Stories Archive

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.

Season Two Episodes:

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.

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.

The National Count for Measles Cases for 2025 is Over 1,100 and Approaching a Thirty-Year High

Health officials remind the public: Measles is serious and very contagious; being vaccinated is the best defense.

Measles is an airborne, highly contagious disease that can be very severe. However, people have the power to protect themselves and their children with the measles-mumps-rubella (MMR) vaccine.

As of June 5, the number of measles cases in the U.S. topped 1,000 and were reported in 34 jurisdictions. The growing case count illustrates that the illness can spread easily in communities with pockets of unvaccinated people. If the rate of new cases continues at its current pace, we could reach a thirty-year high in the annual number of cases this summer. Of the cases reported in 2025, 95 percent were people who were unvaccinated or with unknown vaccination status, and 12 percent of cases have resulted in hospitalization.

Sadly, three deaths have occurred as a result of the current outbreaks in Texas and New Mexico. In late February, the Texas Department of State Health Services reported the first death resulting from the state’s outbreak. The death occurred in a child who was not vaccinated. A second death of a New Mexico adult who tested positive for measles and was also unvaccinated, was reported in early March. Any measles death is particularly tragic because such deaths are preventable.

Here’s what you need to know about measles.

Measles is highly contagious. You can contract measles by breathing air contaminated by an infected person or touching an infected surface. The measles virus can linger in the air for several hours after an infected person coughs or sneezes.
Measles symptoms usually include a fever, rash, cough, and red eyes. Someone who is infected with measles can spread the infection to others before they notice symptoms, especially in the four days before or after a rash develops.
Measles can lead to serious health consequences especially for babies and young children including hearing loss, brain swelling, pneumonia, and even death. Anyone who is not protected against measles is at risk, but children under the age of five, pregnant women, and people with weakened immune systems are particularly susceptible and are at risk for more serious outcomes.
Data show that unvaccinated people have a 90 percent likelihood of contracting measles if they are exposed. One out of five people who contract measles will require hospitalization.
If you have been exposed to someone with measles or display symptoms, like a rash that spreads from the face to the rest of the body, you should isolate and contact a healthcare provider immediately.
Vaccination is the most effective way to avoid contracting measles. The measles-mumps-rubella (MMR) vaccine has been in use since 1971 with the measles vaccine dating back even further to 1963. The MMR vaccine has been shown to be 97 percent effective for people who have received the full series (two doses). After the measles vaccine was introduced, reported cases in the U.S. dropped by 97% in just three years.
Children between the ages of 6 – 11 months can be given the MMR vaccine in areas with measles cases, but most children receive their first dose between 12 and 15 months. Babies younger than 6 months are not yet ready for vaccination, which is why older children and adults who interact with infants should be fully vaccinated.

Resources for further information:

Measles Symptoms and Complications | Measles (Rubeola) | CDC

Measles Vaccination | Measles (Rubeola) | CDC

Vaccinate Your Family: Measles Resources (Vaccinate Your Family)

Measles Vaccination: Know the Facts (Infectious Disease Society of America)

Revised May 27, 2025

COVID-19, Five Years Later: Will We Heed the Public Health Lessons?

(Washington, DC – April 17, 2025) – March 2025 marked the five-year anniversary of the declaration of COVID-19 as a pandemic. This milestone offers an opportunity to reflect on the heroic work of healthcare providers and the public health workforce in limiting the pandemic’s impact on Americans’ health. Public health professionals across the country worked tirelessly on the frontlines—often facing unprecedented challenges, personal risk, and even harassment—while providing essential services such as contact tracing, coordinating testing, distributing and administering vaccines, and offering life-saving guidance to communities. Their dedication and expertise were vital to the national response and demonstrated the indispensable role of public health infrastructure in protecting American lives during a crisis.

It is also a time to remember the pandemic’s toll in illness, lives lost, and social and economic disruption. Finally, this anniversary presents an opportunity to consider what can be learned from the pandemic and how those lessons can be applied to protect the nation’s health and economic security during future emergencies.

