Issue Category: Infectious Disease

TFAH Applauds the Introduction of The Improving Social Determinants of Health Act of 2020 by Representative Nanette Diaz Barragán (CA-44)

(Washington, DC – April 21) – Trust for America’s Health (TFAH), a non-partisan, independent public health policy, research and advocacy organization, applauds the introduction of the Improving Social Determinants of Health Act of 2020  for the critical ways it would address the social, economic and environmental conditions that affect health and wellbeing and drive improved health for millions of Americans.

If enacted, the bill would create a Social Determinants of Health (SDOH) Program at the   Centers for Disease Control and Prevention (CDC). Through grants, this program would improve the capacity of public health departments and community organizations to address social determinants of health and reduce health care costs by building multi-sector collaborations and addressing policies that currently inhibit good health. Grants would also be issued to nonprofit organizations and institutions of higher education to conduct research on SDOH best practices, provide technical, training and evaluation assistance and/or disseminate those best practices. Lastly, the program would coordinate, support and align SDOH activities at CDC.

The President and CEO of Trust for America’s Health, John Auerbach, congratulates Rep. Barragán on the introduction of the bill:

“Now more than ever it is important to address the social and economic conditions, including housing, employment, food security, and education, that contribute significantly to an individual’s health outcomes over their lifetime.

The COVID-19 pandemic has highlighted how a community’s resources directly impact the health of its residents. People at a disproportionate risk for serious health impacts from the novel coronavirus are also more likely to suffer secondary consequences, such as loss of income or health care, as a result of the pandemic.

TFAH believes this legislation is an important step to addressing the non-medical social needs of communities and urges Congressional support. The legislation would empower public health departments and community organizations to act as chief health strategists in their communities and lead efforts to convene partners across sectors to build integrated systems and programs that improve health and health equity.

The Improving Social Determinants of Health Act of 2020 is an important next step in improving health outcomes, would reduce overall healthcare spending and help address health inequities; TFAH is proud to support this bill.”

In addition to TFAH, original endorsing national organizations include:

1,000 Days, The AIDS Institute, Aligning for Health, American Association of Birth Centers, American Association on Health and Disability, American Cancer Society Cancer Action Network, American College of Preventive Medicine, American Federation of Teachers, American Heart Association, American Kidney Fund, American Medical Student Association, American Public Health Association, Asian & Pacific Islander American Health Forum, Association of Maternal & Child Health Programs, Association of Minority Health Professions Schools, Association of Schools and Programs of Public Health, Association of State and Territorial Health Officials, Autistic Self Advocacy Network, ChangeLab Solutions, Coalition for Disability Health Equity, Common Threads, Community Catalyst, Community Cup Classic Foundation, Congregation of Our Lady of the Good Shepherd, U.S. Provinces, Disability Rights Education and Defense Fund (DREDF), Disabled Sports USA, Epilepsy Alliance America, Families USA, Health Leadership Legacy Project, Health Resources in Action, Healthy Kinder International, Hispanic Federation, Japanese American Citizens League, Lakeshore Foundation, Lutheran Services in America, March of Dimes, NAACP, NASTAD, National Advocacy Center of the Sisters of the Good Shepherd, National Association of Certified Professional Midwives, National Association of Counties, National Association of County and City Health Officials, National Association of School Nurses, National Association of Social Workers, National Center for Transgender Equality, National Center for Transgender Equality, National Health Care for the Homeless Council, National Medical Association (NMA), National Network of Public Health Institutes, National Nurse-Led Care Consortium, National REACH Coalition, National WIC Association, National Working Positive Coalition, NERDS RULE INC, Network for Environmental & Economic Responsibility, NETWORK Lobby for Catholic Social Justice, Participatory Budgeting Project, PFLAG National, Population Health Alliance, Praxis Project, Prevention Institute, Public Health Foundation, RESULTS, Society for Public Health Education, Southeast Asia Resource Action Center (SEARAC), Treatment Action Group, WE in the World, Well Being Trust, and Wholesome Wave.

TFAH’s summary of the bill can be found here.   For more information on The Improving Social Determinants of Health Act of 2020, please contact Daphne Delgado at [email protected].

