Issue Category: Obesity/Chronic Disease

Newly Announced Order for Hospitals to Bypass CDC and Send Coronavirus Patient Information Directly to Washington Database Likely to Worsen Pandemic Response Rather than Improve It

(Washington, DC – July 15, 2020) — The U.S. Centers for Disease Control and Prevention (CDC), as the nation’s lead public health agency, is uniquely qualified to collect, analyze and disseminate information regarding infectious diseases. It has been serving in that role since its creation and, in close collaboration with U.S. healthcare facilities nationwide, has developed a health statistics infrastructure that is the gold standard worldwide.

The problems with regard to the COVID-19 data collection have largely been a result of the decentralized and fragmented nature of both healthcare and public health in the United States. Furthermore, hospital data is only one aspect of what we need to know to fight the pandemic. A key role of health departments at all levels of government is to aggregate data to produce a detailed picture of a health problem at the national, state and local levels. Inadequate funding for data infrastructure, at CDC and at the local, state, tribal and territorial levels, is also a contributing factor.  That underfunding should be corrected rather than bypassed.

In the midst of the worst public health crisis in a century, it is counter-productive to create a new mechanism which will be extremely complicated to build and implement.  Another area of concern is that the planning for this new approach did not substantively involve officials at the local, state, tribal and/or territorial levels.  This is a time to support the public health system not take actions which may undermine its authority and critical role.

Americans must have confidence in the integrity of health data and its insulation from even the suggestion of political interference.  Sending these sensitive data to a newly created entity overseen directly by the White House will not eliminate such concerns, it will increase them.

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

Dr. Tom Frieden, President and CEO, Resolve to Save Lives

Lori T. Freeman, Chief Executive Officer, National Association of County and City Health Officials

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

Thomas M. File, Jr., M.D., MSc, FIDSA; President, Infectious Disease Society of America

Chrissie Juliano, MPP, Executive Director, Big Cities Health Coalition

William H. Dietz, MD, PhD, Chair, Redstone Center for Prevention and Wellness, George Washington University

Nearly 350 Public Health Organizations Implore HHS Secretary Azar to Support CDC’s Critical Role in the COVID-19 Pandemic Response

Letter calls on Secretary Azar to “speak up” and be an advocate for CDC and public health

(Washington, DC – July 7, 2020) – The expertise of the U.S. Centers for Disease Control and Prevention (CDC) and all public health agencies is critical to protecting Americans’ health during the COVID-19 crisis, said a letter to Health and Human Services Secretary Alex Azar from 347 health and public health organizations released today.

The authoring organizations, including the American Public Health Association, Association of State and Territorial Health Officials, Big Cities Health Coalition, National Association of County and City Health Officials and Trust for America’s Health,  expressed “deep concern” about increasing reports of resistance to evidence-based public health messages and threats to public health leaders and agencies, and called on the Secretary to be an advocate for public health.

At this sentinel moment, during the worst public health emergency in over a century, all of the nation’s leaders must resist any efforts that would undermine the critical role of the CDC to respond to the pandemic and must be an advocate for increased investment in public health, said the letter signatories.

“Secretary Azar, we urge you to speak up and amplify the critical role of CDC and that of all public health agencies during this monumental crisis,” the letter said.

The public health community’s work to respond to the pandemic, via the federal government, including within the CDC, and at the state, local, territorial and tribal levels, has been tireless but has been hamstrung by shrunken programs and inadequate technology; the result of decades of underfunding.

Public health leaders are calling attention to the need for CDC to play a central role as the nation’s navigates the COVID-19 pandemic, including:

“CDC is the world’s premier public health institution and should be treated as such during this pandemic. It must be appropriately funded and allowed to speak based on the best available science and with an unfettered voice,” said John Auerbach, President and CEO of Trust for America’s Health.

“When you look at the global response to the COVID-19 pandemic, countries that listen to and prioritize public health fare best,” said Dr. Tom Frieden, former director of the CDC, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies. “Trying to fight this pandemic without daily, public guidance from the CDC is like fighting with one hand tied behind your back.”

“There’s no federal agency better suited to lead the response to this unprecedented pandemic. CDC has experts who have studied and helped control coronaviruses and other viral threats for decades, and can help our country emerge from this crisis,” said Dr. Julie Gerberding, former director of the CDC, Co-Chair CSIS Commission on Strengthening America’s Health Security.

