Public Health Funding Policy Activities
After decades of under-investment, our public health system lacks the resources it needs to tackle the full range of health threats, from potential chemical or biological attacks, to serious chronic disease epidemics, or emerging infectious diseases like avian influenza. As the lead federal agency for protecting the public's health, the Centers for Disease Control and Prevention's (CDC) budget must reflect the vital role it plays in the lives of every individual, every day, and its increasing responsibilities for homeland security.
Position Statements and Letters
Group Letter in Support of Funding for National Center for Environmental Health (September 2017)
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Group Letter with Recommendations for Emergency Response Fund (June 2017)
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Group Letter in Support of Funding for the Centers for Disease Control (April 2017)
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Group Letter in Support of Funding to Combat Zika in FY18 (March 2017)
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Group Letter in Support of Funding for Immunization Related Activities at HHS
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Group Letter in Support of Increased Funding for National Center for Environmental Health (April 2016)
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Group Letter in Support of Emergency Funding for Zika Preparedness and Response (February 2016)
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Written Statement of John Auerbach, President and CEO of Trust for America's Health to House Appropriations Subcommittee on Labor, Health & Human Services, Education and Related Agencies (April 2018)
Written Statement of John Auerbach, President and CEO of Trust for America's Health to Senate Appropriations Subcommittee on Labor, Health & Human Services, Education and Related Agencies (June 2017)
Written Statement of John Auerbach, President and CEO of Trust for America's Health to House Appropriations Subcommittee on Labor, Health & Human Services, Education and Related Agencies (March 2017)
Written Statement of Jeffrey Levi, PhD, Executive Director of Trust for America's Health to House Appropriations Subcommittee on Labor, Health & Human Services, Education and Related Agencies (April 2015)
Critical Care List: TFAH Public Health Funding Priorities Fiscal Year 2019
A healthy United States is a strong United States. A prepared nation is a safer nation. But persistent
underfunding of the country’s public health system has left the nation vulnerable.
Right now, Americans arenot as healthy as they could or should be. More than half of Americans live with one or more chronic disease, which costs our health system billions of dollars. Recent infectious disease outbreaks illustrate persistent gaps in the country’s preparedness for diseases, disasters, and bioterrorism. In 2017, the United States suffered multiple natural disasters including hurricanes, floods, wildfires, and drought, and will likely continue to experience such catastrophic weather-related emergencies. The nation remains in the midst of a devastating opioid epidemic with deaths from drug overdoses up a huge 75 percent in the last decade (2007-2016).
The lingering effects of fiscal austerity, including sequestration, have fundamentally eroded the country’s ability to respond to disasters, prevent chronic diseases, reduce health disparities, and ensure the health of all Americans. The United States spends $3.36 trillion annually on health, but only roughly three percent of that spending is directed to public health. Many local and state health departments have lost funding in the face of the new and continuing threats to the health of the American people and are unable to adequately fund prevention initiatives – which have been shown to save money and prevent illness and injury. The country needs a long-term commitment to rebuild the nation’s public
health capabilities – not just to plug some of the more dangerous gaps, but to ensure that each community will be prepared, responsive, and resilient when the unexpected occurs.
Below are the FY 2019 funding priorities for Trust for America’s Health (TFAH). Together, these programs will help prevent disease, save lives, and reduce long-term health costs.
The Centers for Disease Control and Prevention
TFAH is pleased that the Centers for Disease Control and Prevention (CDC) received funding for a much needed laboratory and to expand the work on opioids in fiscal year (FY) 2018. However, much of its vitally important work remains dangerously underfunded – TFAH recommends that Congress provide CDC with $8.445 billion in FY 2019 towards the goal of providing CDC with a 22 percent increase in funding by FY 2022.
The Prevention and Public Health Fund
The Prevention and Public Health Fund (Prevention Fund) was enacted to modernize the public health system, keep Americans healthy and reduce health costs over the long term. To date, the Prevention Fund has invested more than $8 billion to enable communities in every state to invest in effective, proven public health and prevention efforts. These investments support state and local public health efforts to transform and revitalize communities, build epidemiology and laboratory capacity, protect children from lead poisoning, maintain access to vaccines, reduce tobacco use, and control the obesity, heart disease and diabetes epidemics.
TFAH urges Congress to allocate all $900 million of the Fund in FY 2019 and direct its funding toward essential public health programs to help reduce healthcare costs and create a long-term path to a healthier and economically sound America. TFAH opposes cutting or diverting the Prevention Fund for any purpose other than for its intended use.
Preventing and Reducing Chronic Disease
Chronic diseases are responsible for 80 percent of healthcare costs in the United States and the causes are often environmental, social, or economic and not adequately addressed by simply investing in the clinical healthcare system.
CDC’s National Center for Chronic Disease Prevention and Health Promotion funds public and private partners to: reduce the rates of death and disability due to tobacco use; reduce the prevalence of obesity and the rates of death and disability due to diabetes, heart disease, and stroke. TFAH recommends $63.31 million for the Division of Nutrition, Physical Activity, and Obesity at CDC’s National Center for Chronic Disease Prevention and Health Promotion. This would provide roughly $10 million more to state health departments to improve nutrition and promote physical activity. It would support work being done in high-obesity rate counties. The Racial and Ethnic Approaches to Community Health (REACH) program, administered by CDC, works in communities across the country to eliminate racial and ethnic disparities in health and reduce the burden of chronic disease among racial and ethnic minority populations. REACH offers culturally sensitive, evidence- and practice-based strategies to address the root causes of chronic disease among racial and ethnic minorities. TFAH recommends funding REACH at $57.95 million.
