Issue Category: Prevention and Public Health Policy

The ACA is Critical to the Health of all Americans, Particularly as the Nation Struggles to Contain the Coronavirus

(Washington D.C. – June 29, 2020)

The Trump Administration’s efforts to dismantle the Affordable Care Act (ACA), including urging the Supreme Court to overturn the act, is ill-conceived and puts the health of millions of Americans at risk during the worst public health crisis in over a century.

While always a bad idea, overturning the ACA as COVID-19 infection rates hit new highs in five states, would be catastrophic and could result in excess deaths. The loss of the ACA would also exacerbate the racial inequities that exist in healthcare access, adding to the disproportionate deaths of Blacks and other people of color due to the pandemic.

The ACA has been the law of the land for over a decade and millions of people rely on it for essential health services.  If the act was overturned, more than 20 million Americans who gained access to healthcare through the ACA created marketplace and Medicaid expansion would lose that coverage, including vital protections related to pre-existing conditions. Plus, the nearly 30 million Americans who have lost their healthcare due to COVID-19 layoffs would lose access to the critical back-up source for health coverage provided by the ACA marketplace.

There are also major implications for public health. If the law is overturned, it would gut the nation’s investment in public health by eliminating over $15 billion over the next 10 years (FY2021-FY2030) for the Centers for Disease Control and Prevention (CDC) and other public health agencies. The Prevention and Public Health Fund, a dedicated funding stream created by the ACA and specifically designated for public health and prevention, funds approximately 11 percent of the CDC’s budget. These funds are put to work in every state to expand immunizations, prevent suicide, modernize laboratory and epidemiology services to detect and contain disease outbreaks, prevent childhood lead poisoning, and prevent diabetes and other chronic conditions.

Also at risk is the requirement that insurers cover recommended clinical preventive services without cost-sharing. These provisions have meant that an estimated additional 71 million Americans now have access to vaccines, tobacco cessation services, blood pressure and diabetes screenings and other life-saving services previously inaccessible to them.

Public Health Needs Our Support

(Washington D.C. – June 23)

John Auerbach, President and CEO of Trust for America’s Health, issued the following statement:

“As our nation struggles to manage the continued surge of COVID-19 cases, we need to strengthen the public health response.   Resistance to public health messages and threats to public health leaders and agencies undermine the efforts to protect the health and wellbeing of America’s residents.  We need to support the leadership of Centers for Disease Control and Prevention (CDC) and state, local, tribal, and territorial public health agencies in the efforts to re-open safely.

CDC, state, local, tribal, and territorial public health staff have been working around the clock for months to respond to the pandemic and protect the public, while often relying on overworked staff and inadequate systems that are the result of decades of underfunding.

CDC is a scientific agency that must be able to function in an apolitical manner.  We must amplify the unfettered voice of CDC, not stifle it.

The broad scope of CDC’s work – from chronic disease to injury prevention to environmental health to emergency preparedness to infectious disease – is critical.   It isn’t possible to effectively meet the needs of the American people if the scope is narrowed.   The COVID-19 pandemic demonstrates that the underlying health of Americans – including, for example, obesity, heart disease and diabetes – has a direct impact on the risk of serious illness and death. And the pandemic has also starkly highlighted the unacceptable health disparities related to racism and discrimination which can only be addressed with a sweeping health focus.

The mission of the CDC is clear and replicated in every state and local community’s public health department: save lives through sound public health.  Now more than ever we need them to accomplish their mission.”

TFAH’s Statement on Racism and Health and Well Being in America

Trust for America’s Health (TFAH) stands in solidarity with those opposing racism and seeking racial justice. The recent horrific deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery further expose the persistence of racism and racial violence in American society. We must remember the lives of so many Black people taken by such violence. We keep the families in our minds and hearts.

Systemic racism undermines equity and opportunity and is far-reaching – in health, education, economic opportunity, employment, housing, transportation, and criminal justice, only to name a few examples. The toll from racism on the lives and health of Black people and other people of color is vast.  It is seen in the impact of the disinvestment in and marginalization of communities of color, the unhealthy social, economic, and environmental conditions, and the lack of opportunities within community, work and school settings, which result in deaths at earlier ages and high rates of chronic and infectious diseases.  It is seen in the impact of racial violence as well as daily instances of prejudice and racial discrimination that result in adverse mental and physical health effects such as stress, trauma, and elevated blood pressure.  The recent cases of violence against Black people and the disproportionate impact of the COVID-19 pandemic on people of color have highlighted once again the importance of combating racism as a public health imperative.

At Trust for America’s Health, we envision a nation that values the health and well-being of all, where equity is foundational to policymaking at all levels of society.  Together with all justice-seeking people in America, we remain steadfast in advocating for policy solutions to achieve equity so that everyone has a fair and just opportunity for optimal health.