 

 

Nuevo informe muestra que la respuesta de COVID-19 fue años de fabricación

El financiamiento para los programas de preparación y respuesta de salud pública perdió terreno en el año fiscal 2020 y durante la última década

(Washington, DC – 16 de abril de 2020) – La falta de fondos crónica de los sistemas de preparación para emergencias y salud pública del país ha hecho que el país sea vulnerable a los riesgos de seguridad de la salud, incluida la nueva pandemia de coronavirus, según un nuevo informe publicado hoy por Trust for America’s Health.

El informe, El impacto de la falta de fondos crónica en el sistema de salud pública de Estados Unidos: Tendencias, riesgos y recomendaciones, 2020, examina las tendencias federales, estatales y locales de financiamiento de salud pública y recomienda inversiones y acciones políticas para construir un sistema más sólido, priorizar la prevención y efectivamente abordar los riesgos para la salud del siglo XXI.

“COVID-19 ha puesto de relieve la dura falta de preparación del país para hacer frente a las amenazas al bienestar de los estadounidenses”, dijo John Auerbach, presidente y CEO de Trust for America’s Health. “Años de recortar fondos para programas de salud pública y preparación para emergencias han dejado a la nación con una fuerza laboral de salud pública más pequeña de lo necesario, capacidad de prueba limitada, una reserva nacional insuficiente y sistemas de seguimiento de enfermedades arcaicas – en resumen, herramientas del siglo XX para lidiando con los desafíos del siglo XXI “.

Imagen mixta para la financiación de los CDC para el año fiscal 2020

Los Centros para el Control y la Prevención de Enfermedades (CDC) de los Estados Unidos. Son la agencia de salud pública líder del país. El presupuesto general de los CDC para el año fiscal 2020 es de $ 7.92 mil millones: un aumento de $ 645 millones, 9 por ciento sobre el financiamiento de los CDC para el año fiscal 2019, 7 por ciento en dólares ajustados por inflación. El mayor aumento del año fiscal 2020 fue una inversión única en edificios e instalaciones (+ $ 225 millones). Otros aumentos incluyeron fondos para la iniciativa Ending HIV (+ $ 140 millones) y pequeños aumentos para programas de prevención de suicidio y enfermedades crónicas.

Financiamiento de preparación para emergencias este año y por más de una década

Los fondos para los programas de preparación y respuesta de salud pública de los CDC disminuyeron entre los presupuestos del año fiscal 2019 y el año fiscal 2020, de $ 858 millones en el año fiscal 2019 a $ 850 millones en el año fiscal 2020. Los fondos del programa de los CDC para la preparación para emergencias en el año fiscal 2020 ($ 7.92 mil millones) son menores que fue en el año fiscal 2011 ($ 7.99 mil millones en dólares del año fiscal 2020), después de ajustar por inflación.

Los fondos para los programas de preparación y respuesta ante emergencias de salud pública estatales y locales también se han reducido, en aproximadamente un tercio desde 2003. Y, de gran preocupación ahora, los fondos para el Programa de Preparación Hospitalaria, la única fuente federal de fondos para ayudar a la prestación de atención médica. El sistema de preparación y respuesta ante emergencias se ha reducido a la mitad desde 2003.

La acción federal para promulgar tres paquetes de fondos suplementarios para apoyar la respuesta a la pandemia COVID-19 fue crítica. Pero son ajustes a corto plazo que no fortalecen la capacidad central a largo plazo del sistema de salud pública, según los autores del informe. Se necesitan incrementos sostenidos de fondos anuales para garantizar que nuestros sistemas de seguridad de salud e infraestructura de salud pública estén a la altura de la tarea de proteger a todas las comunidades.

El descuido habitual de la salud pública en la nación, excepto durante emergencias, es un problema de larga data. “Las emergencias que amenazan la salud y el bienestar de los estadounidenses son cada vez más frecuentes y más graves. Estos incluyen incendios forestales e inundaciones, la crisis de opioides, el aumento de la obesidad y las enfermedades crónicas, y este año un brote de sarampión, lesiones pulmonares graves debido al vapeo y la peor pandemia en un siglo. Debemos comenzar a hacer inversiones año tras año en salud pública”, dijo Auerbach.

