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The Affordable Care Act at 14: Preserve the Progress

This March marks the 14th anniversary of the enactment of the Affordable Care Act (ACA). Its passage was the most significant advancement of health policy since the establishment of Medicare and Medicaid in the 1960s and made healthcare accessible and affordable for millions more Americans.  Despite efforts to repeal and restrict the ACA, the progress the legislation has made toward health equity and improving public health prevention is significant and lifesaving. It must be preserved.

The ACA was signed into law in March 2010 during the 110th Congress. Some of the major provisions of the legislation include the creation of a public marketplace for health insurance, expansion of Medicaid eligibility to many adults with low incomes, coverage of recommended preventive services, and the establishment of the Prevention and Public Health Fund.

In the decade leading up to the ACA’s passage, the percentage of people without health insurance steadily increased, reaching over 16 percent of all U.S. residents in 2010, according to the U.S. Census Bureau. Preventive services such as mammograms and other cancer screenings, diabetes screenings, and vaccinations were a costly expense and not easily accessible for a significant number of Americans.

Health insurance enrollment has soared in the years since the Affordable Care Act became law. Forty states and D.C. have expanded Medicaid. As a result, many of those states saw a significant decrease in the share of people without insurance. Nationally, the percentage of uninsured adults between 18-65 steadily decreased to 12.2 percent in 2022, according to the Centers for Disease Control and Prevention. Uninsurance rates also dropped significantly for Black, Latino, and Asian Americans, and for households with lower-incomes.

Medicaid expansion has had significant benefits related to greater health insurance coverage. Mortality rates declined in states that expanded Medicaid eligibility to more adults with low incomes, according to a 2021 study (using data from before COVID-19 was declared a public health emergency). Expansion has contributed to healthcare affordability, access and utilization of care, financial security, and positive impacts on state economies.

Additionally, the ACA ensured access to vital preventive care and screenings without a copay. Prior to the ACA, many health plans failed to cover preventive services, and those that did often required individuals to pay a share of the costs. Even small out-of-pocket payments have been shown to deter people from accessing preventive services, particularly people with lower incomes.

The creation of the Prevention and Public Health Fund (PPHF) has been an important tool for improving health outcomes and reducing health expenditures. To date, PPHF has provided over $12 billion to states and territories to expand access to immunizations, strengthen detection of diseases, and prevent chronic diseases. One program supported by PPHF, the Tips from Former Smokers Campaign, has helped one million smokers quit for good, preventing an estimated 129,000 early deaths.

Yet, the ACA’s progress continues to be at risk.

Ten states have yet to expand Medicaid eligibility. And the current unwinding of continuous Medicaid enrollment that was authorized during the COVID-19 public health emergency has left many individuals and families without health coverage.

Litigation currently moving through the courts threatens access to preventive services. TFAH joined other public health organizations and scholars in an amicus brief describing the potential harms of overturning ACA’s preventive services coverage requirements. Should the courts overturn part or all of this important protection, millions of Americans could lose access to these life-saving services.

An additional threat to the ACA’s impact is the use of monies that should be directed to the Prevention and Public Health Fund to other legislation or priorities. To date, nearly $13 billion has been redirected in this manner. Most recently, the proposed costs in the Protecting Health Care for All Patients Act of 2023 were offset by taking more than $1 billion from PPHF. TFAH was joined by more than 100 organizations in a letter opposing these cuts.

TFAH will continue to urge Congress to restore funding for the Prevention and Public Health Fund and protect access to preventive services.

The ACA is a critical catalyst toward the goal of ensuring the opportunity for optimal health for everyone. It has unlocked access to healthcare including preventive services for so many in this country, including those at the highest risk of poor health. We can’t afford to turn back.

What If Congress Adequately Funded Public Health?

You know the old adage, ‘those that don’t learn from history are doomed to repeat it.’ Coming off the COVID-19 public health emergency that has thus far claimed the lives of 1.2 million Americans, there are discussions in Congress to significantly cut funding for public health initiatives to dangerously low levels – again. And it doesn’t have to be like this.

Why do we go through these bleak cycles when anchoring public health in policymaking is a win-win decision for everyone – from elected officials to individual constituents.