According to the World Health Organization, COVID-19 deaths worldwide have exceeded seven million. In the U.S., at least 1.2 million people have died from COVID-19, according to the Centers for Disease Control and Prevention (CDC).

While the public health emergency has ended, COVID-19 infections are still occurring, albeit at a much lower rate. Staying up to date with vaccination remains one of the most effective tools to prevent severe illness, hospitalization, and death from COVID-19—especially when combined with other preventive measures, as appropriate, based on current community transmission levels and individual risk factors.

We continue to face numerous public health risks that demand action, including a multi-state measles outbreak, a tuberculosis outbreak, bird flu, and environmental threats. All of this is happening as federal budget cuts threaten the capacity of federal, state, and local public health departments to respond to emergencies, while workforce reductions risk the loss of sorely needed public health expertise and experience.

COVID-19 Funding Ended the Emergency and Strengthened Public Health Readiness

The COVID-19 pandemic demanded an unprecedented public health response, including funding to modernize the nation’s public health infrastructure and expand its workforce. New funding for CDC’s Data Modernization Program increased the number of healthcare facilities using electronic case reporting (eCR) to report infectious disease cases to public health agencies—from 153 in January 2020 to over 50,000 in February 2025. eCR enables real-time disease tracking, allowing for a faster response to outbreaks. Additional examples include the Public Health Infrastructure Grant, which provides funding to health departments nationwide to support innovative investments in workforce, systems, and services tailored to meet their communities’ specific health priorities and challenges; the establishment of a new Center for Forecasting and Outbreak Analytics at the CDC to model and predict outbreak trends; and the expansion of CDC’s National Wastewater Surveillance System, now implemented in 46 states and the District of Columbia. These critical new capacities are at risk due to federal budget cuts.

What the Pandemic Taught Us

The lessons of the pandemic are numerous and should be applied to strengthen the public health system. Doing so would help ensure that the nation is better prepared for future risks. These lessons include:

Protecting CDC’s mission—including its comprehensive focus on both chronic and infectious diseases—is essential, because healthier communities, particularly those with a lower burden of chronic disease, are more resilient during emergencies and recover more quickly.
A modernized and interoperable health data infrastructure is critical for real-time disease tracking. Such systems allow healthcare and public health officials to target resources where they are needed most. The progress made in data modernization since 2020 must be sustained.
Public health and healthcare readiness, along with surge capacity, are critical in an emergency. Healthcare workforce shortages during the acute phases of the pandemic placed tremendous strain on the system’s ability to manage the surge of patients. The emergency readiness of the healthcare delivery system must be fortified. State public health laboratories were also vital in identifying cases and tracking disease spread. Most states have laboratory surge plans that helped them expand testing capacity during peaks in pandemic transmission. Telehealth was a critical platform for healthcare access during the pandemic, and reimbursement for telehealth services should be preserved.
A strong emergency preparedness system is vital to the nation’s economic security. The COVID-19 emergency led to major economic disruptions and the largest employment loss in the U.S. since World War II. A 2023 study by a team of economists estimated that the pandemic’s impact on the U.S. economy through the end of 2023 was $14 trillion. Going forward, protecting the nation’s economy will require systems and capacities that can prevent a small number of disease cases from escalating into an outbreak—and eventually a pandemic.
The pandemic highlighted the nation’s health and economic disparities and their impact on health outcomes during emergencies. While all communities may face health emergencies, the impacts are not felt equally. Communities with higher rates of chronic disease and underlying health conditions often experience worse outcomes—disparities rooted in systemic barriers such as income inequality, housing instability, discrimination, poor air and water quality, and gaps in healthcare access. Advancing health equity by addressing these challenges is essential to building a more resilient and prepared nation.
The COVID-19 vaccines saved lives and reduced the severity of illness. The rapid development of the vaccines, along with an expansive system to administer them, played a critical role in the national response. According to a Commonwealth Fund study published in December 2022, COVID-19 vaccines prevented an estimated 18.5 million hospitalizations, 3.2 million deaths, and at least $1 trillion in healthcare spending in the U.S. during the first two years of the vaccination program (December 2020 through November 2022). Continued investment in vaccine development, manufacturing and distribution readiness, and other medical countermeasures is essential. mRNA vaccine technology is well-positioned to quickly produce effective vaccines against future virus variants.
The pandemic exacerbated misinformation and disinformation about vaccine safety, particularly on social media. Vaccine education that shares accurate information and builds confidence is essential. These programs should acknowledge that some people—while open to learning more—have questions and want space to make their own decisions. Healthcare and public health officials should seek opportunities to listen and respond to individuals’ questions and concerns.