Además de apoyar las actividades federales, los fondos federales también son la fuente principal de financiamiento para la mayoría de los programas de salud pública locales y estatales. Durante el año fiscal 2018, el 55 por ciento de los gastos de salud pública de los estados, en promedio, fueron financiados por fuentes federales. Por lo tanto, los recortes en el gasto federal tienen un grave efecto de goteo en los programas estatales y locales. Entre el año fiscal 2016 y el año fiscal 2018, los gastos estatales de dinero federal para actividades de salud pública disminuyeron de $ 16.3 mil millones a $ 12.8 mil millones. Además de los recortes federales, algunos estados también han reducido los fondos de salud pública. Más del 20 por ciento de los estados (once) recortaron sus fondos de salud pública entre 2018 y 2019.

Estos recortes de fondos han llevado a reducciones significativas de la fuerza laboral en los departamentos de salud pública estatales y locales. En el 2017, el 51 por ciento de los grandes departamentos locales de salud pública informaron pérdidas de empleos. Algunas de las posiciones pérdidas fueron en el personal de salud pública de primera línea que habría sido movilizado para combatir la pandemia de COVID-19.

El informe incluye 28 recomendaciones de políticas para mejorar la preparación para emergencias del país en cuatro áreas prioritarias:

  • mayor financiamiento para fortalecer la infraestructura de salud pública y la fuerza laboral, incluida la modernización de los sistemas de datos y las capacidades de vigilancia.
  • mejorar la preparación para emergencias, incluida la preparación para eventos relacionados con el clima y brotes de enfermedades infecciosas.
  • salvaguardar y mejorar la salud de los estadounidenses invirtiendo en la prevención de enfermedades crónicas y la prevención del abuso de sustancias y el suicidio.
  • abordar los determinantes sociales de la salud y avanzar en la equidad en salud.

El informe también respalda el llamado de más de 100 organizaciones de salud pública para que el Congreso aumente el presupuesto de los CDC en un 22 por ciento para el año fiscal 2022.

 

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Trust for America’s Health es una organización sin fines de lucro y no partidista que promueve la salud óptima para cada persona y comunidad y hace de la prevención de enfermedades y lesiones una prioridad nacional. Twitter: @healthyamerica1

New Report Shows Hamstrung COVID-19 Response was Years in the Making

Funding for public health preparedness and response programs lost ground in FY 2020 and over the past decade.

(Washington, DC – April 16, 2020) – Chronic underfunding of the nation’s public health and emergency preparedness systems has made the nation vulnerable to health security risks, including the novel coronavirus pandemic, according to a new report released today by Trust for America’s Health.

The report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2020, examines federal, state, and local public health funding trends and recommends investments and policy actions to build a stronger system, prioritize prevention, and effectively address twenty-first-century health risks.

“COVID-19 has shined a harsh spotlight on the country’s lack of preparedness for dealing with threats to Americans’ well-being,” said John Auerbach, President and CEO of Trust for America’s Health. “Years of cutting funding for public health and emergency preparedness programs has left the nation with a smaller-than-necessary public health workforce, limited testing capacity, an insufficient national stockpile, and archaic disease tracking systems – in summary, twentieth-century tools for dealing with twenty-first-century challenges.”

Mixed Picture for CDC FY 2020 Funding

The U.S. Centers for Disease Control and Prevention (CDC) is the nation’s leading public health agency. The CDC’s overall budget for FY 2020 is $7.92 billion – a $645 million increase, 9 percent over FY 2019 CDC funding, 7 percent in inflation-adjusted dollars. The largest FY 2020 increase was a onetime investment in buildings and facilities (+$225 million). Other increases included funding for the Ending HIV initiative (+$140 million) and small increases for suicide and chronic disease prevention programs.

Emergency Preparedness Funding Down This Year and For Over a Decade

Funding for CDC’s public health preparedness and response programs decreased between the FY 2019 and FY 2020 budgets – down from $858 million in FY 2019 to $850 million in FY 2020.  CDC’s program funding for emergency preparedness in FY 2020 ($7.92 billion) is less than it was in FY 2011 ($7.99 billion in FY 2020 dollars), after adjusting for inflation.

