States Can Improve Residents’ Health and Reduce Healthcare Spending by Adopting Policies Outside of the Healthcare Sector, New Report Shows

February 21, 2019

Policies that can improve health and save money include: Pre-K and school nutrition programs, syringe access, tobacco and alcohol taxes, paid family leave, the Earned Income Tax Credit and rapid rehousing.

(Washington, DC) — States can improve their residents’ health and well-being, and lower healthcare costs, by implementing a range of policies in sectors beyond healthcare, according to a new report, Promoting Health and Cost Control: How States Can Improve Community Health and Well-being through Policy Change, released today by Trust for America’s Health (TFAH).

The new report analyzes state action on 13 policies outside the healthcare sector that have a long-term impact on health and an evidence base showing their effectiveness. They include: tobacco and alcohol taxes, syringe access programs, universal pre-K and rapid rehousing laws, among others. The wide policy lens of the report, which covers numerous sectors, including taxation, employment, education, housing and transportation, underscores the many economic and social factors beyond medical care that influence health.

In the context of the longest decline in life expectancy since World War I, and, insufficient resources dedicated to preventing health problems before they arise, this new report serves as an urgent call to state policymakers to take concrete steps to improve residents’ health. The report was made possible by financial support from the Robert Wood Johnson Foundation and Kaiser Permanente.

“In the current environment, states have an even more vital role to play in promoting the health and well-being of their residents,” said John Auerbach, President and CEO of Trust for America’s Health. “Our goal in creating this report is to provide state public health officials and policymakers the evidence and business case for the adoption of policies that have been shown to improve community health.”

Policies Analyzed in the Report Number of States with the Policy
Universal Pre-K program* 10 (incl. DC)
School breakfast program 31 (incl. DC)
School lunch program 20
School competitive foods (snacks and drinks) 28 (incl. DC)
Syringe access programs 27 (incl. DC)
Smoke-free laws** 29 (incl. DC)
Tobacco taxes*** 51 (incl. DC)
Alcohol taxes*** 51 (incl. DC)
Complete streets 30 (incl. DC)
Housing rehabilitation loan and grant programs**** 40 (incl. DC)
Rapid re-housing laws 9 (incl. DC)
Earned income tax credit 30 (incl. DC)
Paid sick leave 12 (incl. DC)
Paid family leave 7 (incl. DC)
Fair hiring protections (ban the box) 34 (incl. DC)

The economic benefits of these policies can be substantial. For example:

  • Pre-K education programs can generate $4.63 in benefits to participants, taxpayers, and others in society for every $1 spent on such programs.
  • Expanding syringe exchange programs could return $7.58 for every $1 invested in the long run, by lowering HIV rates and reducing treatment costs. There is no evidence such programs lead to higher drug use.
  • Rapid re-housing programs, which focus on getting homeless individuals into stable housing before addressing other challenges, can reduce hospital admissions and jail bookings. One pilot study found that such an approach saved more than $36,000 in treatment costs per person over the course of a year, nearly twice what the program cost.

“While the healthcare sector plays an important role in providing health services when someone gets sick, many of the factors that keep people healthy are outside the healthcare system and involve where people live, work, play and learn,” said Adam Lustig, Manager of the Promoting Health and Cost Control in States initiative and one of the report authors.  “This report gives state policymakers a menu of evidence-based policies that have been shown to improve individual and community health.”

“I encourage all state policymakers to read this important report.  Doing so will give them access to proven solutions to the challenge of run-away healthcare spending yet so little improvement in health outcomes. To improve Americans’ health, we have to think beyond the healthcare sector and about the many factors that impact health,” said Anand Parekh, MD, MPH, Chief Medical Advisor, Bipartisan Policy Center and a member of the Promoting Health and Cost Control in States Advisory Board.

To create the report, TFAH reviewed approximately 1,500 evidence-based programs and strategies.  The 13 policies ultimately included in the report all:

  • Have a strong health impact and economic evidence of that impact, such as cost avoidance or reduction.
  • Focus on prevention at the population health level, i.e., are designed to prevent illness or injury at the community level rather than the individual level.
  • Focus on primary prevention, preventing an injury or illness rather than treating it.
  • Can be implemented by state legislative action.