The COVID-19 crisis has also illuminated the ways in which racial inequities impact health. Higher rates of COVID-19 deaths within communities of color illustrate the importance of all of CDC’s work, including its focus on chronic disease prevention. It is not possible to effectively meet the needs of the American people if that scope is narrowed.

The letter furthermore calls on Secretary Azar to be an advocate for increased funding for CDC’s core budget. While emergency supplemental funding has been critical to begin to address the immediate COVID-19 response needs, robust, sustained, and predictable funding for its full public health mission is essential to sustain its public health activities and to prevent the next emergency.  Increasing the federal investment in public health will be particularly important, as state and local government budgets are likely to be severely hampered in the coming fiscal year due to tax revenue losses during the COVID-19 related economic shutdown.

Today’s laser focus should be on preventing further deaths and disruptions due to the pandemic and the CDC, as the world’s premier public health institution, should be at the helm of that effort, the letter said. Once the pandemic is controlled, the CDC, other federal agencies, state and local leaders and the public health community should collaboratively evaluate their performance and must acknowledge and address shortcomings of the response in order to be better prepared for the next public health emergency.

Signing the letter were:

1,000 Days

Academic Health Resource

Academy for Eating Disorders

Action on Smoking and Health

Advocates for Better Children’s Diets

AES Consulting

AFSCME

AIDS Alliance for Women, Infants, Children, Youth & Families

AIDS United

AlohaCare

Alzheimer’s and Dementia Alliance of WI

Alzheimer’s Association

Alzheimer’s Impact Movement (AIM)

Alzheimer’s of Central Alabama

Alzheimer’s Orange County

American Academy of Family Physicians

American Academy of Pediatrics

American Academy of Pediatrics, California

American Association for Clinical Chemistry

American Association for Dental Research

American Association for the Study of Liver Diseases

American Association of Colleges of Pharmacy

American Association on Health and Disability

American Cancer Society Cancer Action Network (ACS CAN)

American College Health Association

American College of Clinical Pharmacy

American College of Clinical Pharmacy (ACCP)

American College of Obstetricians and Gynecologists

American College of Physicians

American College of Preventive Medicine

American Council on Exercise

American Dental Association

American Foundation for Suicide Prevention

American Geriatrics Society

American Heart Association

American Kidney Fund

American Lung Association

American Medical Women’s Association

American Organization for Nursing Leadership

American Public Health Association

American School Health Association

American Sexual Health Association

American Society for Clinical Pathology

American Society for Microbiology

American Society of Hematology

American Society of Pediatric Nephrology

American Society of Tropical Medicine & Hygiene

American Thoracic Society

American University Department of Health Studies

APLA Health

Arizona Community Health Workers Association

Arizona Public Health Association

Art & Science of Health Promotion Institute

Asian Health Coalition

Asian Health Services

Association for Prevention Teaching and Research

Association for Professionals in Infection Control and Epidemiology

Association of American Cancer Institutes

Association of American Medical Colleges

Association of Asian Pacific Community Health Organizations (AAPCHO)

Association of Departments of Family Medicine

Association of Family Medicine Residency Directors

Association of Food and Drug Officials

Association of Immunization Managers

Association of Maternal & Child Health Programs

Association of Minority Health Professions Schools

Association of Ohio Health Commissioners

Association of Population Centers

Association of Public Health Laboratories

Association of Schools and Programs of Public Health

Association of SNAP Nutrition Education Administrators

Association of State and Territorial Health Officials

Association of State Public Health Nutritionists

Autistic Self Advocacy Network

Big Cities Health Coalition

Bipartisan Policy Center

Black AIDS Institute

Black Men’s Health Initiative

Boston Public Health Commission

Bristol Health Equity Zone

Bronx Health REACH

California Coalition for Children’s Safety and Health

California Immunization Coalition

California Pan-Ethnic Health Network

California School Nurses Organization

Cambridge Public Health Department

Campaign for Tobacco-Free Kids

Cancer Council of the Pacific Islands

Caring Ambassadors Program

Cascade AIDS Project

Center for Community Resilience

Center for Health and Learning

Center for Law and Social Policy (CLASP)

