoring, laboratory capacity, emergency preparedness, and mental health services.

The report is focused on changes to CDC and other select HHS agencies due to their central role in supporting public health programs and crisis response at the state and local level. About 80 percent of the CDC’s domestic budget flows to states, localities, tribes and tribal organizations, healthcare systems, and community partners to support state and local public health initiatives. Federal funding accounts for about half of state and local health department budgets so cuts to federal spending are cuts to local public health budgets.

“The consequential changes occurring in federal public health agencies impact every community and the lives of every American. State and local health departments, which are on the frontlines of protecting the health of their residents rely on the federal government, particularly CDC, for public health funding, expertise, and technical assistance. With the loss of funding, workforce, and programs, our country will be less prepared for future health emergencies, Americans’ health will suffer, and healthcare costs will rise,” said J. Nadine Gracia, M.D., MSCE, President and CEO, Trust for America’s Health.

Included in the report are interviews with two public health officials – Dr. Scott Harris, State Health Officer of Alabama, and Dr. Katherine Wells, Director of Public Health, City of Lubbock, Texas – describing the on the ground impacts and challenges created by the recent and proposed federal actions. Both are grappling with budget reductions of at least half of their annual budget due to federal cuts.

The report also acknowledges that the public health system has room for improvement. It needs to be modernized and strengthened to meet ongoing and emerging population health challenges. The report calls for collaboration between the administration, Congress, and public health leaders to strengthen the system through data driven actions. Some of the policy actions it recommends are:

  • Congress and the administration should restore federal health agencies, funding, and workforces that were cut in 2025.
  • The administration and Congress should maintain and strengthen the structure and capabilities of federal health agencies, which have specific, complementary, and distinct roles and expertise in protecting the nation’s health.
  • Congress, in collaboration with federal agencies and outside experts and partners, should lead a bipartisan, deliberative process of reviewing proposals for federal health agency restructuring or development of new agencies.
  • Congress and the administration should strengthen CDC as a national, comprehensive public health agency with responsibilities across the detection, prevention, and mitigation of the leading causes of preventable death, illness, and injury.
  • Federal agencies must spend all funds appropriated by Congress, as required by law, and the Office of Management and Budget should release full-year funds to agencies after enactment of appropriations legislation.
  • Congress should ensure continuous improvement of the nation’s public health capabilities and essential services, including workforces, laboratories, and data systems at all levels.
  • Congress should restore the Prevention and Public Health Fund, a critical source of sustained funding for disease prevention and health promotion activities in every state and territory, as well as in localities and tribal communities, and prevent future cuts.

TFAH Reflections on the 20-year Anniversary of Hurricane Katrina

(Washington, DC – August 29, 2025) – This week marks 20 years since Hurricane Katrina hit the Gulf Coast and devastated communities in Louisiana, especially New Orleans and its surrounding areas, Mississippi, and other Gulf Coast states, including Alabama and Florida. Tragically, nearly 1,400 lives were lost in the storm. Entire areas were destroyed. Some neighborhoods, which are mostly historically Black or low-income, still haven’t fully recovered from the disaster. This somber milestone should serve as a reminder for government at every level to make necessary and consistent investments in the nation’s emergency preparedness capabilities. Extreme weather events have increased in frequency and intensity since the Category 5 storm ripped through the Gulf Coast in 2005. The lasting and often disparate impacts on the health, economy, and ecology of the region are a call to action that we must be better prepared for future emergencies.

We recognize that many jurisdictions have improved their public health infrastructure and preparedness over the last two decades, with support from the Centers for Disease Control and Prevention, the Administration for Strategic Preparedness and Response, and other federal agencies. TFAH’s annual report, Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, has chronicled this progress. But we’ve also found more work is needed to ensure every community is prepared. Furthermore, much of the progress that has been achieved is now at risk due to proposed cuts in federal support for the public health workforce and outbreak prevention and preparedness programs.

The loss of entire swaths of neighborhoods due to extreme weather events is unacceptable. This is a shared responsibility. The federal government has an important leadership role to play in emergency readiness and response. Federal, state, and local governments should collaborate with each other and with trusted local organizations and leaders to safeguard every community.

Hurricane Katrina showed us that our most under-resourced communities must be a focus of and have a role in emergency planning. Failure to do so will not only exacerbate health and economic disparities but will also have a ripple effect on the entire community’s ability to thrive.