Federal public health funding is facing challenges on multiple fronts right now. Congress continues to negotiate appropriations bills for the 2024 fiscal year, which will have major implications for the next fiscal year and beyond. The current short-term funding agreement for Health and Human Services expires on March 22. If Congress passes another continuing resolution rather than new appropriations, it could trigger extreme, across-the-board cuts to non-defense spending.

First, continuing resolutions, which are short-term measures to fund the government at the previous year’s levels, negatively impact the systems we need to protect the nation’s health. And severe cuts triggered by failing to pass a long-term spending bill would be even more dangerous. TFAH has joined more 1,000 other organizations in urging Congress to pass a full-year funding bill using the bipartisan framework laid out in the Senate as a starting point for negotiations.

Secondly, the FY2024 bills proposed by the House and Senate for Labor, Health and Human Services, Education and Related Agencies – the main funding source for public health programs – are vastly different and neither addresses the chronic underfunding of public health. Congress has already rescinded hundreds of millions of dollars intended to shore up the public health workforce and readiness and response efforts. The Senate’s bill proposes a small cut to the Centers for Disease Control and Prevention (CDC), and the House version would cut about $1.6 billion from CDC’s budget. TFAH and partners have called for a $2.5 billion increase for CDC.

Finally, we continue to see proposals to cut the Prevention and Public Health Fund, a critical investment in programs ranging from immunizations to tobacco use prevention. If these proposals were to move forward, this would again push public health funding into the “bust” phase of a decades long “boom and bust” funding pattern.

The health, safety, and well-being of individuals and communities should be at the foundation of U.S. policy and be funded accordingly.

Imagine if we fully invested in the prevention of adverse childhood experiences, suicide, and substance misuse. Many communities would see suicide and overdose rates fall.

Imagine if we prevented the root causes of death, injury, and excess healthcare costs instead of spending trillions of dollars to treat preventable chronic conditions. Workers would be healthier and more productive, employers would face fewer financial burdens, and the nation would be more resilient and thriving.

Imagine if CDC, state, local, tribal, and territorial health departments had modern data systems instead of rudimentary spreadsheets to track the spread of diseases. This country could contain potential outbreaks in their earliest stages and save lives.

Much of our health and well-being is determined by economic, environmental, and societal factors. In the midst of a recent and troubling decrease in life expectancy, TFAH believes that investing in the foundations of public health and effective prevention programs is a critical and indispensable path forward to protecting and promoting the health of the nation.

 

 

 

 

Black History Month Spotlight: National Council of Negro Women and Good Health WINs Initiative

February marks Black History Month, and the theme for this year celebrates Black artists as ‘agents of change.’

The National Council of Negro Women’s Good Health Women’s Immunizations Networks (Good Health WINS) initiative, of which Trust for America’s Health (TFAH) is a founding member, has certainly been an agent of change in the art of public health. The historic national organization’s efforts to bolster vaccinations among African Americans and counter misinformation during the COVID-19 pandemic were important to reaching and educating Black families and communities across the country.

The National Council of Negro Women (NCNW) was founded in 1935 by legendary philanthropist, civil rights activist, and suffragist Dr. Mary McLeod Bethune as a vehicle to empower African American women, their families, and communities. It has historically served as an umbrella organization for a network of chapters and groups advancing Black women civically, politically, and economically. The organization and its revered leaders have provided housing and education for women, particularly in the South, and been recognized for its influence and measured approach to policy advocacy.

At the height of the COVID-19 pandemic, the organization furthered its leadership on the front lines of promoting and protecting the health of communities of color, particularly as the first COVID-19 vaccines began to rollout. Fears, mistrust, inequitable distribution, barriers to access and misinformation led to African Americans initially having much lower vaccination rates than other populations.

In 2021, NCNW partnered with TFAH, Vaccinate Your Family (VYF) – a collaborative that drew on its partners’ expertise and reach to provide culturally-specific educational and messaging resources to its communities.

The initiative elevated voices trusted in Black communities to provide crucial information about vaccines at a time when past racial medical injustices, such as the Tuskegee experiments, were being used against the new vaccines. Good Health WINs produced how-to videos for social media and fact sheets. In its first year alone, the nationwide network hosted nearly 1,500 vaccination events, reaching 750,000 people.

COVID-19 vaccination rates are now higher for African American adults than their white counterparts, according to the Centers for Disease Control and Prevention (CDC), largely due to Good Health WINs and efforts like it. At the end 2023, nearly 83 percent of African Americans received at least one dose of the COVID-19 vaccine, compared to 80 percent of white Americans who received at least one dose.