Las muertes anuales debidas al alcohol, las drogas o el suicidio superaron los 150,000 según los datos más recientes, y podrían empeorar debido a COVID-19

Las muertes por alcohol, drogas y suicidios aumentan en 27 estados

(Washington, DC – 21 de mayo de 2020) –  Datos recientemente publicados muestran que 151,964 estadounidenses murieron debido al alcohol, las drogas o el suicidio en el 2018. Esta tasa nacional de mortalidad por muertes por alcohol, drogas y suicidio en el 2018 fue muy ligeramente inferior a la que hubo en  el 2017 a pesar del progreso en la reducción de muertes debido a algunos tipos de sobredosis de opioides, según un nuevo estudio realizado por Trust for America’s Health (TFAH) y Well Being Trust (WBT).

Entre 2017 y 2018, 27 estados experimentaron tasas más altas (incrementos superiores al 0.04 por ciento) de muertes por alcohol, drogas y suicidio. Dos estados, Vermont y Delaware, experimentaron aumentos de la tasa de mortalidad de dos dígitos: 13 por ciento y 10 por ciento, respectivamente. Veintitrés estados y el Distrito de Columbia tuvieron menos muertes por alcohol, drogas y suicidio durante el mismo período.

Los estados con las tasas más altas de mortalidad por alcohol, drogas y suicidio en el 2018 fueron:

  • West Virginia (84.9 por 100,000)
  • Nuevo México (82.8 por 100,000)
  • New Hampshire (68.2 por 100,000)
  • Alaska (67.8 por 100,000)
  • Delaware (62.9 por 100,00)

Los estados con las tasas más bajas de alcohol, drogas y suicidio en el 2018 fueron:

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

Por el año, las muertes por alcohol aumentaron un 4 por ciento y las muertes por suicidio aumentaron un 2 por ciento en todo el país. Los nuevos datos también muestran un cambio continuo dentro de la crisis de los opioides con reducciones en las muertes por abuso de opioides recetados, pero aumentan las muertes relacionadas con opioides sintéticos, incluido el fentanilo. Las tasas de mortalidad de todos los opioides disminuyeron un 2 por ciento, pero la tasa de mortalidad de los opioides sintéticos aumentó un 10 por ciento. Además, las muertes por heroína fueron menores, pero las muertes por abuso de cocaína y psicoestimulantes fueron mayores.

Aunque todavía es inquietantemente alto, los datos del 2018 son la primera vez desde 1999, cuando comenzó la recopilación de datos actual, que no ha habido un aumento considerable en el índice nacional de muertes por alcohol, drogas y suicidios por cada tasa de 100,000. Sin embargo, esta estabilización en la tasa de mortalidad no fue uniforme. Algunos lugares y grupos de población están experimentando tasas de mortalidad estables o decrecientes, mientras que las tasas entre otros grupos o en otros lugares continúan aumentando.

“Estos datos son un llamado a la acción”, dijo John Auerbach, presidente y CEO de Trust for America’s Health. “Sabemos lo que funciona para abordar las muertes por desesperación, pero el progreso ha sido desigual y las tasas de mortalidad continúan aumentando, con comunidades de color que experimentan tasas más altas de aumento en las muertes por drogas y alcohol. Y hay otra preocupación inmediata: la crisis de COVID-19 ha aumentado las cargas sanitarias y las presiones económicas en muchas comunidades de color “.

Los indios americanos, asiáticos, negros, latinos y adultos mayores experimentaron aumentos en las muertes inducidas por drogas entre 2017 y 2018. Los negros y los indios estadounidenses tuvieron el mayor aumento. Los negros ahora tienen tasas más altas de sobredosis de opioides sintéticos (10.7 por 100,000), tasas de sobredosis de cocaína (8.8 por 100,000) y casi la misma tasa general de mortalidad inducida por drogas (21.8 por 100,000) que los blancos, después de décadas de tener tasas de sobredosis sustancialmente más bajas. Los grupos de población que experimentaron tasas de mortalidad más bajas inducidas por drogas en el 2018 incluyeron adultos de 18 a 54 años y blancos.

“Simplemente, muchos estadounidenses están muriendo por causas prevenibles. Las profundas disparidades raciales de salud observadas en estos datos muestran que muchos grupos de minorías étnicas se están quedando atrás en nuestros esfuerzos de respuesta “, dijo Benjamin F. Miller, PsyD, director de estrategia de Well Being Trust. “La nación necesita un marco integral para la excelencia en la salud mental y el bienestar, uno que intencionalmente brinde soluciones para los indios americanos, negros, asiáticos y latinos. Con todas las demás inversiones relacionadas con COVID-19, es hora de que el gobierno federal invierta completamente en salud mental ahora y que todos los estados tomen medidas “.