The findings show dramatic variability in how states approach these health-promoting policies. For instance, all 50 states plus DC institute tobacco and alcohol taxes. But only nine states and DC have laws in place to encourage universal pre-K programs, which have been shown to set children up for better health later in life. Universal pre-K programs are state funded programs that support pre-K for nearly 50 percent or more of the state’s 4-year-olds. Only six states and DC support paid family leave, even though data show such policies support maternal and child health, and, can save employers money in the long run.

“Action is imperative,” said Auerbach.  “As a nation, we spend trillions of dollars a year on healthcare and yet Americans are getting less healthy.  The solution is two-fold: direct more spending to prevention efforts and address the social determinants of health instead of their impact after someone is sick.”

Notes:
*states that support state-funded pre-K to nearly 50% or more of the state’s 4-year-olds.
**comprehensive smoke-free as per the American Lung Association
*** rates vary, and higher taxes are generally more effective
**** many states fund such programs in the absence of statewide legislation

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

National Association of County and City Health Officials’ (NACCHO) Podcast from Washington features talk with TFAH CEO John Auerbach on the Social Determinates of Health

February 19, 2019

Public health officials need to understand the leading causes of disease in their communities, and they must partner with multiple sectors to address the social determinants of health.

Last week on Podcast from Washington, TFAH CEO John Auerbach and de Beaumont Foundation CEO Brian Castrucci sat down with Ian Goldstein from NACCHO to discuss their Health Affairs blog: Meeting Individual Social Needs Falls Short Of Addressing Social Determinants Of Health. In this podcast, the two CEOs also share evidence-based policy solutions to tackle social inequities in communities and improve population health.

New Report Finds Nation’s Public Health Emergencies Are Increasing While State Emergency Preparedness Levels Are Mixed

17 States Score in Top Readiness Tier, 20 States and DC in Middle Tier, 13 States in Lower Tier

Report provides action steps for states to improve emergency preparedness; progress will require action by public health agencies, elected officials and state residents

(Washington, DC – February 12, 2019) – Seventeen states place in the top tier of a three-tiered measure of performance on 10 indicators of public health and emergency readiness, according to a new report Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, released today by the Trust for America’s Health (TFAH). Twenty states and the District of Columbia score in the middle tier and 13 states score in the lower tier.

State public health preparedness, by scoring tier:

 Performance Tier States Number of States
Top Tier AL, CO, CT, FL, ID, KS, MA, MD, MO, MS, NC, NE, NJ, RI, VA, WA, WI 17 states
Middle Tier CA, DC, GA, HI, IA, IL, LA, ME, MI, MN, MT, ND, NH, NM, NV, OK, OR, SC, TX, VT, WV 20 states and DC
Lower Tier AK, AR, AZ, DE, IN, KY, NY, OH, PA, SD, TN, UT, WY 13 states

The report takes an annual snapshot of states’ public health and emergency readiness.  Authored by TFAH since 2003, it documents that all states have made progress in preparedness since 9/11, but, also highlights pressing needs for additional action particularly as weather-related and other public health emergencies become more frequent.

The report, although not a comprehensive evaluation of any state’s overall emergency readiness or response, focuses on key indicators of states’ level of emergency preparedness. It identifies specific action-steps that if taken would improve the jurisdiction’s overall level of emergency preparedness, including dedicated funding for health security initiatives, modernizing and supporting technologies and innovations within public health programs, and building multisectoral collaboration and leadership.

The report’s 10 key indicators of state public health preparedness are:

Indicators
1 Incident Management: Adoption of the Nurse Licensure Compact.

 

6 Water Security: Percentage of the population who used a community water system that failed to meet all applicable health-based standards.
2 Cross-Sector Community Collaboration: Percentage of hospitals participating in healthcare coalitions. 7 Workforce Resiliency and Infection Control: Percentage of employed population with paid time off.
3 Institutional Quality: Accreditation by the Public Health Accreditation Board. 8 Countermeasure Utilization: Percentage of people ages 6 months or older who received a seasonal flu vaccination.
4 Institutional Quality: Accreditation by the Emergency Management Accreditation Program. 9 Patient Safety: Percentage of hospitals with a top-quality ranking (Grade A) on the Leapfrog Hospital Safety Grade.
5 Institutional Quality: Size of the state public health budget, compared with the past year. 10 Health Security Surveillance: The public health laboratory has a plan for a six- to eight-week surge in testing capacity.