NCNW’s ability to build and facilitate this coalition has been instrumental to its wide reach. NCNW itself is a collaborative of 36 national organizations that serve the Black community. Many chapters of historically Black Greek-letter fraternities and sororities are part of the NCNW/Good Health WINs network. Lifelong community service is an integral part of membership for these Pan-Hellenic organizations. The network also includes many faith-based organizations with sophisticated external marketing capabilities, such as the Alfred Street Baptist Church.

“We were facing a pandemic unprecedented in our lifetimes that, because of longstanding social determinants of health, posed an existential threat to African Americans,” said NCNW President and CEO Reverend Shavon Arline-Bradley. “Fortunately, our network and experience, including with HIV/AIDS education, equipped us to act quickly and decisively.  We appreciate the support of Trust for America’s Health, Vaccinate Your Family, the Centers for Disease Control, Moss Consulting, our dedicated employees and tens of thousands of volunteers who support Good Health WINs.”

To date, more than 600,000 people have attended Good Health WINs events, and it has reached over 1.4 million people on social media with its science-based information about the safety and effectiveness of COVID-19 vaccines, according to the organization.

Good Health WINs provides communications toolkits for its members and circulates success stories from local chapters with the rest of the network.

The community engagement expertise of the NCNW, combined with the public health expertise of TFAH, CDC, and VYF, has been a fruitful recipe for raising awareness on other critical health needs in Black communities. The work now includes efforts to provide immunization resources for seasonal viruses and other diseases, as well as publicizing other health and wellness events, particularly around preventing heart disease.

“Outreach efforts that authentically and meaningfully seek to empower its constituents is an artform that the National Council of Negro Women has long mastered and that the country needs to achieve health equity,” said TFAH President and CEO Dr. J. Nadine Gracia. “Partnerships with community-based organizations that are trusted in their communities, supported by funding and resources to implement effective programs, are essential to promote optimal health, reduce health disparities, and advance health equity.”

TFAH’s President and CEO Dr. Gracia Discusses the Significance of Dr. Martin Luther King Jr. Day & National Day of Racial Healing

(Washington, DC – January 15, 2024) – This week TFAH’s President and CEO, Dr. J. Nadine Gracia and Director of Strategic Communications and Policy Research Rhea Farberman discussed the significance of two important observances, Dr. Martin Luther King Jr. Day and the National Day of Racial Healing. The conversation focused on the intersections between Dr. King’s mission to advance social justice and TFAH’s work to promote optimal health. Also discussed were the ways in which structural racism creates barriers to good health for many people of color and the policy actions needed to dismantle those barriers.

“What we know, especially in thinking about this in terms of Dr. Martin Luther King, Jr. Day and the National Day of Racial Healing, is that for too many people of color and communities of color there has been, over many decades, a disadvantage in terms of access to health promoting resources.”

“We have to act with a sense of urgency because the health, well-being and prosperity of our nation depends on it.  That’s the call that I believe Dr. King would challenge us to continue, to strive for and not relent.  That’s his legacy to us, to ensure that everyone us the opportunity to reach their full potential for health.”

Dr. J. Nadine Gracia
President and CEO
Trust for America’s Health

“Listen to the full conversation”

 

Ending Structural Racism’s Impact on Health in Communities of Color – Public Health’s Role

Dr. Martin Luther King, Jr. called health injustice “the most inhumane form” of inequality.

As the nation recognizes Dr. Martin Luther King Jr., Day and the National Day of Racial Healing, Trust for America’s Health (TFAH) is reflecting on how the public health sector has and can continue to overcome barriers to optimal health caused by the historical and contemporary effects of structural racism. These barriers include long-standing policies, investment and funding patterns, and laws that continue to limit access to safe housing, quality education, employment, healthcare, and even healthy and nutritious food in many communities of color. The result is, on average, higher rates of chronic disease and lower life expectancy for people of color. These inequities will continue to have serious health and economic consequences for the entire country if not fully confronted.