We Need to Act on the Pandemic’s Lessons

Increased, sustained, and flexible public health funding is essential. The pattern of boom-and-bust funding cycles has left the system with serious preparedness gaps. Funding levels must be increased, and flexible funding is critical because it allows state and local health officials to quickly target and deploy resources where they are most needed. Investment in workforce growth and retention is also crucial.
Invest in prevention to improve health and reduce healthcare spending. As a nation, we don’t spend enough on public health and prevention. Investments in these areas yield healthier communities and significant long-term savings. Typically, less than five percent of the nation’s nearly $5 trillion in annual health spending is directed to public health and prevention programs.
Numerous sectors have a role to play in improving the public’s health. These partnerships should include public health, healthcare, educators, community–based organizations, faith leaders, the business community, and others. Strong relationships established before a crisis are central to an effective emergency response.
Public trust in government is critical during health emergencies. The politicization of public health has weakened the system and threatens its ability to respond effectively to future crises. Upholding scientific integrity—empowering public health experts to make recommendations based on the best available information—is essential for effective emergency response. Public health authorities must be preserved, and public health agencies must be effective communicators who can clearly explain the rationale behind their guidance. Timely and transparent communication with the public is essential. Public health officials also understand the importance of maintaining strong, ongoing relationships with community organizations and leaders—not just during emergencies. A diverse public health workforce that reflects the communities it serves is also key to building trust.

Closing Thoughts

The COVID-19 pandemic was a tragic event, worsened in part by an inadequate early response. Failing to learn from the pandemic experience would only compound the tragedy. The task now facing policymakers at all levels is to invest in policies and programs that will fortify our public health system—ensuring it is fully prepared to respond quickly to future emergencies—and to restore trust in the system so it can function effectively when lives are on the line.

TFAH’s annual report series, Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, identifies key strengths, areas for improvement, and recommendations to enhance the nation’s emergency preparedness.

To learn more about TFAH’s recommendations for a stronger public health system, read our 2024 report: Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress.

Support for Prevention and Public Health Fund Remains Strong

Over 200 public health and health organizations urge Congress to support the Prevention and Public Health Fund as the nation faces growing public health threats

(Washington, DC – February 28, 2025) – At a time of increasing healthcare costs and uncertain funding for public health, the Prevention and Public Health Fund (Prevention Fund) is more important than ever. A guaranteed source of funding for public health programs, the Prevention Fund has invested more than $13.5 billion in every state and territory to improve health and help restrain the rate of growth in healthcare costs.

Recently, Senator Richard Blumenthal and Congresswoman Doris Matsui introduced the Public Health Funding Restoration Act which would restore the Prevention and Public Health Fund to its original $2 billion allocation as established by the Affordable Care Act (ACA). Under its original allocation, the Prevention Fund should have risen to $2 billion by FY 2015. After multiple cuts over the years, the Prevention Fund will not reach that number until FY 2030, a full fifteen years later than intended. In total, the Prevention Fund has been cut by $12.95 billion over FY 2013 – 2029.

Again, the Prevention Fund has been proposed as a possible offset as part of the FY25 budget reconciliation process. Yet, support for the Prevention Fund remains strong. Last week, 200 organizations joined TFAH in sending a letter to congressional leaders urging them to avoid further cuts to the Fund.

Proven Track Record of Success

While the majority of its investments are at Centers for Disease Control and Prevention (CDC), the Prevention Fund also supports programs at the Administration for Community Living and the Substance Abuse and Mental Health Services Administration for suicide prevention, Alzheimer’s disease prevention, falls prevention, and chronic disease self-management.