Key report findings include:

  • A majority of states (31) have made preparations to expand public health and healthcare capabilities in an emergency, often through inter-state collaboration and compacts.
  • A strong majority of Americans (96%) who access water from a community water system, have access to water that meets all applicable health-based standards. Ninety percent of all Americans get their water from a community water system.
  • Most states are accredited in the areas of public health and emergency management, many in both. These accreditations are one measure of a state’s capacity to effectively respond to health threats.

However, areas of concern include:

  • Seasonal flu vaccination rates, already below 50 percent, fell last year. The flu vaccination rate for Americans ages 6 months and older dropped from 47 percent in the 2016 – 2017 season to 42 percent during the 2017- 2018 season.
  • In 2018, 45 percent of employed state residents did not have access to paid time-off, meaning they were more likely to go to work if ill, increasing the potential for infections to spread.
  • Only 28 percent of U.S. hospitals, on average, earned top-quality patient safety grades. Hospital safety scores measure performance on such issues as infection control, intensive-care capacity, nursing staff volume and an overall culture of error prevention.

“Preparedness is key to preventing harm when public health emergencies and natural disasters occur, but, being prepared requires dedicated funding and multi-sector planning and collaboration,” said John Auerbach, President and CEO of the Trust for America’s Health.   “The risks to America’s health security are very real, and in the headlines – from wildfires to floods to food borne illnesses.  These events are wake-up calls.  To stay safe, we need to devote more time and money to emergency preparedness.”

TFAH’s report also includes a number of recommendations across 11 high priority areas.  Among the top priorities:

  • Congress should fund public health and health system preparedness and response as well as global health security.
  • Congress should pass the Pandemic and All-Hazards Preparedness and Advancing Innovation Act.
  • Investment in disease surveillance and data infrastructure needs to be significantly increased.
  • The “last mile” of medical countermeasure distribution, meaning ensuring that important medications or other needed supplies get to the right person at the right time, needs to be strengthen.

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

Government Shutdown Puts the Public’s Health at Risk; Potential for Harm Increases as Impasse Continues

11 health advocacy and civil rights organizations call for an immediate end to the shutdown

(Washington, DC, – January 10, 2019)

As the government shutdown reaches its 20th day, leaders across a spectrum of health, public health and civil rights organizations call on Congress and the President to immediately reopen the government.

The ongoing shutdown is having a negative impact on the public’s health, both directly and by impacting other factors that influence health such as nutrition support programs at the Department of Agriculture and rental assistance programs at the Department of Housing and Urban Development. That impact will only grow and become more detrimental if the shutdown continues.

Direct health impacts of the impasse include the virtual shutdown of the Indian Health Service and suspension of many food safety inspections by the Food and Drug Administration. An ongoing shutdown threatens nutrition assistance that millions of families depend on. Furthermore, the fact that hundreds of thousands of federal employees have gone without pay since December 22, while federal contractors will likely never receive back pay for lost work time, puts their families’ food, health and housing security in jeopardy.

John Auerbach, President and CEO, Trust for America’s Health

“Every day we learn more about the many negative health impact of an extended government shutdown. A continued shutdown will create an emergency for families who rely on government assistance to pay for rent, heat, food, and medical care. It will put the health and safety of all the nation’s residents at risk as such things as safety inspections are suspended. Americans should be able to rely on their government to provide these services without fail.”

Georges C. Benjamin, MD, Executive Director, American Public Health Association

“This shutdown impacts the things that influence our health both inside and outside the doctor’s office. Access to food assistance for the most vulnerable, food and product safety for us all and income security for those federal workers and contractors who depend on federal paychecks to cover utility costs for this cold weather, shelter and urgent health care costs. These are not discretionary expenses and neither is the work they do to keep us safe.”