Changing this narrative starts with anchoring discussions with the truth about the impact of racism and working collectively to heal and advance racial equity. Increasingly, the public health field is acknowledging the negative effects that racism has on individuals’ and community health and is working across communities to find solutions, including:

Still, more needs to be done to end the vestiges of structural racism and this country’s longstanding public health crisis. Here are five ways to help fully realize that vision:

  • Center communities and people of color when developing health promoting strategies. Agencies and organizations should work with communities that are disproportionately impacted and incorporate their voice and lived experience in decision-making wherever possible.
  • Invest in the public health system, including building a larger and more racially and ethnically diverse and inclusive public heath workforce. Public health authorities should also be protected so that health officials can implement science-based, nonpartisan health measures routinely and during emergencies.
  • Increase and consistently fund public health measures, rather than allocating money only in response to emergencies. Communities that are historically under-resourced and marginalized should be a priority in funding decisions.
  • Modernize technology for disease monitoring systems for improved, disaggregated health data collection and sharing that will lead to tailored approaches for specific populations.

TFAH is committed to partnering with organizations of color and advocating for and supporting policies that advance health equity.

“Public health, collaborating with its multi-sector partners, is uniquely positioned to address structural racism’s impact on health. As the nation observes Dr. Martin Luther King Jr., Day and the National Day of Racial Healing, TFAH commends the efforts of the public health community striving toward the goal of optimal health and well-being for all people, while we also recognize that more work must be done in our journey to health equity,” said TFAH President and CEO Dr. J. Nadine Gracia.

Advocates Urge Congressional Leaders to Reject Massive Cuts Which Would Put Public’s Health at Risk

(Washington, DC – January 8, 2024) This week, Trust for America’s Health joined the Coalition for Health Funding and a broad, multisector group of over 1,100 organizations in a letter to Congress voicing strong concern that a full-year continuing resolution would trigger massive cuts that would be “disastrous for the capacity of the Federal government to serve the public.” The letter to Senate Majority Leader Charles Schumer, Senate Minority Leader Mitch McConnell, House Speaker Mike Johnson, and House Minority Leader Hakeem Jeffries urged policymakers to work together using the bipartisan Senate Appropriations Committee funding levels as a starting point for FY2024 negotiations moving forward.

At stake is funding for programs that are critical to safeguarding the public’s health. Examples include prevention and response to health emergencies; programs that provide nutrition assistance to young children, families, and older adults; medical care for veterans; housing and home energy assistance programs; and investments that ensure safe transportation and drinking water. These programs are a small part of the federal budget but represent major impacts on communities’ health and wellbeing.

Read the letter at: NDD United Letter, January 7, 2024 

Trust for America’s Health 2023 Year in Review

The past year included divergent trends within the public health sector. While the country emerged from the emergency phase of the COVID-19 pandemic, other threats to the nation’s health, including chronic disease rates, substance misuse and suicide, and the impacts of climate change continued to increase. TFAH spent the past year raising awareness and advancing policy actions to address these long-standing and emerging public health challenges with a particular focus on the ways these issues disproportionally impact certain communities.

Public Health Warning Signs in 2023

The work of public health and healthcare professionals was key to turning the corner in the fight to control COVID-19. However, the end of the public health emergency and Congressional action resulted in the rollback of federal and state funds allocated to respond to the pandemic and strengthen public health capacity. Consequently, money for thousands of public health positions funded by temporary response dollars was lost, and public health measures were given less priority. Being fully prepared for the next public health emergency will depend on breaking out of the boom-and-bust cycle of public health funding and growing and diversifying the public health workforce.

Obesity rates also continued to increase, as TFAH noted in this year’s State of Obesity: Better Policies for a Healthier America report.  As reported, obesity rates continued their 20-year climb for every demographic group measured. Nearly 42 percent of all adults in the United States have obesity compared to 30 percent in 1999-2000. One in five children ages 2-19 have obesity, according to 2017-2020 data from the National Health and Nutrition Examination Survey. That’s three times the rate from the 1970s.

Extreme weather events fueled by climate change took lives and caused billions of dollars in damage in communities across the country. Parts of the south and southeast experienced unprecedented and dangerous levels of extreme heat. Wildfires that erupted in Hawaii in August devastated the town of Lahaina, and wildfires in Canada created health-impacting smoke events across the U.S. Mid-Atlantic and into the Midwest. The 2023 edition of Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism showed that many states have improved their public health and emergency management systems, but 15 states were placed in the low-performing tier for preparedness.

This year’s edition of TFAH’s Pain in the Nation report also noted that the alarming increase in the number of deaths from substance misuse and suicide over the last decade is continuing. There was an all-time record of 209,225 Americans that lost their lives due to drugs, alcohol, or suicide in 2021, which was double the amount in 2011.