CenterLink: The Community of LGBT Centers

Ceres Community Project

ChangeLab Solutions

Child Welfare League of America

Children’s Environmental Health Network

Children’s Mental Health Network

Christian Council of Delmarva

City of Houston Health Department

City of Milwaukee of Health Department

Climate for Health, ecoAmerica

Coalition for a Tobacco Free Arkansas

Coalition of National Health Education Organizations

Cohen Veterans Bioscience

Colorado Association of Local Public Health Officials

Colorado Public Health Association

Colorado Public Health Nursing Leaders

Community Access National Network

Community Education Group

Connecticut Public Health Association

Cooley’s Anemia Foundation

Council of State and Territorial Epidemiologists

Counter Tools

County Health Executives Association of California

Cuyahoga County Board of Health

Cystic Fibrosis Foundation

Delaware Academy of Medicine

Delaware Academy of Medicine / Delaware Public Health Association

Delaware Academy of Medicine and the Delaware Public Health Association

East Shore District Health Dept.

Eating Disorders Coalition for Research, Policy & Action

Education Development Center

Element Health, Inc.

Endocrine Society

Enlace Chicago

Epilepsy Alliance America

Epilepsy Foundation

Equality California

Eta Sigma Gamma

Families USA

Family Voices

Fetal Alcohol Syndrome Information Network

FHI 360

FIRST Family Service Center

Fletcher Group, Inc.

Florida Institute for Health Innovation

Florida Public Health Association

Foundation for Healthy Generations

Galaxy Aviation Corp

Gateway Region YMCA

George Mason University Center for Climate Change Communication

GLMA: Health Professionals Advancing LGBTQ Equality

Global Alliance for Behavioral Health and Social Justice

Global Health Council

Global Health Technologies Coalition (GHTC)

Global Healthy Living Foundation

Global Liver Institute

Grand Traverse County Health Department

Green & Healthy Homes Initiative

Harm Reduction Michigan

Hawaii Public Health Association

Hawaii State Dept of Health, Office of Primary Care and Rural Health

Health by Design

Health Care Improvement Foundation

Health Enhancement Research Organization (HERO)

Health Resources in Action

Healthcare Foundation Northern Sonoma County

Healthcare Ready

HealthHIV

HealthPartners Institute

Healthy Schools Campaign

Healthy Weight Partnership Inc.

Heartland Alliance

Hep B United

Hepatitis B Foundation

HIV Medicine Association

Hogg Foundation for Mental Health

Hope and Help Center of Central Florida, Inc.

Idaho Public Health Association

Immunization Action Coalition

Immunize Nevada

Impetus – Let’s Get Started LLC

Indiana Public Health Association

Infectious Diseases Society of America

Institute for Family Health

Interdisciplinary Association for Population Health Science (IAPHS)

International Association of Emergency Managers

International Association of Fire Chiefs

IWC Resources, LP

Jeffrey Modell Foundation

Journal of Public Health Management and Practice

Jump IN for Healthy Kids

Kaplan Health Innovations

Kentucky Health Departments Association

KidsAndCars.org

L.A. Care Health Plan

Lakeshore Foundation

League of American Bicyclists

Linn County Public Health

Louisiana Community Health Worker Outreach Network

Louisiana Public Health Association

Lupus and Allied Diseases Association, Inc.

Macoupin County Public Health Department

Maine Public Health Association

March of Dimes

MaryCatherine Jones Consulting, LLC

Maryland Association of County Health Officers (MACHO)

Maryland Office of Minority Health

Massachusetts Public Health Association

Medicago

MEND Foundation

Metropolitan Group

Michigan Association for Local Public Health

MindWise Innovations

Minneapolis Health Department

Mississippi Public Health Institute

Montana Public Health Association

Monterey County Health Department

Morehouse School of Medicine

MountainCare

Multnomah County Health Department

NAACP

NAPHSIS

NASTAD

National Adult Day Services Association

National Association of Chronic Disease Directors

National Association of Community Health Workers

National Association of County and City Health Officials

National Association of Pediatric Nurse Practitioners

National Association of School Nurses

National Athletic Trainers’ Association

National Birth Equity Collaborative

National Center for Disaster Preparedness, Columbia University

National Center for Healthy Housing

National Coalition for LGBT Health

National Coalition for the Homeless

National Coalition of STD Directors

National Environmental Health Association (NEHA)

