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 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 (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 2018
Every American should have the opportunity to be as healthy as he or she can be. Every community should be safe from threats to its health. All individuals and families should have access to a high level of services that protect and support their health, regardless of who they are or where they live. But right now, Americans are not 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; recent infectious disease outbreaks illustrated persistent gaps in the country’s preparedness for diseases, disasters, and bioterrorism; and prescription drug abuse has quickly grown into a full-blown epidemic, with overdose deaths quadrupling in just over a decade.
In order to build a public health system prepared to deal with these challenges, a set of core capabilities must be funded on a strong and steady basis. 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.
While the Fiscal Year (FY) 2016 and 2017 Labor, Health and Human Services, Education, and Related Agencies appropriations bills restored some prior cuts to the Centers for Disease Control and Prevention (CDC) and other critical public health agencies, we need a long-term commitment to building the nation’s public health capabilities. Below are the FY 2018 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 Prevention and Public Health Fund
The Prevention and Public Health Fund (the Fund) is the nation’s only dedicated funding source for prevention and public health. To date, the Fund has invested over $7 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, train the nation’s public health workforce, prevent the spread of HIV/AIDS, expand access to vaccines, reduce tobacco use, and control the obesity epidemic.
The Fund has provided the first-ever, reliable national funding stream for public health while also creating jobs, bending the healthcare cost curve, and prioritizing disease prevention. For the past four years, Congress has exercised its authority to allocate the Prevention Fund. TFAH urges Congress to do so again in FY 2018 and to direct funding toward essential public health programs to help reduce healthcare costs and create a long-term path to a healthier and economically sound America.
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 coordinates with public and private partners to work toward health outcome goals: reducing rates of death and disability due to tobacco use, reducing the prevalence of obesity and reducing rates of death and disability due to diabetes, heart disease, and stroke. TFAH recommends $61,000,000 for the Division of Nutrition, Physical Activity, and Obesity at CDC’s National Center for Chronic Disease Prevention and Health Promotion. This would represent an $11.08 million increase, which would permit CDC to increase enhanced support to state health departments to deploy interventions focused specifically on improving nutrition and promoting physical activity to 18 states and D.C. It also would help support a proposed $15 million expansion of coordinated activities in Indian Country and $12.72 million for the 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 to reduce the burden of chronic disease among at-risk populations. REACH complements other community-based programs, but is unique in offering culturally sensitive, evidence- and practice-based strategies to address the root causes of chronic disease among racial and ethnic minorities neglected by our healthcare system. TFAH recommends funding REACH at $50.95 million to maintain funding to enable the program to begin new three-year cooperative agreement.
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. Yet 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 recent Ebola and Zika outbreaks have 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, Legionnaire’s and other infectious diseases, and mass casualty events. However, federal, state, and local budget cuts threaten more than a decade of progress. 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. The CDC and the HHS Assistant Secretary for Preparedness and Response (ASPR) work to ensure that public health and health systems can respond adequately and effectively when disaster strikes. CDC’s Division of Global Health Protection contributes to global health security by building public health capacity to detect and respond to outbreaks.
- 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 15 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. The grants fund nearly 4,000 state and local public health preparedness staff positions, 75 percent of state and local electronic disease surveillance systems, and 81 percent of state and local emergency management capability. TFAH recommends $705 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 nearly 500 healthcare coalitions with 28,000 participating facilities from across the health system, an increase of 63 percent in membership since 2012. 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 $300 million for HPP in FY 2018, as FY 2017 marks the beginning of the new project period, which will shift the focus of the program from supporting establishment of healthcare coalitions to ensuring they are ready to respond to emergencies.
- The CDC’s Division of Global Health Protection (DGHP) protects Americans and people around the world from the leading public health threats. The Division builds the capacities of local, national and regional public health to detect emerging threats, prevent disease and prepare for and respond to public health emergencies. The centerpiece of the division is the Global Disease Detection (GDD) program, which supports GDD Centers in 10 countries (Bangladesh, China, Egypt, Georgia and the South Caucasus, Guatemala and Central America, India, Kazakhstan and Central Asia, Kenya, South Africa and Thailand) and has extended a regional reach and support to 50 countries. The GDD Centers work with local ministries of health to develop core capacities such as emerging infectious disease detection and response, field epidemiology and laboratory training, pandemic flu preparedness and response, zoonotic disease detection and control, health communication and information technology, and laboratory systems and biosafety, as well as cooperative agreements with academic partners and ministries of health. TFAH recommends $264.2 million for the Division of Global Health Protection.
- The Antibiotic Resistance Initiative (ARSI) represents a multi-pronged approached to reducing inappropriate prescribing, improving detection of resistant bacteria, investing in new and evidence-based interventions, and supporting global partnerships. The CDC estimates that each year in the United States, inappropriate antibiotic use leads to more than two million people sickened with antibiotic resistant infections, with at least 23,000 dying as a result. On top of those numbers, the enormous problem of c. difficile continues to grow, with nearly half a million infections and contributing to 15,000-29,000 deaths per year. TFAH recommends $200 for the Antibiotic Resistance Initiative to continue the progress made in year one and expand prevention and response capacity to remaining states.
Addressing the Prescription Drug Abuse Epidemic
Prescription drug abuse is a public health epidemic. Approximately 6.1 million Americans abuse or misuse prescription drugs, and more than 90 Americans die every day from opioid overdoses. Overdose deaths involving prescription painkillers have quadrupled since 1999 and now outnumber deaths from all illicit drugs, including heroin and cocaine, combined. This epidemic is also contributing to an increase in heroin overdose deaths. Addressing the misuse and abuse of prescription and illicit opioids requires investments both in prevention and in treatment of those already suffering from substance misuse.
- TFAH recommends $98 million for the CDC’s Injury Center for the Prescription Overdose Prevention Program 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 nearly all states with funding to improve prescription drug monitoring programs (PDMPs), expand insurer mechanisms to address PDO, and improve clinical practice. As the opioid overdose epidemic evolves, specifically with a recent surge in heroin overdose deaths, CDC continues to provide scientific expertise, enhance surveillance activities, and tailor resources to address states’ growing and changing needs.