TFAH’s 2023 Policy Activities

During the year, TFAH worked to raise awareness and educate policymakers about the importance of investment in public health programs and the benefits of those investments.

Our outreach efforts went beyond Capitol Hill. TFAH provided advice throughout the year to key staff at the White House, federal agencies and the health and public health sectors.

  • TFAH submitted comments to the Office of Management and Budget on its plan to update the way the federal government collects data by race and ethnicity. Ensuring health equity starts with accurate and comprehensive collection of data on race and ethnicity.
  • The White House created the Office of Pandemic Preparedness and Response in July. Solidifying this type of federal leadership structure is a long-standing recommendation of our annual Ready or Not
  • TFAH collaborated regularly with the Office of National Drug Control Policy including providing comments on the Biden-Harris Administration’s efforts to curb substance misuse.
  • TFAH President and CEO Dr. J. Nadine Gracia was appointed by President Joe Biden to serve on the President’s Council on Sports, Fitness, & Nutrition, along with other leaders from the world of sports, fitness, nutrition, and advocacy.
  • TFAH supported policy initiatives to promote healthy eating. Dr. Gracia also provided testimony before the Dietary Guidelines for Americans Advisory Committee on the public health impacts of updating the dietary guidelines.
  • The U.S. Department of Agriculture proposed aligning school nutrition standards with the standard Dietary Guidelines for Americans. This was a key recommendation in the State of Obesity
  • TFAH’s Age-Friendly Public Health Systems movement expanded to include working with state public health institutes to build expertise in healthy aging policy and programs with the goal of elevating healthy aging as a core function of state departments of health.
  • TFAH partnered with the Office of Disease Prevention and Health Promotion at the U.S. Department of Health and Human Services to facilitate collaborations between state departments of health and state departments of aging that prioritize older adult health issues, such as mitigating the effects of social isolation, including older adults in emergency planning, and addressing shortages in the direct care workforce.

Amplifying Our Voice 

TFAH also continued to work to disseminate data and key messages to the public health community and to our partners to not only inform the field at large, but also to help build a unified front to protect critical public health functions and authorities.

In 2020, TFAH, the CDC Foundation and the de Beaumont Foundation formed the Public Health Communications Collaborative to provide the field with science-based messages and resources to help state and local public health officials be effective communicators during the pandemic and to counter misinformation. This year, as the collaborative began to create messaging materials on public health issues beyond the pandemic, the appetite for PHCC information was just as strong as it was during its inception, which included providing resources on effective crisis communications and culturally-relevant messaging. Messaging support materials created during the year included communicator toolkits on when to take an at-home COVID-19 test, managing health during air quality alerts, and on fall respiratory illness prevention. PHCC’s monthly webinars averaged over 1,000 participants and newsletter subscriptions were up over 13 percent.

During 2024

Our strategic priorities to advance a strong, resilient, trusted, and equitable public health system and to ensure that prevention and health equity are foundational to policymaking will be central to and at the forefront of TFAH’s work in the coming year.

Our research, policy, advocacy, and organizational development efforts will lead to:

  • A strong, resilient, trusted, and equitable public health system that addresses our nation’s public health opportunities and challenges.
  • Innovation that drives systemic change to promote and protect health and well-being for all.
  • The advancement of health equity in public health and prevention.
  • Ensuring that TFAH is a dynamic, sought-after, people-centered organization that is thriving.

TFAH is committed to being a tireless advocate for the nation’s public health needs and system. Return to our website throughout the coming year for information and updates.

Giving Tuesday is an Opportunity to Support TFAH’s Mission

For Giving Tuesday 2023 we invite you to consider a donation to Trust for America’s Health (TFAH) in support of our critical mission to promote and protect health for every person and in every community.

The COVID-19 pandemic demonstrated the urgent need to transform our public health system through sustained investment in infrastructure, the public health workforce, and in health promotion and disease prevention. But the most critical lesson of the pandemic is that none of these investments will be effective until the nation addresses structural racism, economic disparities, and the social determinants of health.

TFAH is not a membership organization, and we don’t accept government or corporate funding – all to preserve our independent voice. As the challenges before our public health system continue to grow the need to expand our work does too. Your support as an individual donor will help us continue to achieve our mission to advance health equity and give everyone the opportunity to lead a healthy life.