National Forum for Heart Disease & Stroke Prevention

National Hemophilia Foundation

National Kidney Foundation

National Lipid Association

National Medical Association (NMA)

National Network of Public Health Institutes

National Nurse-Led Care Consortium

National Prevention Science Coalition to Improve Lives

National REACH Coalition

National Safety Council

National Viral Hepatitis Roundtable

National WIC Association

Nebraska Association of Local Health Directors

Network for Environmental & Economic Responsibility of United Church of Christ

Nevada Public Health Organization

Nevada Rural Hospital Partners

New Jersey Association of County and City Health Officials

New Jersey Public Health Association

New York State Public Health Association

North American Primary Care Research Group

North Carolina Healthcare Foundation

Northwest Center for Public Health Practice

NYU Grossman School of Medicine

NYU School of Global Public Health

Ohio Public Health Association

Onyx Strategic Consulting LLC

Pacific Island Health Officers Association

Partnering for Community Transformation Inc

Partnership to Fight Chronic Disease

Partnership to Fight Infectious Disease

PATH

Patrick Risha CTE Awareness Foundation

Pawtucket Central Falls Health Equity Zone

Peggy Lillis Foundation

Pennsylvania Public Health Association

PFLAG National

Population Association of America

Population Health Alliance

Prevent Blindness

Prevent Child Abuse America

Prevention Institute

Preventive Cardiovascular Nurses Association

Public Health Advocates

Public Health Alliance of Southern California

Public Health Foundation

Public Health Institute

Public Health Law Center

Public Health Solutions

Puerto Rico Public Health Association

Pulmonary Hypertension Association

Redstone Global Center for Prevention and Wellness GWU

Research!America

Residential Eating Disorders Consortium

RESOLVE

Resolve to Save Lives, an initiative of Vital Strategies

Respiratory Health Association

Rhode Island Department of Health

RiverStone Health

Rural Health Association of Tennessee

Rural Health Association of Utah

Safe Routes Partnership

Safe States Alliance

Samueli Integrative Health Programs

SANIPLAN

School-Based Health Alliance

SF Hep B Free – Bay Area

SHAPE America – Society of Health and Physical Educators

Shoals Community Clinic

Silver State Equality-Nevada

Smoke Free St. Joe

Society for Advancement of Violence and Injury Research

Society for Maternal-Fetal Medicine

Society for Public Health Education

Society of State Leaders of Health and Physical Education

Society of Teachers of Family Medicine

Southern California Public Health Association

Southwick BOH

Stanislaus County Medical Society

Susan G. Komen

Tennessee Justice Center

Tennessee Public Health Association

Texas Public Health Association

The AIDS Institute

The Broussard Company

The Center for Community Resilience, George Washington University

The Consortium

The Foundation for Sustainable Communities

The George Washington University (GW) Cancer Center

The Gerontological Society of America

The Immunization Partnership

The John A. Hartford Foundation

The Kennedy Forum

The Los Angeles Trust for Children’s Health

The National Commission for Health Education Credentialing, Inc

The Nourished Principles, LLC

The Permanente Medical Group

Thomas Jefferson University

Training Resources Network, Inc.

Treatment Action Group

Trillium Health

Trust for America’s Health

Truth Initiative

U.S. Breastfeeding Committee

UCLA Fielding School of Public Health

UNC Gillings School of Global Public Health

United Ostomy Associations of America

United Way of Greenwood and Abbeville Counties

University of Washington Department of Global Health

University of Washington School of Nursing

University of Washington School of Public Health

University of Wisconsin Population Health Institute

USAgainstAlzheimer’s

Vaccinate Your Family

Washington State Association of Local Health Officials

Washington State Department of Health

Washington State Public Health Association

WelCore Health, LLC

West Valley Neighborhoods Coalition

Whitefoord

Winer Family Foundation

Wisconsin Public Health Association

Women Of A Certain Age

WomenHeart: The National Coalition for Women with Heart Disease

Women’s Resource Center

Woodhull Freedom Foundation

Xavier University for Population Health

YMCA of the USA

Zell Community Health Strategies

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Annual Deaths Due to Alcohol, Drugs or Suicide Exceeded 150,000 According to the Most Recent Data – And Could Get Worse Due to COVID-19

Alcohol, drug and suicide deaths up in 27 states

(Washington, DC – May 21, 2020) – Newly released data show that 151,964 Americans died due to alcohol, drugs or suicide in 2018. This 2018 national death rate for alcohol, drug and suicide deaths was only very slightly lower than what it had been in 2017 despite progress in reducing deaths due to some types of opioid overdose, according to a new study by Trust for America’s Health (TFAH) and Well Being Trust (WBT).