Prevention Fund-supported programming has been shown to reduce the significant healthcare costs associated with chronic disease in the United States. For example, The Tips from Former Smokers campaign, aimed at encouraging smoking cessation, helped 1 million smokers successfully quit between 2012 and 2018, prevented an estimated 129,000 early deaths, and saved roughly $7.3 billion in smoking-related healthcare costs. In addition, the Diabetes Prevention Program has saved $1,146 per participant in related healthcare costs. Both programs are either partially or fully supported by the Prevention Fund.

The Prevention Fund also keeps the nation prepared against emerging threats. With experts raising concerns over the spread of H5N1 bird flu, the Prevention Fund supports CDC’s National Immunization Program as well as epidemiology and laboratory capacity grants in every state and U.S. territory to detect and investigate outbreaks and prevent further infections.

Maintaining support for the Prevention Fund is critical as the United States navigates rising chronic disease costs, higher rates of suicide, and decreasing life expectancy. Continued cuts will only impede the nation’s ability to protect communities.

For more information on how the Prevention Fund helps safeguard health and economic security in every state visit Prevention and Public Health Fund State Fact Sheets – TFAH.

Creating Healthier Communities: The Value of Community Health Workers

The reasons to strengthen and modernize the nation’s public health system are numerous, such as H5N1 Bird Flu, more frequent and severe weather events, and more people living with chronic diseases. These challenges to the nation’s health will require multiple solutions including a focus on the importance of Community Health Workers (CHWs). In fact, any efforts to holistically improve health in this country should include such community-based workers.

Community Health Workers are frontline public health professionals that share life experience, trust, compassion, cultural and value alignment with the communities where they live and serve, according to the National Association of Community Health Workers. Community Health Workers provide services in communities they know well and can play an important role in addressing health disparities and reducing healthcare spending on preventable disease.

The Common Health Coalition, a newly-formed partnership whose mission is to improve the nation’s health system through innovative partnerships between healthcare and public health, recently issued a call to action to its members and partners challenging them to showcase community health worker initiatives that connect the gap between health care and public health.

By “taking” the Challenge, members are joining a movement to advance these types of partnerships. The Challenge also includes a funding opportunity for interested organizations – called the “Catalyst Awards.” These monetary awards are intended to fund organizations that demonstrate existing work and/or a strong capacity to integrate CHWs in ways that strengthen partnerships and help inform tools and resources for others.

The Coalition is translating lessons from the COVID-19 pandemic into concrete action steps in pursuit of a reimagined and more effective health system. Community Health Workers have proven to be a key component for catalyzing partnerships between healthcare, public health, and community organizations and for improving community health, and these types of partnerships should be sustainably expanded across the country.

“Community health workers are a key bridge between healthcare, public health, social services, and the communities they serve. This trusted workforce helps individuals and families navigate these systems, connect people to services, and address barriers to achieving optimal health. Healthcare, public health, and policymakers should take action to strengthen and integrate community health workers into their strategies to improve community health and advance health equity,” said TFAH President and CEO J. Nadine Gracia, M.D., MSCE, in a press release announcing the Coalition’s challenge. Dr. Gracia serves as the Common Health Coalition’s Strategic Advisory Council Co-chair and as a member of the Steering Committee.

With the U.S. spending nearly 20 percent of its gross domestic product on healthcare, expanding support for and engagement of Community Health Workers could help reduce that spending. A study published by the Milbank Memorial Fund reported that Community Health Workers working with Medicaid beneficiaries with chronic diseases helped prevent costly hospitalizations and save $2,500 per enrollee annually. The study noted that not only do well-designed community health worker programs reduce hospitalizations for chronic disease, they also contribute to improving mental health, promote healthy behaviors in individuals, and increase patient participation in primary care.