Hilary O. Shelton, Director, NAACP Washington Bureau and the Association’s Senior Vice President for Policy and Advocacy

“The government shutdown is affecting all Americans, regardless of where they live, their age, race, ethnicity, gender, or station in life.  The longer the shutdown lasts, the more evident and serious these problems will become.  Unfortunately, it is the least prosperous among us who will suffer disproportionately.”

Rachel Davis, Executive Director, Prevention Institute

 “Government should be what we do together for the benefit of all. When the government shuts down, we all suffer and communities that are most vulnerable face the steepest consequences. Clean air and water, access to food and shelter, and jobs with paychecks are just a few of the conditions that support health, safety, and wellbeing that are currently without funding. We need a government that works for everyone.”

Mary A. Pittman, President and CEO, Public Health Institute

“Closures in any part of the system have cascading impacts on the public’s health: a missed paycheck may drive some people into debt or a medical emergency; expired housing contracts may force others out of their homes. Meanwhile, refugees are facing a humanitarian crisis at our southern border. We need political action that doesn’t compromise our values, or sacrifice people’s health and wellbeing.”

Stacy A. Bohlen, CEO, National Indian Heath Board

“Our ancestors signed treaties with the United States that ceded hundreds of millions of acres of land in exchange for certain benefits, such as the provision of healthcare.  Today, unrelated political battles, some in Washington are abrogating those agreements and causing our people to suffer and curtailing health care and programs.  When possible, Tribal governments are cutting other services and scraping together scarce dollars to keep health clinics operational, but this is not sustainable. The shutdown is destabilizing Native health delivery and health care provider access; as well as destabilizing Tribal Governments, families, children and individuals.   Services will be cut, and loss of life will be the result if this shutdown is not ended soon.

Janice L. Mathis, Executive Director, National Council of Negro Women

“The government shutdown only exacerbates growing wealth and income inequality, as middle-class families are further squeezed to provide the basic necessities of food, shelter and medical care.”

Kathy Ko Chin, President and CEO, Asian & Pacific Islander American Health Forum

“It is unconscionable that our government remains shutdown over a manufactured border crisis fueled by anti-immigrant sentiment. It is time we govern by values and restore the ability of our government to provide for the health, safety and welfare of the people and reopen the government.”

Authoring organizations:

Trust for America’s Health
American Public Health Association
Asian & Pacific Islander American Health Forum
NAACP
National Black Nurses Association
National Council of Negro Women
National Indian Health Board
National Medical Association
Public Health Institute
Prevention Institute
UnidosUS

Congress and the President Should Act to End the Government Shutdown and Restore Critical Health Services

(Washington, DC – January 4, 2019) – With the government shutdown nearing the two-week point, Trust for America’s Health (TFAH) calls on Congress and the President to act immediately to reopen the government and restore critical services that impact our nation’s health.

Protecting the public’s health is one of the most basic responsibilities of government. While most parts of the Department of Health & Human Services remain open, several of its critical agencies have been impacted, including the Indian Health Service (IHS) and the Food and Drug Administration (FDA). This shutdown is already having a serious detrimental impact on health around the country:

  • The FDA, which safeguards our food, medicine, medical devices and more, has furloughed as much as 40 percent of its staff. While “mission critical” activities, such as food safety inspections and surveillance, are continuing during the shutdown, new drug and device applications and other work has been suspended.
  • Many services provided to tribal nations have been impacted, like preventive health clinics, food pantries, and payments for employees who provide basic services. Patient health care could be significantly cut back if the shutdown continues.
  • The Agency for Toxic Substances and Disease Registry (ATSDR), which protects the public from hazardous substances and other environmental health threats, is continuing emergency services but will be unable to update health exposure assessments, provide technical assistance and support to state and local partners nor carry out professional training. ATSDR is located at the Centers for Disease Control and Prevention but funded through the Environmental Protection Agency.
  • While the Women, Infants and Children (WIC) nutrition program is still open for business, agencies will need to tap into reserves should the shutdown continue beyond January, threatening critical nutrition assistance which the nation’s most at-risk families depend on.
  • Nutrition programs such as School Lunch, School Breakfast, Child and Adult Care Feeding, Summer Food Service and Special Milk will also need to stop operations if the shutdown extends into February.
  • The Environmental Protection Agency’s capacity for ensuring safe drinking water and regulating dangerous pesticides will also be limited. According to the agency, more than 13,000 workers have been furloughed and an additional 700 employees are working without pay, including those who work on Superfund sites or other activities where the “threat to life or property is imminent.”