Between 2017 and 2018, 27 states experienced higher rates (increases above 0.04 percent) of alcohol, drug and suicide deaths. Two states, Vermont and Delaware, experienced double-digit death rate increases – 13 percent and 10 percent respectively. Twenty-three states and the District of Columbia had lower alcohol, drug and suicide deaths during the same period.

States with the highest alcohol, drugs and suicide death rates in 2018 were:

  • West Virginia (84.9 per 100,000)
  • New Mexico (82.8 per 100,000)
  • New Hampshire (68.2 per 100,000)
  • Alaska (67.8 per 100,000)
  • Delaware (62.9 per 100,00)

States with the lowest alcohol, drug and suicide rates in 2018 were:

  • Texas (31.7 per 100,000)
  • Mississippi (31.7 per 100,000)
  • Hawaii (34.6 per 100,000)
  • Nebraska (35.5 per 100,000)
  • Iowa (35.7 per 100,000)

For the year, alcohol deaths were up 4 percent and suicide deaths were up 2 percent across the country. The new data also show a continuing shift within the opioid crisis with reductions in deaths due to prescription opioid abuse but increases in deaths involving synthetic opioids including fentanyl. Death rates for all opioids were down 2 percent, but the death rate for synthetic opioids was up 10 percent. Additionally, heroin deaths were lower but deaths due to cocaine and psychostimulants abuse were higher.

While still disturbingly high, the 2018 data is the first time since 1999, when the current data collection began, that there hasn’t been a sizable increase in the national alcohol, drugs and suicide deaths per 100,000 rate. However, this stabilization in the deaths rate was not uniform. Some places and populations groups are experiencing stable or decreasing deaths rates while rates among other groups or in other places are continuing to rise.

“These data are a clarion call to action,” said John Auerbach, President and CEO of Trust for America’s Health. “We know what works to address deaths of despair but progress has been uneven and death rates continue to climb, with communities of color experiencing higher rates of increases in drug and alcohol deaths. And there’s another immediate concern: the COVID-19 crisis has increased the health burdens and economic pressures on many communities of color.”

American Indians, Asians, Blacks, Latinos and older adults all experienced increases in drug-induced deaths between 2017 and 2018. Blacks and American Indians had the largest increase. Blacks now have higher synthetic opioid overdose rates (10.7 per 100,000), cocaine overdose rates (8.8 per 100,000) and nearly the same overall drug-induced death rate (21.8 per 100,000) as Whites, after decades of having substantially lower overdose rates. Population groups that experienced lower drug-induced death rates in 2018 included adults ages 18-54 and Whites.

“Quite simply, too many Americans are dying from preventable causes. The profound racial health disparities seen in these data show that many ethnic minority groups are being left behind in our response efforts,” said Benjamin F. Miller, PsyD, chief strategy officer, Well Being Trust. “The nation needs a comprehensive framework for excellence in mental health and well-being, one that intentionally provides solutions for American Indians, Blacks, Asians and Latinos. With all the other COVID-19 related investments, it’s time for the federal government to fully invest in mental health now and for all states to take action.”

Deaths by Drug Type

Synthetic Opioids – in 2018, 31,355 Americans died from synthetic opioid overdose; up 10 percent since 2017. In total, the synthetic-opioid-involved overdose death rate has increased 10-fold since 2013.

Cocaine – In 2018, 14,666 Americans died from cocaine-involved overdoses; up 5 percent since 2017. The overall cocaine overdose death rate has increased by 187 percent since 2013.