Fighting Environmental Causes of Disease
Much of our health is affected by the environment in which we live, work, learn, and play. Supporting research and implementing the knowledge it generates helps to create safe, healthy environments that are free of environmental toxicants and other hazards to enable people to make healthy choices that are not currently possible in many communities across the country. Without the right data, researchers and policymakers struggle to answer basic questions about life-threatening health conditions
Since 2002, the National Environmental Public Health Tracking Network has provided data on cancer rates, reproductive health outcomes, birth defects, socioeconomics, air quality, community design, and developmental disabilities to help policymakers answer basic questions about health. Currently, only 25 states and the District of Columbia are funded. TFAH recommends funding CDC’s National Environmental Public Health Tracking Network at $40 million as a down payment towards fully funding the Network within the next five years.
Preparing for Public Health Emergencies and Pandemics
The Ebola and Zika outbreaks and the natural disasters in 2017 demonstrated that we cannot become complacent in the face of public health emergencies. Over the past few years, state and local health departments and health systems have responded to crises like the Flint water contamination, extreme weather, wildfires, outbreaks of HIV, measles, and other infectious diseases, and mass casualty events. However, federal, state, and local budget cuts threaten the ability to respond adequately. More than any other source, federal dollars fund state and local agencies to ensure that they have the vital public health infrastructure and capacity to prepare for and respond to acts of terrorism, natural disasters, and infectious disease outbreaks. CDC and the HHS Assistant Secretary for Preparedness and Response (ASPR) work to ensure that public health and health systems can respond effectively when disaster strikes.
The Public Health Emergency Preparedness (PHEP) Cooperative Agreements program at CDC is the only federal program that supports the work of health departments to prepare for and respond to all types of disasters, including bioterror attacks, natural disasters, and infectious disease outbreaks. PHEP supports 62 state and local grantees to develop core public health capabilities, including in the areas of public health laboratory testing, health surveillance and epidemiology, community resilience, countermeasures and mitigation, incident management, information management, and surge capacity. PHEP funding ensures that state and local jurisdictions can respond to a wide range of emergencies, regardless of origin. PHEP funding has been cut by about 29 percent between FY2002-FY2018 ($940 million to $670 million). TFAH recommends $824 million for Public Health Emergency Preparedness Cooperative Agreements to address gaps in state and local preparedness.
The Hospital Preparedness Program (HPP), administered by the Assistant Secretary for Preparedness and Response (ASPR), provides funding and technical assistance to every state and territory to prepare the health system to respond to and recover from a disaster. HPP is building the capacity of healthcare coalitions (HCCs) - regional collaborations between healthcare organizations, providers, emergency managers, public sector agencies, and other private partners - to meet the disaster healthcare needs of communities. Healthcare coalitions’ roles include conducting exercises and trainings, providing situational awareness across the system, sharing resources, and leading scenario planning. The grants support 476 healthcare coalitions with 28,000 participating facilities from across the health system, an increase of 63 percent in membership since 2012. Despite this growth, HPP funds have been cut nearly in half, from $514 million in FY2003 to $264 million in FY2018. ASPR supports coalitions to develop key capabilities, including health system preparedness and recovery, emergency operations coordination, information sharing, medical surge and responder safety. Most jurisdictions receive no other federal or state support for health system preparedness. TFAH recommends $474 million for HPP in FY 2019.
Addressing the Prescription Drug Abuse Epidemic
Opioid misuse is a public health epidemic. Drug-related deaths have tripled since 2000 — and were responsible for more than 52,400 deaths in 2015. More than 33,000 of these were from opioids, mainly prescription opioids, heroin and fentanyl. Overall, 7.7 million Americans (2.9 percent) have a drug use disorder. This rise is prescription drug misuse is also contributing to an increase in heroin overdose deaths. There was a 72.2 percent increase in fentanyl-related deaths); and 20 percent rise in heroin-related deaths between 2014 and 2015. Addressing substance misuse epidemic requires investments in prevention as well as treatment and recovery services. TFAH urges Congress to fully fund programs authorized by the Comprehensive Addiction and Recovery Act (CARA).
TFAH recommends $62.54 million for the CDC’s Injury Center for Opioid Abuse and Prevention to provide a national response to a national epidemic by expanding its work to all 50 states and the District of Columbia. The Injury Center has steadily increased its work in prescription drug overdose (PDO) prevention over recent years, working with state health departments to accelerate prevention efforts. CDC is supporting 29 states with funding to improve prescription drug monitoring programs (PDMPs). 13 states are funded under the Data-Driven Prevention Initiative to improve data collection efforts that can be used to develop strategies to target risk factors, while 32 states are funded for Enhanced State Opioid Overdose Surveillance to gather timely and comprehensive data on both fatal and nonfatal overdoses. This funding would enable the Injury Center to expand their activities and support of state health departments to improve monitoring and surveillance, expand and strengthen evidence-based prevention activities, and continue to improve prescribing practices.