A prolonged shutdown will put the health and safety of all the nation’s residents at risk. Americans should be able to rely on their government to provide these services without fail. Trust for America’s Health calls on Congress and the President to reopen the government while working on a deal to complete work on FY 2019 spending bills.

TFAH Statement on Texas Court ACA Ruling

John Auerbach, President and CEO of Trust for America’s Health released the following statement in response to the Texas court ruling on the ACA.

 “Last Friday’s ruling by a Texas court that the Affordable Care Act (ACA) is unconstitutional due to the elimination of the individual mandate puts millions of Americans – particularly those with pre-existing conditions – at risk of losing health coverage. It would also eliminate the Prevention and Public Health Fund, coverage of preventive services, and many other health protections. The ACA remains the law of the land as this lawsuit moves through the appeals process, and TFAH calls on Congress to ensure the health care coverage, public health investments and other protections that Americans depend on remain available.”

 

 

 

Nearly 30 national organizations urge immediate federal action on all-hazards, pandemic reauthorization

December 6, 2018
By Kim Riley
Homeland Preparedness News

“A coalition of national organizations representing public health, healthcare providers, biotechnology companies, and researchers this week urged congressional leaders to swiftly approve the Pandemic and All-Hazards Preparedness and Advancing Innovation (PAHPAI) Act of 2018 before Congress adjourns for the year.”

View the full story here.

New Data Show Drug Overdose and Suicide Deaths Climbed at Alarming Rates in 2017

Washington, DC and Oakland, CA – Nationally, deaths due to drug overdose and suicide increased last year according to data released today by the National Centers for Health Statistics at the Centers for Disease Control and Prevention and analyzed by Trust for America’s Health (TFAH) and Well Being Trust (WBT).

In 2017, 70,237 Americans died from drug overdoses, a rate of 21.7 deaths per 100,000 people. In comparison, 63,600 Americans died of drug overdoses in 2016, a rate of 19.8 deaths per 100,000.  Nationally, the 2017 rate was 9.6 percent higher than the 2016 rate.

In 2017, 47,173 Americans died by suicide. Suicide accounted for 14.0 deaths per 100,000 in 2017, up from 13.5 deaths per 100,000 in 2016— a 3.7 percent increase.  Between 1999 and 2017, the age-adjusted suicide rate increased 33 percent from 10.5 per 100,000 deaths to 14.0 per 100,000.

According to TFAH’s and WBT’s analysis:

  • West Virginia continued to have the highest rate of drug overdose deaths (57.8 deaths per 100,000) in 2017. Ohio was second (46.3 per 100,000) and Pennsylvania was third (44.3 deaths per 100,000).
  • Drug overdose death rates were higher in 2017 compared to 2016 in 39 states and the District of Columbia. States with the largest change in drug overdose death rates between 2016 and 2017 were: New Jersey (29 percent increase), Nebraska (27 percent increase), Indiana (23 percent increase), and, North Carolina (22 percent increase).
  • Drug overdose death rates were lower in 8 states, most were less densely populated states: Wyoming (31 percent decrease), North Dakota (13 percent decrease), Oklahoma (7 percent decrease), New Hampshire (5 percent decrease), Idaho (5 percent decrease), Massachusetts (4 percent decrease), New Mexico (2 percent decrease) and Missouri (1 percent decrease).
  • The increase in opioid overdose rates was driven by a 45 percent increase in the death rate from synthetic opioids including fentanyl. Heroin, natural and semisynthetic opioids, and methadone overdose death rates were flat or declined nationally.