 

Donate Today!

Nutrition Support Programs are Vital to Preventing Food and Nutrition Insecurity and Reducing Chronic Disease – Congress Must Act to Support Them

As of early November 2023, draft appropriation bills by both the House of Representatives and the Senate do not adequately fund the WIC nutrition support program, threatening to break a nearly 30-year, bipartisan commitment to ensure all participants can access the program without waitlists.

(Washington, DC – 11/20/23) – Access to nutritious food is critical to preventing many chronic diseases and is particularly important to keep young children on track with their growth and developmental needs. In 2022, an estimated 12.8 percent of U.S. households experienced food and or nutrition insecurity sometime during the year.
As Trust for America’s Health’s (TFAH) State of Obesity report series has demonstrated, food insecurity is a risk factor for obesity and other nutrition-related chronic diseases. Progress on addressing these critical public health issues is in jeopardy if Congress does not provide funding for federal nutrition support programs during the current fiscal year.
One of the key federal nutrition programs supporting the specific nutritional needs of young children, infants, and birthing people is the Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC. Created in 1972, the WIC program is a short-term, public health intervention program designed to strengthen lifetime nutrition and health behaviors within households with low-incomes. The WIC program provides nutrition benefits tailored to support a young child’s development. Over time, the program, including its food packages, has aligned with new science about the key nutrients infants and children need. These changes have had a significant impact. Studies show that the 2007 benefit update helped improve beneficiaries’ diets and decreased rates of obesity among enrolled toddlers ages 2-4.

The WIC program also adapted to challenges created by the COVID-19 pandemic by implementing new flexibilities, such as allowing WIC agencies to remotely load benefits cards. In 2021, Congress also increased the monthly benefit available to families to purchase more fruits and vegetables from $9 to $26 for children, and from $11 to $47 for pregnant and postpartum participants. These changes modernized the program and in turn increased participation; important because WIC has long had lower participation rates in comparison to the number of eligible families.

Today, nearly seven million parents and children under five years old depend on the WIC program, and participation is expected to grow due to increased program flexibilities. To keep up with increased demand, additional program funding is needed. As of early November 2023, draft appropriation bills by both the House of Representatives and the Senate do not adequately fund the WIC program, which threatens to break a nearly 30-year, bipartisan commitment to ensure all participants can access WIC without waitlists. Increasing food costs, make action to grow the WIC program critically important as families are struggling to afford healthy meals and may be forced to turn to cheaper but less nutritious alternatives.

Critical public health programs like WIC not only provide nutritious foods to families in the short term, but also help prevent diet-related diseases. Trust for America’s Health urges Congress to increase funding in the Fiscal Year (FY) 2024 budget for the WIC program to ensure pregnant and postpartum birthing people and their young children have the nutrition they need to enjoy good

Reflecting on Structural Health Challenges and Successes in Native Communities During Native American Heritage Month

November is Native American Heritage Month in recognition of the many contributions and accomplishments of American Indian and Alaska Native people. It is also a time to reflect on structural health challenges in Native communities—often linked to centuries of historical and current day trauma and discrimination—as well as the successful health initiatives driven by and in collaboration with Native communities. These programs deserve more attention and support. Furthermore, the special relationship and treaty responsibilities between the federal and tribal governments obligate support for the health and well-being of American Indian and Alaska Native people.

Population health outcomes are connected to underlying current and historic social, economic, and environmental conditions in all communities. Native communities have inherent strengths but must also cope with a legacy of historical trauma, including removal and resettlement from their original lands, forced assimilation, and a lack of infrastructure and investment by the federal government. Centuries of discrimination and intergenerational trauma play out today in a host of ways, including disproportionately high rates of poverty, food insecurity, and lack of health insurance coverage. These kinds of conditions contribute directly (e.g., access to healthy foods and healthcare) and indirectly (e.g., through stress and Adverse Childhood Experiences) to poor health outcomes.

As a result, Native communities have faced health challenges and disparities for generations. In 2021, the American Indian and Alaska Native population in the United States had a life expectancy of 65.2 years—more than 10 years lower than the overall U.S. population’s life expectancy (76.1 years) and the lowest of any racial/ethnic group that the Centers for Disease Control and Prevention (CDC) tracks. The differences in life expectancy has been further exacerbated recently due to very high mortality from COVID-19 for American Indian and Alaska Native people when compared to other racial and ethnic groups.