TFAH’s Ready or Not report outlines specific policy recommendations for strengthening the nation’s preparedness. We encourage policymakers to act on these recommendations and make the necessary investments to safeguard our communities.

 

 

 

 

 

Immunizations are a Critical Public Health Tool to Support Both Individual and Community Health

Observed annually in August, National Immunization Awareness Month (NIAM) highlights the importance of vaccination for people of all ages. Some vaccines prevent the spread of diseases, while others protect people from serious illness. Vaccines have saved millions of lives worldwide.

This awareness month is an opportunity to understand vaccines’ role in our overall health, their safety record, and how they fit into the larger picture of individual, community, and public health.

Childhood vaccinations
Infants and children are vaccinated against numerous infectious diseases based on a schedule recommended by pediatricians and vaccine experts. Following the recommended vaccine schedule gives children the best protection from preventable diseases and protects communities against outbreaks. Children often receive vaccines during well-child care visits or in preparation for a new school year.

Vaccines during adulthood
Vaccines aren’t just important for kids – adults need them too. Vaccination is recommended throughout life to prevent vaccine-preventable diseases and the complications of these diseases. Vaccines may be administered as an annual shot, to update waning immunity, or because a new vaccine was developed in response to a disease threat. Some vaccines are recommended for receipt during adulthood as the risks of certain diseases increase later in life. Adult vaccine recommendations may be based on age, health history, underlying risk factors, travel, occupation, and previous vaccinations.

Immunization supports healthy communities
Vaccinations function as a core element of public health infrastructure. Much like clean water systems or food safety regulations, immunization programs operate in the background to reduce the risk of disease across entire populations. When maintained effectively, they prevent disease spread, reduce demand on healthcare systems, and support uninterrupted access to work, school, business activities, and community life.

The strength of any vaccine infrastructure is rooted in convenient, no-cost access, reliable public communication, public confidence, and sustained uptake. Disruptions, whether due to healthcare access gaps, shifting policy priorities, or declines in public trust, can lead to the return of diseases that had achieved elimination status. Elimination status means that cases of the disease are not naturally occurring within a specific geographic area, however, infections can still happen when an infected person travels from one area to another. Elimination status is jeopardized when vaccination rates drop, and illnesses begin to circulate in communities. Recent increases in measles and pertussis cases in parts of the United States reflect the consequences of uneven vaccination rates in some U.S. communities or in other countries.

Disease elimination requires continued vigilance
Vaccines have significantly reduced the incidence of many infectious diseases in the U.S., with some being eliminated. However, it’s important to note that elimination is not the same as eradication. Disease eradication is when a disease is permanently eliminated, with no new cases from any source. Unfortunately, recent data indicate a resurgence of certain illnesses:

These trends emphasize the need for continued vigilance in vaccination efforts to prevent the reemergence of preventable diseases.

Immunization’s role in overall health and emergency preparedness
Vaccines serve not only as a means of individual protection, but also as a mechanism for ensuring community health and supporting a strong economy. Investing in the immunization pipeline and infrastructure means investing in the long-term resilience of communities.

To strengthen the role of immunization in supporting health and community resilience, TFAH’s  reports Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress and  Ready or Not 2025: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism outline several policy recommendations aimed at reinforcing the nation’s immunization infrastructure and access, including:

  • Ensuring access to and affordability of health insurance.
  • Preserving access to recommended vaccines without cost sharing. Research shows that even small co-payments can be barriers to people getting preventive services like vaccines.
  • Investing in the Centers for Disease Control and Prevention (CDC) workforce and infrastructure, which work with states and communities to detect and prevent outbreaks.
  • Sustained funding for CDC’s National Immunization Program, which supports vaccine infrastructure, outreach, and access and outbreak response at the federal, state, and local levels. The Vaccines for Children program, which provides free vaccines to children in the U.S. whose families couldn’t otherwise afford them, also relies on the infrastructure and public health workforce funded by this program.
  • Providing resources for public health communications strategies, including effective communications about the safety and efficacy of vaccines.
  • Ongoing funding for the Antimicrobial Resistance Solutions Initiative, which includes prevention strategies tied to immunization.
  • Accelerated development, stockpiling, and distribution capacity for vaccines in response to emerging threats.
  • Enhanced demographic data collection and analysis to ensure vaccine efforts reach communities that experience health and economic disparities.

These priorities reflect the role of immunization not just in public health response, but in prevention at the population level. When vaccine systems are well-funded and equitably implemented, they allow for stronger disease protection in everyday life and community level resilience during public health emergencies.