Another study published by the American Heart Association showed that Community Health Workers working collaboratively with care managers and other specialists in Maryland and Pennsylvania helped significantly decrease blood pressure of individuals with previously uncontrolled blood pressure levels and one other risk factor. Due to its importance, the report was highlighted by the U.S. Surgeon General.

Whether working through community-based organizations, places of worship, faith-based organizations, hospitals, clinics, or other settings, Community Health Workers bring knowledge and lived experience of a community’s culture and language to health education and a personal touch to connecting people to services that address health-related social needs such as nutrition and access to healthcare, safe housing, and transportation.

This is particularly evident in Spanish-speaking communities and households where CHWs are often referred to as promotores. Over 18 percent of Latinos in the country lack health insurance, according to UCLA’s Latino Data Hub. Promotores use their intrinsic connection with and knowledge of the cultural norms of communities they serve to provide vital resources to their fellow community members and help build trust and lifelong connections between their communities and public health initiatives.

“There’s a direct through-line between promotoras and community clinics and health centers,” said Maria Lemus, executive director of Visión y Compromiso (VyC), a California-based organization providing leadership training and advocacy for promotoras.

Promotoras within the VyC network were instrumental in mobilizing scores of Californians of Latino descent to get vaccinated against the COVID-19 virus, Lemus said. VyC said its network of promotoras was responsible for arranging testing and vaccine appointments and referrals for nearly 50,000 people at the height of the COVID-19 public health emergency and developed and provided cultural humility training for nearly 10,000 contact tracers.

These workers promote prevention in holistic ways as well. One study found that a network of promotores in Allegheny County, Pennsylvania were able to help increase physical activity and improve dietary practices in communities with growing Latino populations. Latinos have higher rates of obesity compared to non-Hispanic white people, and efforts like this can help lower those disparities.

Despite their effectiveness, funding and resources to support promotores and their work is often limited, Lemus said.

“We’re on the front lines every day,” Lemus said. “To see promotoras as just volunteers is a misconception.”

TFAH has encouraged federal and state policymakers to increase and diversify the public health workforce in an effort to meet the growing needs of individuals, families, and communities, address non-medical drivers of health, and reduce health disparities. Community Health Workers are an important component of the health workforce and play a critical role in meeting these goals.

2024 Year in Review and Looking Ahead to 2025

During 2024, Trust for America’s Health (TFAH) continued its work to create a more resilient, trusted, and equitable public health system, and a healthier nation.

TFAH continued its work in a number of critical issue areas to improve the nation’s health, including emergency preparedness, public health funding, chronic disease prevention, the role of food and nutrition policy in stemming the nation’s obesity crisis, preventing substance misuse and suicide, supporting healthy aging, and addressing the health impacts of climate change and other environmental health risks.

Progress and Risks

The nation’s public health system is at an inflection point; progress has been made in many areas but there are also continuing and potential new risks to the nation’s health. The following are examples of areas of progress and areas of risk.

Areas of progress:

Drug overdose deaths, including from fentanyl, are down. The reduction can be credited in part to the increased availability of treatment options and the adoption of harm reduction strategies such as readily available naloxone, the overdose reversal drug, in many communities. However, disparities persist, with overdose rates increasing in many Black and Native American communities.
COVID-19 infection rates are currently low across the country, a testament to what can be achieved when the public health community rallies and has the funding and resources necessary to meet an immediate challenge.
Investments in public health data modernization, wastewater surveillance, and the Centers for Disease Control and Prevention’s (CDC) Center for Forecasting and Outbreak Analytics have improved the nation’s ability to identify and track emerging health threats. The Center has awarded more than $100 million to partners who are technologically advancing the use of outbreak data to control infectious disease spread.
Fifty-nine state and local health departments have earned Age-Friendly Public Health Systems Recognition Status through TFAH’s Age-Friendly Public Health Systems initiative by making healthy aging a core function of the department. In addition, four public health organizations and 154 individual public health practitioners have been recognized as public health champions.
Fifteen states and D.C. have adopted paid sick leave laws which require private employers to provide paid sick leave to employees attending to their own or a family member’s health. Alaska, Missouri, and Nebraska will require employers to provide paid sick leave beginning in 2025. Paid sick leave has been a long-standing TFAH policy recommendation.