Other psychostimulants – In 2018, 12,676 Americans died from overdoses involving psychostimulants and 52,279 have died over the past decade due to psychostimulants abuse.  The 2018 psychostimulants overdose death rate was 22 percent higher than it was in 2017.

Alcohol-induced Deaths

In 2018, 37,329 Americans died due to alcohol-induced causes; the rate of alcohol-induced deaths in 2018 was 4 percent higher than the prior year.

Alcohol induced deaths are highest among American Indians (30.0 per 100,000) and adults ages 55 to 74 (27.6 per 100,000). All population groups had higher rates of alcohol deaths in 2018 as compared to the prior year except youths ages 0-17, whose rate held steady.

Suicide Deaths

In 2018, 48,344 Americans died as a result of suicide. Nationally, the 2018 suicide rate was two percent higher than the prior year (that is after a four percent increase in 2017). Suicide rates increased across all demographics, except for adults ages 18-54 whose rate remained stable. In addition, all racial and ethnic minority groups experienced larger proportional changes in suicide rates than did Whites.

Death by suicide in 2018 was highest among males (23.4 percent per 100,000), those living in rural areas (19.7 per 100,000), Whites (16.8 per 100,000) and American Indian/Alaska Natives (14.1 per 100,000).

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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. Twittwe: @HealthyAmerica1

 

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

 

 

 

 

 

When Two Health Risks Merge – Rising Obesity Rates Put More Americans at Risk for Serious Health Impacts of the Novel Coronavirus

High obesity rates in communities of color may be one of a number of factors leading to severe COVID-19 impacts in those communities

(Washington, DC – May 6, 2020) – New data drawn from the National Health and Nutrition Examination Survey (NHANES) found that 42.4 percent of U.S. adults age 20 and older have obesity. That rate was up nearly three percentage points from the previous NHANES survey taken in 2015-2016 when 39.6 percent of the nation’s adults had obesity. After remaining relatively stable in the 2000s, these new data represent the third consecutive NHANES survey that found increases in the nation’s adult obesity rate of 2.8, 1.9 and 2.8 percentage points respectively.

The latest survey also showed a continuing pattern of higher rates of obesity in Black and Latino communities than in the White population. Among adults, the prevalence of both obesity and severe obesity was highest in Black adults compared with other races/ethnicities.

Rates of Obesity – U.S. Adults by Race:

  • Blacks – 49.6%
  • Latinos – 44.8%
  • Whites – 42.2%

Rates of Obesity – U.S. Adults by Race and Gender

  • Black Women – 56.9%
  • Black Men – 41.1%
  • Latina Women – 43.7%
  • Latino Men – 45.7%
  • White Women – 39.8 %
  • White Men – 44.7 %

Childhood obesity is also increasing across the country. Having obesity as a child puts you at a higher risk of having obesity as an adult.


Having obesity puts people at higher risk for severe COVID-19 impact
It is well-established that obesity is associated with serious health risks.  The risk of diabetes is closely associated with obesity. In addition, people with obesity have higher levels of pre-existing respiratory and cardiac disease which puts them at higher risk for serious impacts if infected by the novel coronavirus.  In a study in review for publication, researchers at New York University found that obesity is one of three of the most common risk factors for COVID-19 hospitalizations.

The COVID-19 crisis is disproportionately causing severe illness and taking the lives of Black Americans. As of April, of COVID-19 positive tests where the patient’s race/ethnicity was known, 28.5 percent were Black. Blacks make-up 13.4 percent of the U.S. population.  Additional examples include Milwaukee County, Wisconsin, Blacks are 28 percent of the county’s population but as of early April were 73 percent of its coronavirus deaths. In Michigan, Blacks are 14 percent of the state’s population and 41 percent of the state’s coronavirus deaths. In Chicago, Blacks are 23 percent of the city’s residents and 58 percent of its coronavirus deaths.

The social, economic, and environmental conditions that lead to higher rates of obesity and other chronic diseases in communities of color are tied to factors that also elevate the risk of COVID-19 related hospitalizations and death.  Factors such as lack of economic opportunities, for example in the form of good jobs with living wages, contribute to obesity by making it more difficult to afford healthier foods or have access to stores that sell affordable healthy produce.  Additional conditions in many communities of color that contribute COVID-19 infections, hospitalizations and deaths are living in multigenerational households, working in public-facing jobs that elevate COVID-19 risk (such as work in home health care, grocery stores, delivery services and the public transit system) and less access to healthcare.