Maintaining continuity in immunization
Immunization is not a one-time decision; it is an ongoing element of preventive healthcare. Over time, the immunity created by a vaccine can weaken making a booster dose important. In addition, a virus can change or mutate making the original vaccine less effective and a reformulated dose necessary. Also, as new data emerges showing changes in disease patterns, vaccine recommendations may change.

Like other foundational aspects of health, such as preventive care, good nutrition, physical activity, and healthy environments, vaccination is most effective when integrated consistently over time. It is one part of a broader health strategy, supporting both individual well-being and community health.

Recommended resources:

Age-Friendly Public Health: The Podcast

July 2025

In this episode of Age-Friendly Public Health: The Podcast, host Dr. J. Nadine Gracia, President and CEO of Trust for America’s Health is joined by Alison Barkoff, Associate Professor of Health, Law, and Policy at the George Washington University Milken Institute School of Public Health, to discuss how disability and aging policy intersect and can support one another. 

The Intersections Between Aging and Disability Policy – transcript

Season Two Episode:

Season One Episodes:

You can listen on Apple Podcasts, Spotify or where ever you access your favorite podcast.

Age-Friendly Public Health: The Podcast is a production of Trust for America’s Health’s (TFAH) Age-Friendly Public Health Systems Initiative. This quarterly podcast, hosted by TFAH’s President and CEO Dr. J. Nadine Gracia, will feature conversations with leaders in the age-friendly public health systems movement on challenges, opportunities, and model programs, with a focus on the role public health can play in helping older adults thrive.

 

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    Marking Three Years of 988 Suicide and Crisis Lifeline Support for People in Need

    Since its launch in July 2022, the 988 Suicide and Crisis Lifeline has responded to millions of individuals and has provided immediate support to callers who are in crisis.  Still, recent and proposed cuts to the Substance Abuse and Mental Health Services Administration (SAMHSA) and 988 services and the lack of state funding could leave individuals in need or others with fewer options for life-saving help.

    The national 988 Suicide and Crisis Lifeline has answered more than 14 million calls, texts, and chats since it was introduced. Call volume to the Lifeline in the first two years of its existence was up 95 percent nationally as compared to calls to the 1-800 system it replaced.  In addition, call answer rates have improved and wait times have been reduced.

    Still, recent major cuts to agency workforce and a recent decision to end specialized services through 988 for LGBTQIA+ youth and young adults is poised to set that progress back and could have dire consequences.

    Brief History

    The 988 Suicide and Crisis Lifeline was established by Congress in 2020 and launched officially in 2022 in an effort to enhance the nation’s crisis care system. Established by Congress, 988 was designed to make the previous seven-digit 1-800 suicide prevention lifeline more accessible by creating an easy to remember call number and adding a text option. In 2024, calls and texts began being routed to local crisis centers based on geographic location instead of area codes to help connect users with faster and local support.

    In addition, the 988 Lifeline has included specialized support for military veterans, LGTBQIA+ youth, and Spanish-language speakers. To address the disproportionate rates of suicide among American Indian and Alaska Native populations and provide culturally and trauma informed crisis services, the state of Washington offers specialized care for Washington’s American Indian and Alaska Native communities.

    People seeking assistance through the 988 Lifeline are able to call, text, and chat through the website with trained professionals at 988 call centers. Counselors either counsel callers through their crisis or direct individuals to acute care in their community.

    Research from the American Association of Suicidology found that two-thirds of the people who had suicidal thoughts and reached out via the Lifeline’s online chat reported that the correspondence had been helpful, and 45% reported being less suicidal.

    The Need and Demand for the Crisis Lifeline

    According to the latest edition of Trust for America’s Health’s Pain in the Nation: The Epidemics of Alcohol, Drug, and Suicide Deaths report, nearly 50,000 Americans of all ages died by suicide in 2023. Although there has been some fluctuation over the past few years, suicide rates have generally been on the rise since 1999. Nearly a half million people died from died by suicide in the U.S. from 2014 to 2023.

     

    Some of the highest age-adjusted suicide rates are seen in males and adults ages 75 and older. Suicide rates in rural areas are consistently and significantly higher than urban areas, research shows as well.