Funding for state and local public health emergency preparedness and response programs has also been reduced, by approximately one-third since 2003. And, of critical concern now, funding for the Hospital Preparedness Program, the only federal source of funding to help the healthcare delivery system prepare for and respond to emergencies, has been cut by half since 2003.

Federal action to enact three supplemental funding packages to support the COVID-19 pandemic response was critical. But they are short-term adjustments that do not strengthen the core, long-term capacity of the public health system, according to the report’s authors.  Sustained annual funding increases are needed to ensure that our health security systems and public health infrastructure are up to the task of protecting all communities.

The nation’s habitual neglect of public health, except during emergencies, is a longstanding problem. “Emergencies that threaten Americans’ health and well-being are becoming more frequent and more severe. These include wildfires and flooding, the opioid crisis, the increase in obesity and chronic illness, and this year a measles outbreak, serious lung injuries due to vaping, and the worst pandemic in a century. We must begin making year-in and year-out investments in public health,” Auerbach said.

In addition to supporting federal activities, federal monies are also the primary source of funding for most state and local public health programs. During FY 2018, 55 percent of states’ public health expenditures, on average, were funded from federal sources. Therefore, federal spending cuts have a serious trickle-down effect on state and local programs. Between FY 2016 and FY 2018, state expenditures of federal monies for public health activities decreased from $16.3 billion to $12.8 billion.   On top of federal cuts, some states have also reduced public health funding.  More than 20 percent of states (eleven) cut their public health funding between 2018 and 2019.

These funding cuts have led to significant workforce reductions in state and local public health departments. In 2017, 51 percent of large local public health departments reported job losses.  Some of the positions lost were frontline public health staff who would have been mobilized to combat the COVID-19 pandemic.

The report includes 28 policy recommendations to improve the country’s emergency preparedness in four priority areas:

  • increased funding to strengthen the public health infrastructure and workforce, including modernizing data systems and surveillance capacities.
  • improving emergency preparedness, including preparation for weather-related events and infectious disease outbreaks.
  • safeguarding and improving Americans’ health by investing in chronic disease prevention and the prevention of substance misuse and suicide.
  • addressing the social determinants of health and advancing health equity.

The report also endorses the call by more than 100 public health organizations for Congress to increase CDC’s budget by 22 percent by FY 2022.

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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. Twitter: @healthyamerica1

Protecting Older Adults from the Harms of Social Isolation and Providing a Continuum of Care During COVID19

The ongoing COVID-19 crisis presents unique challenges for the public health and aging sectors. While social distancing protects older adults who are at higher risk for complications from the virus, the practice can exacerbate social isolation, a longstanding issue for this population. The needs of older adults must be considered across a continuum of care from primary prevention to post-acute care in the coming months.

Trust For America’s Health Policy Development Manager, Megan Wolfe  for a Web Forum to discuss how to address the unique challenges that older adults face while adhering to public health advice to minimize risk of infection. Attendees will learn about the consequences of social isolation, how the aging services sector has adapted its delivery models, and hear about promising practices from the field and the importance of working with public health partners to address the needs of older adults.

Combating COVID-19: Why Paid Sick Leave Matters to Controlling its Spread

This webinar highlights recommendations made in TFAH’s Ready or Not and Promoting Health and Cost Control in States (PHACCS) reports on the important role of paid sick leave in combating infectious diseases, as well as other complementary evidence-based policies that can be adopted by federal, state and local governments and by employers.

Presenters focused on pending federal legislation, states that have adopted laws regarding paid leave, and businesses that are expanding these benefits. In addition, they discussed the potential short-term uses of the recently approved supplemental budget to assist individuals without paid leave when confined to their homes.

Recommended for anyone working in public health, advocacy, school health, community-based organizations, businesses, labor unions, hospitals, health systems, insurers, policy staff, and local and state health officials.

Trust for America’s Health Statement in Response to Congressional Passage of the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”)

March 27, 2020

“Congress took an important step today to begin giving public health the resources it needs now to respond to the COVID-19 pandemic. We are seeing in real-time the impact of the chipping away at public health budgets over the past 15 years. Health departments are facing unprecedented crises, and in many cases are doing so with a reduced workforce and 20th-century technologies.