“Numerous factors are leading to the tragic overrepresentation of people of color in the nation’s COVID-19 deaths, among them the number of people of color working on the frontlines as essential workers, where telework or physical distancing is not possible,” said Dr. J. Nadine Gracia, Trust for America’s Health’s Executive Vice President and Chief Operating Officer. “In addition, high levels of chronic disease within communities of color, such as diabetes and heart disease, are contributing to higher levels of COVID-19 deaths”.

The nation’s obesity crisis and the COVID-19 pandemic will continue to interact in additional ways. For example, food insecurity is associated with obesity. An additional contributing factor is lack of physical activity. Unfortunately, COVID-19 will increase both of those concerns as millions of families are currently food insecure due to job loss and many places to exercise such as gyms, community centers and parks are closed.

“The COVID-19 crisis has illuminated systemic and structural inequities that impact the health and well-being of people of color,” Dr. Gracia said. “The factors associated with maintaining a healthy weight are another example of the ways in which where people live, the neighborhood resources available, and the economic opportunities afforded to them drive their health, and are now driving their degree of health risk due to COVID-19.”

While federal and state leaders are immediately focused on protecting lives during the current crisis, investing in programs to stem the rise in the country’s obesity rates will not only improve Americans’ health, it will also make the country more resilient during future health emergencies.

Some of the federal policy actions TFAH recommends to reverse the country’s rising obesity rates are:

  • Congress should fully fund CDC’s Division of Nutrition, Physical Activity and Obesity’s SPAN (State Physical Activity and Nutrition program) grants for all 50 states and the District of Columbia. Current CDC funding only supports 16 states out of 50 approved applications.
  • Congress should increase funding for CDC’s Racial and Ethnic Approaches to Community Health (REACH) program which works with community organizations to deliver effective local and culturally appropriate obesity prevention programs in communities that bear a disproportionate burden of chronic disease. Current funding only supports 31 grantees out of 261 approved applications.
  • Build capacity for CDC and public health departments to work with other sectors (such as housing and transportation) to address social determinants of health, the nonmedical factors that affect communities’ health status including rates of obesity.
  • Without decreasing access or benefit levels, ensure that anti-hunger and nutrition-assistance programs, like the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants and Children (WIC) follow the Dietary Guidelines for Americans and make access to nutritious food a core program tenet.
  • Expand the WIC program to age 6 for children and for two years postpartum for mothers. Fully fund the WIC Breastfeeding Peer Counseling Program.
  • Increase the price of sugary drinks through excise taxes and use the revenue to address health and socioeconomic disparities. Increasing the price of surgery drinks has been shown to decrease their consumption.
  • Enforce existing laws that direct most health insurers to cover obesity-related preventive services at no-cost sharing to patients. Comprehensive pediatric weight management programs and services should also be covered by Medicaid.
  • Encourage safe physical activity by funding Complete Streets, Vision Zero and other pedestrian safety initiatives through federal transportation and infrastructure funding.
  • In schools, strengthen and expand school nutrition programs beyond federal standards to include universal meals and flexible breakfasts, eliminate all unhealthy food marketing to students, support physical education programs in all schools and expand programs that ensure students can safely walk or ride bicycles to and from school.

See TFAH’s State of Obesity: Better Policies for a Healthier America 2019 for additional recommendations on how to stem the country’s obesity crisis. https://www.tfah.org/report-details/stateofobesity20

 

 

 

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

New Report Places 25 States and DC in High Performance Tier on 10 Public Health Emergency Preparedness Measures

As Threats Increase, Annual Assessment Finds States’ Level of Readiness for Health Emergencies is Improving in Some Areas but Stalled in Others

February 5, 2020

(Washington, DC) – Twenty-five states and the District of Columbia were high-performers on a three-tier measure of states’ preparedness to protect the public’s health during an  emergency, according to a new report released today by Trust for America’s Health (TFAH). The annual report, Ready or Not 2020: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, found year-over-year improvement among 10 emergency readiness measures, but also notes areas in need of improvement. Last year, 17 states ranked in the report’s top tier.