Areas of risk:

Public health faces a serious funding cliff as monies infused into the public health system as part of the pandemic response are expiring or in some cases rescinded. The loss of such funding returns the public health system to the state of underfunding it experienced for decades prior to the global pandemic. TFAH’s annual report, The Impact of Chronic Underfunding on America’s Public Health System 2024: Trends, Risks, and Recommendations called attention to the critical need to increase investment in public health on a sustained basis.
The COVID-19 pandemic exposed serious gaps in the nation’s emergency infrastructure that have not been fully addressed. Furthermore, misinformation about the pandemic, particularly about lifesaving COVID-19 vaccines, contributed to an uptick in mistrust of public health officials that could lead to more vaccine hesitancy and challenges to important public health authorities, all of which could make containing future disease outbreaks more difficult.
New disease outbreaks such as the H5N1 Bird Flu could grow.
Rates of recommended childhood vaccinations are down.
Health disparities continue to impact the nation. Rates of chronic disease are on the rise in every community but are higher, for example, among many communities of color and in rural communities, due to structural barriers to health like access to healthy and affordable food, secure housing, and opportunities for physical activity in those communities.
Health risks are also increasing due to an increase in the number and severity of weather-related incidents including extended periods of extreme heat and extreme heat in regions of the country unaccustomed to such weather.

Working With Partners and Providing Leadership to Strengthen the Nation’s Public Health Ecosystem

TFAH released its Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress in October, after consultation with more than 45 experts, practitioners, organizations, and community members. The Blueprint provides the incoming Administration and Congress a policy roadmap for improving the nation’s health, economy, and national security within six priority areas: 1) invest in public health infrastructure and workforce, 2) strengthen prevention, readiness, and response to health security threats, 3) promote the health and well-being of individuals, families, and communities across the lifespan, 4) advance health equity by addressing structural discrimination, 5) address the non-medical drivers of health to improve the nation’s health outcomes, and 6) enhance and protect the scientific integrity, effectiveness, and accountability of agencies charged with protecting the health of all Americans.

Working with partners across multiple sectors is central to TFAH’s work. TFAH staff led or participated in a number of coalitions during 2024, including the Coalition for Health Funding, the CDC Coalition, the Common Health Coalition, the Well-Being Working Group, the Injury and Violence Prevention Network, National Alliance for Nutrition and Activity, the Coalition to Stop Flu, the Adult Vaccine Access Coalition, the Age-Friendly Ecosystem Collaborative, the National Alliance to Impact the Social Determinants of Health, the National Commission on Climate and Workforce Health, and the National Council on Environmental Health & Equity.

Advocating for Evidence-Based Solutions

A healthy community supports the health of individuals and families by creating access to non-medical drivers of health such as secure housing, transportation, quality healthcare, high-quality childcare and educational opportunities, and jobs that pay a living wage. Such health security supports individuals, families, communities, and the nation’s economy.

Throughout the year, TFAH convened partners to strategize ways to effectively advance health promoting policies and programs at the federal and state levels. In addition, TFAH staff worked with numerous federal agencies and offices, like CDC, FDA, and SAMHSA, as well as public health organizations such as the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), Big Cities Health Coalition, and the National Governors Association to advance policies and garner support for programs that will improve Americans’ health. Among TFAH’s legislative goals for 2024 and moving into 2025 are increased and sustained investment in public health agencies, infrastructure, and programs; passage of a new Farm bill that provides access to nutrition support programs; reauthorization of the Pandemic and All Hazards Preparedness Act and the Older Americans Act; and passage of the Public Health Infrastructure Saves Lives Act and the Social Determinants of Health Act.

These advocacy efforts earned numerous policy wins, including the U.S. Department of Agriculture’s (USDA) updates to school meals formulas and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefit food packages that aligns with TFAH recommendations.