“Just one person dying from a preventable cause is one death too many,” said Benjamin F. Miller, Psy.D., Chief Strategy Officer, WBT. “Evidence provides clear ways to more proactively address issues of substance misuse and help build resiliency in our communities, but, our country has not yet prioritized investing in prevention and intervention. If we continue to fail to put dollars and common sense into a systematic approach to prevention and treatment, we’ll never ensure optimal health and well-being for our nation.”

In addition, the analysis found that, while the number of drug overdose deaths continue to be historically and tragically high nationwide, the epidemic continues to have a differential impact in some population groups, comparing 2016 to 2017:

  • Drug overdose rates for men: increased by 11.1 percent
  • Drug overdose rates for women: increased by 7.5 percent
  • Drug overdose rates for 15- to 24-year-olds increased by 1.6 percent
  • Drug overdose rates for 25- to 34-year-olds increased by 11.0 percent
  • Drug overdose rates for 35- to 44-year-olds increased by 11.4 percent
  • Drug overdose rates for 45- to 54-year-olds increased by 9.3 percent
  • Drug overdose rates for 55- to 64-year-olds increased by 9.4 percent

“Another year of increasing numbers of drug overdose deaths is a national emergency, that can’t be overstated,” said John Auerbach, President and Chief Executive Officer of the Trust for America’s Health.  “Government and the healthcare sector at all levels must adopt a comprehensive approach and strengthen efforts to prevent substance misuse and suicide attempts by addressing their underlying causes. We face a crisis that requires a multi-faceted response and the skills of the public health sector.”

Last year, TFAH and WBT released Pain in the Nation: The Drug, Alcohol and Suicides Epidemics and the Need for a National Resilience Strategy, which included recommendations for evidence-based policies and programs that federal, state, and local officials should put in place or extend to address drug misuse and save lives.  These recommendations include:

  • Identifying and addressing “upstream” risks such as trauma and extreme stress.
  • Building resiliency in children and adults with programs in schools, workplaces and community settings.
  • Promoting responsible opioid prescribing practices.
  • Patient education about the risks of addiction when taking opioids.
  • Improved non-drug pain management interventions.
  • Expanded availability and use of rescue drugs.
  • Enhancing and enforcing mental health parity laws.
  • Drug disposal programs.
  • Support for “whole person” healthcare including mental and behavioral health, substance misuse screening within primary care settings and ensuring availability of evidence-based substance abuse treatment programs.

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

 

Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community well-being. www.wellbeingtrust.org. Twitter: @WellBeingTrust

 

 

Health Equity Leaders, Dr. Gail Christopher and Heather McGhee, Co-Host Webinar on the Impact of Racism on Health Outcomes and the Importance of Individual and Organizational Leadership in Efforts to Overcome Racist Beliefs

 

Gail C. Christopher, D.N.     Heather C. McGhee, J.D.        

FOR IMMEDIATE RELEASE: November 14, 2018

Health Equity Leaders, Dr. Gail Christopher and Heather McGhee, Co-Host Webinar on the Impact of Racism on Health Outcomes and the Importance of Individual and Organizational Leadership in Efforts to Overcome Racist Beliefs

WASHINGTON, DC – Dr. Gail C. Christopher and daughter, Heather C. McGhee, two of the country’s most acclaimed social justice and health equity advocates, shared their insights on the impact of racism on health outcomes during a November 1 Trust for America’s Health (TFAH) webinar entitled: Creating Change Through Leadership: Two Extraordinary Leaders, a Mother and Daughter, Share their Experiences Promoting Racial Equity

“We have a moment in history where fear is driving levels of division and actual hatred that are unprecedented in my adult lifetime.  It makes us want to step away from this work.  But more than ever we have to step into this work.  We have to do it from a place not of animus and not of incivility but from a place of engagement, engagement for ourselves and for future generations.” – Dr. Gail Christopher

“I strongly believe that we do ourselves a disservice when we pretend that addressing racism is only or even primarily for the benefit of people of color.  The creation of this belief of racial hierarchy was something that fundamentally distorted not just the life experiences of people of color, but white people as well.” – Heather McGhee

Listen to the entire series here: Taking Action to Promote Health Equity – Using the Lessons from Cutting-Edge Practices to Improve Health and Well Being