For 2020, 12 states placed in the middle performance tier, down from 20 states and the District of Columbia in the middle tier last year, and 13 placed in the low performance tier, the same number as last year.

The report found that states’ level of preparedness has improved in key areas, including public health funding, participation in healthcare coalitions and compacts, hospital safety, and seasonal flu vaccination. However, other key health security measures, including ensuring a safe water supply and access to paid time off, stalled or lost ground.

Performance Tier States Number of States
High Tier AL, CO, CT, DC, DE, IA, ID, IL, KS, MA, MD, ME, MO,
MS, NC, NE, NJ, NM, OK, PA, TN, UT, VA, VT, WA, WI		 25 states and DC
Middle Tier AZ, CA, FL, GA, KY, LA, MI, MN, ND, OR, RI, TX 12 states
Low Tier AK, AR, HI, IN, MT, NH, NV, NY, OH, SC, SD, WV, WY 13 states

 

The report measures states’ performance on an annual basis using 10 indicators that, taken together, provide a checklist of a jurisdiction’s level of preparedness to prevent and respond to threats to its residents’ health during an emergency. The indicators are:

Preparedness 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 (“A” grade) 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.

Four states (Delaware, Pennsylvania, Tennessee, and Utah) moved from the low performance tier in last year’s report to the high tier in this year’s report. Six states (Illinois, Iowa, Maine, New Mexico, Oklahoma, Vermont) and the District of Columbia moved up from the middle tier to the high tier. No state fell from the high to the low tier but six moved from the middle to the low tier. Hawaii, Montana, Nevada, New Hampshire, South Carolina, and West Virginia.

“The increasing number of threats to Americans’ health in 2019, from floods to wildfires to vaping, demonstrate the critical importance of a robust public health system. Being prepared is often the difference between harm or no harm during health emergencies and requires four things: planning, dedicated funding, interagency and jurisdictional cooperation, and a skilled public health workforce,” said John Auerbach, President and CEO of Trust for America’s Health.

“While this year’s report shows that, as a nation, we are more prepared to deal with public health emergencies, we’re still not as prepared as we should be. More planning and investment are necessary to saves lives,” Auerbach said.

TFAH’s analysis found that:

  • A majority of states have plans in place to expand healthcare capacity in an emergency through programs such as the Nurse Licensure Compact or other healthcare coalitions. Thirty-two states participated in the Nurse Licensure Compact, which allows licensed nurses to practice in multiple jurisdictions during an emergency. Furthermore, 89 percent of hospitals nationally participated in a healthcare coalition, and 17 states and the District of Columbia have universal participation meaning every hospital in the state (+DC)  participated in a coalition. In addition, 48 states and DC had a plan to surge public health laboratory capacity during an emergency.
  • Most states are accredited in the areas of public health, emergency management, or both. Such accreditation helps ensure that necessary emergency prevention and response systems are in place and staffed by qualified personnel.
  • Most people who got their household water through a community water system had access to safe water. Based on 2018 data, on average, just 7 percent of state residents got their household water from a community water system that did not meet applicable health standards, up slightly from 6 percent in 2017.
  • Seasonal flu vaccination rates improved but are still too low. The seasonal flu vaccination rate among Americans ages 6 months and older rose from 42 percent during the 2017-2018 flu season to 49 percent during the 2018-2019 season, but vaccination rates are still well below the 70 percent target established by Healthy People 2020.
  • In 2019, only 55 percent of employed people had access to paid time off, the same percentage as in 2018. The absence of paid time off has been shown to exacerbate some infectious disease outbreaks . It can also prevent people from getting preventive care.
  • Only 30 percent of hospitals, on average, earned top patient safety grades, up slightly from 28 percent in 2018. Hospital safety scores measure performance on such issues as healthcare associated infection rates, intensive-care capacity and an overall culture of error prevention. Such measures are critical to patient safety during infectious disease outbreaks and are also a measure of a hospital’s ability to perform well during an emergency.

The report includes recommended policy actions that the federal government, states and the healthcare sector  should take to improve the nation’s ability to protect the public’s health during emergencies.

Other sections of the report describe how the public health system was critical to the vaping crisis response, how health inequities put some communities at greater risk during an emergency, and the needs of people with disabilities during an emergency.

Read the full text report