The bill invests $4.3 billion in CDC, state and local public health to carry out critical response activities. It includes funding for state, local, tribal and territorial public health departments, global health security, and modernizing public health’s outdated data systems. We applaud Congress for allowing these funds to be spent over five years due to the increasing number and complexity of the nation’s public health challenges. The legislation includes funding for the Hospital Preparedness Program, a program that has seen its funding cut in half since 2003. It funds the development and purchase of vaccines and other critical needs.

Supplemental funding is critical during an emergency but cannot make up for long-standing, chronic underfunding of the public health system. We urgently need to rebuild and modernize the nation’s public health infrastructure and workforce. A significant, long-term commitment to public health infrastructure and programs is needed to prepare for the next pandemic and build a healthier, more resilient population. We need to strengthen the vaccine infrastructure, which will need to successfully and quickly distribute an eventual vaccine. We need to prevent and treat mental health issues and substance misuse, resolve health inequities and address the social determinants of health. The battle has begun.”

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

10th Anniversary of the ACA: A Time to Reflect on its Impact and Refocus Efforts on the Act’s Purpose and Goals

COVID-19 has shown how important it is to fully fund the ACA created Prevention and Public Health Fund

March 23, 2020

This tenth anniversary of the enactment of the Affordable Care Act (ACA) is an appropriate time to measure its impact and recommit to its purpose.  Prior to the ACA, more than 44 million non-elderly adults were uninsured. By 2016, that rate of uninsured people reached a historic low as approximately 20 million Americans gained access to health insurance coverage under the ACA including 12 million adults who gained coverage due to Medicaid expansion.[1]

The ACA was transformative legislation in at least three ways. It offered Americans access to medical care when they were acutely ill and when they needed ongoing treatment for a chronic condition (78 percent of U.S. adults 55 and older have at least one chronic condition[2]). In addition, millions of Americans gained access to preventive care such as vaccinations and health screenings.   Thirdly, it helped advance health equity by narrowing – although not eliminating – the gaps in access to high-quality care experienced by people of color due to economic disadvantage and systemic discrimination.

Prior to the ACA, Black Americans were 70 percent more likely to be uninsured than Whites and the uninsured rate for Latinos was nearly three times the uninsured rate for Whites[3]. After the ACA became law, Latinos had the largest decrease in uninsurance rates, falling from 32.6 percent to 19.1 percent between 2010 and 2016. Uninsurance rates also fell by 8 percent for Asian Americans and Black Americans during the same period.[4]

Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates among low-income individuals and within specific vulnerable populations.[5] A study by the National Bureau of Economic Research found that Medicaid expansion is associated with reduced mortality.[6]  According to the study, states that expanded Medicaid had an estimated 19,200 fewer adult deaths (ages 55 to 64) between 2014 and 2017 than did states that did not expand Medicaid.[7]

Furthermore, the ACA created the Prevention and Public Health Fund (PPHF) and allocated $2 billion annually as an “expanded and sustained national investment in prevention and public health programs”. Unfortunately, much of the PPHF funding has been reallocated to other programs outside prevention and public health. On this 10th anniversary of the passage of the ACA, Congress should redouble its efforts to ensure the Prevention Fund is fully funded and that those funds are directed as intended, to prevention and public health programs.

As the COVID-19 pandemic has put in the spotlight, individual health is often linked to community health. The Prevention and Public Health Fund’s intended purpose and emphasis: sustained investment in the nation’s public health infrastructure would, if fully realized, strengthen our national readiness for health emergencies. A level of readiness that the COVID-19 pandemic has shown to be seriously inadequate.

While this 10th anniversary of the Affordable Care Act is a time to recognize and applaud its significant impact, it is also a time to shine a spotlight on the fact that over 27 million Americans remain without access to healthcare due to being uninsured.  Ensuring that all Americans have access to healthcare is a priority of Trust for America’s Health and must be a national priority.

 

[1] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/ Google Scholar

[2] CDC, National Center for Health Statistics. Percentage of U.S. Adults over 55 with Chronic Conditions. https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm

[3] Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106(8):1416–21

[4] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/

[5] Madeline Guth, et al. The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review. March 17, 2020.

[6] Sarah Miller et al., “Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data,” National Bureau of Economic Research working paper, August 2019, https://www.nber.org/papers/w26081.

[7] Ibid