Some of TFAH’s priority issues—including prevention of obesity, diabetes, and other chronic diseases, and alcohol, drug, and suicide mortality—consistently show American Indian and Alaska Native people with among the worst health outcomes for any racial/ethnic population in the United States. For example, TFAH’s 2023 Pain in the Nation report found that, in 2021, American Indian and Alaska Native people had a mortality rate of 178.7 deaths per 100,000 from alcohol, drug, and suicide causes combined. This is more than twice the mortality rate of the white population (69.5 deaths per 100,000), which had the next-highest mortality rate of any other race/ethnicity measured. Other concerning health issues in Native communities include alarming maternal and infant health trends—with Native women dying from pregnancy-related causes at twice the rate of white women and Native infants dying in their first year of life at nearly twice the rate of white infants in the United States—and high rates of domestic violence.

There are many examples of valuable, community-led work focused on improving health and well-being and reducing disparities in Native populations. A few examples include:

  • Good Health and Wellness in Indian Country is a CDC grant program that supports tribal organizations, including Urban Indian organizations, to reduce chronic disease and promote healthy living in American Indian and Alaska Native populations. The current 2019­­-2024 grant cycle provides $19.3 million per year of funding to 27 tribal organizations and consortiums which reach more than 130 tribes across the United States. With 574 federally-recognized tribes in the United States, there is need for this proven program to be scaled to reach more people.
  • CDC’s Suicide Prevention Program includes a focus on Tribal suicide prevention. The Southern Plains Tribal Health Board and Wabanaki Health and Wellness organization are working to increase capacity to adapt and implement suicide prevention programs in tribal populations at increased risk for suicide.
  • The Native and Strong Lifeline— a program within Washington State’s 988 lifeline dedicated to helping American Indian and Alaska Native people in crisis—launched in November of 2022 and handled 1,200 calls in its first eight months of operation. It is staffed by Native volunteers who have lived experience with mental health challenges, and share tribal and culturally-specific resources and community connections.
  • The National Indian Health Board’s Climate Ready Tribes Initiative focuses on climate-related health threats. The Initiative works to raise awareness and share pertinent resources to tribal organizations broadly, as well as fund individual tribes to lead climate health and resiliency work in their community. Current awardees are Lummi Nation, the Pala Band of Mission Indians, and the Sitka Tribe of Alaska, whose work includes climate adaptation planning and identifying community health resources.
  • In 2021, American Indian and Alaska Native people were the group to most quickly get the first doses and full vaccination series for Covid-19 across all race/ethnicities. Community leaders and researchers attribute this success to direct vaccine distribution to tribes and the Indian Health Service, and ensuring tribal organizations could adapt vaccine messaging—like focusing on being vaccinated to reduce community harm—and engage trusted messengers—like tribal elders—that resonate with community members. Despite this success, COVID-19 death rates before the vaccine was available were very high in Native communities and Native peoples continue to have high rates of serious illness and poor health outcomes from COVID-19 due to the prevalence of chronic disease within the community.
  • The Substance Abuse and Mental Health Services Administration’s Tribal Opioid Response grant program supports tribal organization’s efforts to increase culturally appropriate and evidence-based prevention, treatment, and recovery support services in their communities. The FY 2022 grants included $55 million in funding. Examples of grantees include Cherokee Nation, which focused on expanding treatment recovery support and harm reduction services across more counties, and Wyandotte Nation, which focused on prevention, treatment, and training to support cultural and family connections.
  • The Northwest Washington Indian Health Board, a consortium of six tribes, is currently participating in the Age-Friendly Public Health Systems movement, facilitated by TFAH and the Washington State Department of Health. The primary goal of the project is to enhance public health efforts to improve the health and well-being of older adults in tribal communities. This begins with collecting relevant and robust data on older adults to identify needs and community assets that will inform interventions, like caregiving needs and home repairs.

Importantly, these and other community-led programs emphasize the need for culturally-competent approaches that are tailored to and that respect culture, belief, practices, and linguistic needs of every tribe and community.

TFAH calls for increased federal investment in evidence-based initiatives that prioritize prevention in Native communities, as well as steps to ensure prevention funding reaches underserved American Indian and Alaska Native populations. All American Indian and Alaska Native people should have the opportunity to live their healthiest lives.