TFAH’s core annual reports, which track data and recommend policy solutions in the areas of emergency preparedness, public health funding, preventing substance misuse and suicide, and addressing the nation’s obesity crisis, continue to be a critical source for data trends and evidence-based policy and program solutions for health officials, policymakers, other decision-makers, and advocates across the country.

Making Healthy Aging a Core Function of Local Health Departments

Through its Age-Friendly Public Health Systems Initiative (AFPHS), TFAH continues to provide guidance and resources to state and local health departments to help them promote healthy aging in their communities. During 2024, AFPHS co-hosted the 2024 National Healthy Aging Symposium with the U.S. Department of Health and Human Services’ (HHS) Office of Disease Prevention and Health Promotion. The symposium brought together speakers from sectors across all levels of government, philanthropy, academia, nonprofits, community-based organizations, tribal representatives, and others who shared their perspectives on important topics related to healthy aging including caregiving, brain health, the caregiving workforce, transportation, housing, and social engagement. TFAH also launched the Age-Friendly Ecosystem Collaborative to continuously engage organizations and sectors central to healthy aging.

Supporting Public Health Communicators

TFAH continues to be a managing partner of the Public Health Communications Collaborative (PHCC). PHCC provides no-cost messaging resources and communications training to state and local health departments to help the field effectively address the public’s information needs on public health issues. The Collaborative was first established during the COVID-19 pandemic and now works across the public health sector on such issues as H5N1 Bird Flu, Mpox, protecting health during periods of extreme heat, and vaccine confidence. Its training materials include resources on strengthening public health through community engagement, responding to misinformation, and using social media in health communications. The PHCC newsletter is shared with over 38,000 opted-in subscribers, and its website has earned over 1.2 million page views since its launch in 2020.

Looking Ahead

The 2025 calendar year promises to be pivotal for the nation’s health. TFAH looks forward to bringing evidence-based policy recommendations to the new Administration and Congress, particularly on issues such as emergency preparedness, chronic disease prevention, mental health, veterans’ and rural health, and investing in prevention to reverse the pattern of increasing healthcare spending without better health outcomes. We are committed to making the case for policies and programs that address the non-medical drivers of health in order to promote the nation’s health and economic security.

Supporting and Promoting Native American Health

In 1990, then President George H.W. Bush signed a joint Congressional resolution designating November as Native American Heritage Month. Native American communities and culture are strongly rooted in community health and healing, an emphasis that has supported generations of Native Americans, despite experiencing past systemic atrocities.

This November, in recognition of the annual observance, Trust for America’s Health (TFAH) urges federal lawmakers to address hardships within Native American communities caused by government actions of past eras and to renew its commitment to improving health outcomes for Native American peoples by removing barriers to federal funding and by fully respecting Tribal Nations’ right to self-determination.

TFAH’s Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress outlines several recommendations that the Administration and Congress taking office in January should act on to help promote healthier tribal communities and reduce health disparities that have long burdened Native American populations.

The well-documented history of forced removal from original homelands and assimilation away from cultural and generational ties, along with centuries of underinvestment and underfunding of tribal communities, have perpetuated the poor health outcomes seen in American Indian/Alaska Native populations. Nearly 30 percent of American Indian/Alaska Native high schoolers have obesity, according to TFAH’s 2024 State of Obesity report – the highest rate among populations groups in the United States. The report also noted that 45 percent of American Indian/Alaska Native adults had obesity, according to a self-reported study. That was higher than white adults at 34 percent.

American Indian/Alaska Native adults also have the highest rates of drug overdose, alcohol-related deaths, and suicide deaths as compared to other population groups, as noted in the latest edition of our Pain in the Nation report.

Despite the loss of much of cultural and ancestral homelands, many traditional Native American health practices are still used to this day. In October 2024, the Centers for Medicare & Medicaid Services announced an historic action for Medicaid and the Children’s Health Insurance Program to cover traditional health care practices when provided by Indian Health Service facilities.