     

     

     

    To turn the tide, TFAH urges federal and state policymakers to transform the nation’s mental health and substance use prevention system, in part by strengthening the continuum of crisis intervention supports and programs. TFAH also urges federal agencies to do more to encourage and make people feel more comfortable seeking help with mental health issues, for example by promoting culturally appropriate messaging on mental health screening and treatment to reduce stigma. The 988 Lifeline provides a pathway for states and local communities to implement those recommendations.

    Federal and State Support Needs to be Sustained and Increased

    The 988 Lifeline is funded primarily through federal funding and is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). Some states provide additional funding support through their annual budgets and/or telecommunications fees. To date, 16 states are providing funding for their 988 networks. Unfortunately, there are ongoing threats to funding for 988 and suicide prevention services. In March 2025, the Department of Health and Human Services (HHS) announced they would be clawing back $1 billion in SAMHSA funds, including mental health grants many states were applying to 988 suicide lifelines and crisis services. Litigation is putting this clawback on hold in some states. In addition, reductions in force at SAMHSA and the President’s FY 26 Budget Request which proposes to eliminate SAMHSA and significantly reduce mental health programs and funding, could undo progress communities are making in addressing suicide, mental health, and substance use crises.

    Where Do We Go From Here?

    To continue to support the nation’s crisis services, the following action steps are needed:

    • Congress and the Administration should strengthen the 988 Suicide and Crisis Lifeline by maintaining SAMHSA funding for the Lifeline and by restoring the workforce devoted to these services. SAMHSA should also retain the 988 Lifeline’s specialized services, including specialized support for LGBTQIA+ youth and Spanish-language services.
    • Congress should also pass the 9-8-8 Implementation Act, which would authorize funding for crisis call centers to purchase or upgrade call center technology, hire and train call center staff, and improve call center operations.
    • More states should dedicate funding for the 988 Lifeline and more investments should be made to improve geo-location technology so people that need help are directed to services in their community.

     

    New 6Cs Training and Implementation Guide will Help Communities Implement Strategies to Support Older Adults

    TFAH’s Age-Friendly Public Health Systems (AFPHS) team recently released a new toolkit, The 6Cs Training and Implementation Guide, to give public health professionals an in-depth understanding of the AFPHS “6Cs” Framework. The guide will help communities build effective public health strategies and practices to support older adults.

    Megan Wolfe, who leads AFPHS, sat down to answer a few questions about this new resource:

    TFAH: What is the 6Cs Training and Implementation Guide and how did it come about?

    Megan: The 6Cs Guide resulted from the need to provide guidance to state and local health departments seeking recognition through the Age-Friendly Public Health Systems (AFPHS) Recognition Program. The Recognition Program requires health departments to commit and complete strategies and activities and adopt policies and programs to support older adult health and well-being. These activities need to be aligned with the AFPHS 6Cs Framework. So, the Guide includes a comprehensive set of strategies that public health practitioners can learn and hopefully adopt as part of their AFPHS journey.

    As we were developing the Guide, we realized that we accumulated a great deal of valuable resources that we could use to build a truly comprehensive library, including examples of data dashboards on older adults, examples of partnerships, as well as tools to enhance the community health improvement process.

    TFAH: Who is the Guide intended for? Who should use the Guide?

    Megan: The Guide can be used by anyone who wants to build expertise in healthy aging, especially from a public health perspective. Our vision is that entire health department staffs will use it, but it’s also perfect for individuals or small teams to work through together.

    TFAH: How should an individual or community group use the Guide. Is there a proper order to best utilize the Guide?

    Megan: The Guide is aligned with the six tenets of the AFPHS framework, so we developed one module for each of the six tenets, as well as an introductory module. We suggest that users start with the introduction and then complete Module 1, because it   is focused on creating and leading change and really sets the tone for the other modules. After that, users can really jump around and complete whichever module that provides the guidance they need, or simply complete them in order, one through six.

    TFAH: Are there any features in the Guide that are a personal favorite of yours?

    Megan: So many things! My absolute favorite are the lists of resources that are included in each module. This will be a dynamic list that we’ll update regularly, based on the development of new tools and identification by our team of great examples of the 6Cs in action. I also really like the Competence Checks that are part of Modules 1-3, as they provide an opportunity for a user to reflect on the expertise they’re building and assess where they go next. Modules 4-6 have application exercises rather than Competence Checks, and these are valuable for putting the strategies into action.

    Megan Wolfe, JD is the Senior Policy Development Manager at TFAH, where she works with the Policy Development team to advance a modernized, accountable public health system through the Age-Friendly Public Health Systems initiative.