TFAH’s Blueprint report details several additional recommendations to advance the federal government’s trust responsibility and treaty obligations to promote tribal self-government and support the health and well-being of Native populations. Those recommendations include removing barriers that currently exist to fully funding the programs identified in Executive Order 14112 – Reforming Federal Funding and Support for Tribal Nations to Better Embrace Our Trust Responsibilities and Promote the Next Era of Tribal Self-Determination.

The report also recommends that the federal government ensures more complete and accurate collection of health-related data across demographic characteristics to ensure that investments in health-promoting programs are made where they are most needed, including in Native communities. In addition, the report calls on all federal agencies to regularly update and report progress on their agency equity plans and to be more transparent about their progress toward meeting equity goals.

Federally funded, community driven programs have demonstrated effectiveness in improving the well-being of Native Americans. The Special Diabetes Program for Indians, for example, has provided $150 million annually for local prevention programs around the country for nearly 30 years and has been able to incrementally decrease diabetes prevalence in American Indian/Alaska Native communities, according to the latest report to Congress.

More recently, the Strengthening Public Health Systems and Services in Indian Country grant program facilitated by the Centers for Disease Control and Prevention (CDC) has supported dozens of tribal organizations’ efforts to reduce chronic disease and promote healthy living in American Indian and Alaska Native populations. One of the programs funded by this grant program is the CDC’s Tribal Suicide Prevention Program, which is using holistic, community and culturally-centered approaches to reduce deaths from suicide. Also, a partnership between the CDC and AmeriCorps, Public Health AmeriCorps, has launched the public health careers of more than 4,000 individuals, to work in underserved rural, tribal, and urban communities.

Since 2020, TFAH’s Age-Friendly Public Health Systems initiative has partnered with the Washington State Department of Health and the Northwest Washington Indian Health Board (NWWIHB), a coalition of six federally recognized tribes in Washington state, to support exploration of the needs of tribal elders so that the NWWIHB can better provide resources and supports to its tribal elders.

Investing and scaling these evidence-based strategies that prioritize prevention are key steps in leading the systemic change needed to eradicate health inequities and disparities, including in Native American communities.

TFAH Joins Public Health Organizations and Scholars in Authoring an Amicus Brief for the U.S. Supreme Court on Becerra v. Braidwood Management, Inc.

Brief Calls on U.S. Supreme Court to Reverse Lower Court Ruling that Would Threaten Access to Preventive Health Services for Millions of Americans

(Washington, DC – October 31, 2024) – Trust for America’s Health (TFAH) joined the American Public Health Association, the Robert Wood Johnson Foundation, ChangeLab Solutions, and 120 distinguished public health deans and scholars in filing an amicus brief in Becerra v. Braidwood Management, Inc., a case currently under review by the U.S. Supreme Court.

The brief outlines the public health implications of an earlier ruling in the case by the U.S. Court of Appeals for the Fifth Circuit that would threaten no-cost coverage of preventive health services and screenings for more than 150 million Americans who are enrolled in private insurance plans. A decision that if not reversed would exacerbate the nation’s high rates of chronic disease and health disparities.

Free access to recommended preventive health services is a critical feature of the Affordable Care Act. Such preventive care has been proven to save lives and reduce healthcare costs. Affected services could include cancer screenings, infectious disease vaccinations, and cardiovascular disease prevention. Heart disease and cancer are among the leading causes of death in the United States.

Key points of the amicus brief:

Evidence shows that access to preventive services is critical to supporting the health and well-being of individuals and families.
The earlier ruling eliminates guaranteed no-cost coverage for dozens of preventive health screenings and services, significantly increasing the risk of poor health and preventable death for millions of Americans.
The added burden of paying out-of-pocket for health screenings will lead to many illnesses going undetected in their early, most treatable stages.

“Health screenings and other preventive services are bedrock to ensuring Americans’ health and to addressing the country’s growing rates of chronic disease and reducing health disparities,” said J. Nadine Gracia, M.D., MSCE, TFAH’s President and CEO. “TFAH joins the growing chorus of public health leaders and experts calling on the Supreme Court to reverse the Fifth Circuit decision. Doing so will save lives.”

Read the full brief here: Braidwood – Cert stage amicus brief final(773325504.8)

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