Muertes por tipo de droga

Opioides sintéticos: en el 2018, 31,355 estadounidenses murieron por sobredosis de opioides sintéticos; un aumento del 10 por ciento desde el 2017. En total, la tasa de mortalidad por sobredosis con opioides sintéticos ha aumentado 10 veces desde el 2013.

Cocaína: en el 2018, 14,666 estadounidenses murieron por sobredosis de cocaína; hasta un 5 por ciento desde el 2017. La tasa general de mortalidad por sobredosis de cocaína ha aumentado en un 187 por ciento desde el 2013.

Otros psicoestimulantes: en el 2018, 12,676 estadounidenses murieron por sobredosis de psicoestimulantes y 52,279 murieron en la última década debido al abuso de psicoestimulantes. La tasa de mortalidad por sobredosis de psicoestimulantes en el 2018 fue un 22 por ciento más alta que en el 2017.


Muertes inducidas por alcohol
En el 2018, 37,329 estadounidenses murieron debido a causas inducidas por el alcohol; La tasa de muertes inducidas por el alcohol en el 2018 fue un 4 por ciento más alta que el año anterior.

Las muertes inducidas por el alcohol son más altas entre los indios americanos (30.0 por 100,000) y adultos de 55 a 74 años (27.6 por 100,000). Todos los grupos de población tuvieron tasas más altas de muertes por alcohol en 2018 en comparación con el año anterior, excepto los jóvenes de 0 a 17 años, cuya tasa se mantuvo estable.


Muertes por suicidios
En el 2018, 48,344 estadounidenses murieron como resultado del suicidio. A nivel nacional, la tasa de suicidios de 2018 fue dos por ciento más alta que el año anterior (es decir, después de un aumento de cuatro por ciento en 2017). Las tasas de suicidio aumentaron en todos los datos demográficos, excepto en adultos de 18 a 54 años cuya tasa se mantuvo estable. Además, todos los grupos minoritarios raciales y étnicos experimentaron cambios proporcionales mayores en las tasas de suicidio que los blancos.

La muerte por suicidio en el 2018 fue más alta entre los hombres (23.4 por ciento por 100,000), aquellos que viven en áreas rurales (19.7 por 100,000), blancos (16.8 por 100,000) y nativos de los indios americanos / Alaska (14.1 por 100,000).

 

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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. www.tfah.org. Twitter: @HealthyAmerica1

 

Well Being Trust es una fundación nacional dedicada a promover la salud mental, social y espiritual de la nación. Creado para incluir la participación de organizaciones de todos los sectores y perspectivas, Well Being Trust se compromete a innovar y abordar los desafíos de salud mental más críticos que enfrenta Estados Unidos, y a transformar el bienestar individual y comunitario. www.wellbeingtrust.org. Twitter: @WellBeingTrust

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

Despite decreases in overall opioid overdose deaths, deaths involving synthetic opioids, cocaine and other psychostimulants increased sharply and alcohol and suicide deaths are also up.

(Washington, DC and Oakland, CA – May 21, 2020) – Newly released data show that 151,964 Americans died due to alcohol, drugs or suicide in 2018. This 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 some types of opioid overdose, according to a new study by Trust for America’s Health (TFAH) and Well Being Trust (WBT).

For the year, alcohol deaths were up 4 percent and suicide deaths were up 2 percent. The new data also show a continuing shift within the opioid crisis with reductions in deaths due to prescription opioid overdose 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 involved overdose deaths were lower but deaths involving cocaine and other psychostimulants, such as methamphetamine, ecstasy, amphetamine and prescription stimulants, were higher.

While still disturbingly high, the s2018 data is the first time since 1999, when the current data collection began, that there has not been a sizable increase in the alcohol, drugs and suicide deaths per 100,000 rate. However, this stabilization in the deaths rate was not uniform. Some places and population groups are experiencing stable or decreasing deaths rates while rates among other groups or in other places continue 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-induced 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 absolute increase. Black now have higher synthetic opioid overdose rates (10.7 per 100,000), cocaine overdose rates (8.8 percent per 100,000) and nearly the same overall drug-induced rate (21.8 per 100,000) as Whites, after decades of having substantially lower 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.”

The reduction in certain opioid deaths suggests that the policies and programs targeting the opioid epidemic may be taking hold in some populations – but many racial and ethnic groups are not seeing the same progress as Whites. The nation should build on the small degree of success and bring the same focus to populations who are at increasing risk, especially Blacks, Latinos and American Indians.

Policy recommendations outlined in the report include:

  • Investing in prevention by addressing the upstream factors that create the conditions that improve outcomes. Numerous factors contribute to well-being or the lack of it including Intergenerational poverty, systemic racism, ethnic discrimination, and homophobia/transphobia are among the social, economic, and environmental factors that elevate risk. Government agencies at all levels should take steps to promote racial equity and combat racism and discrimination.
  • Reducing risk factors and promoting resilience in children, families, and communities. Support equitable policies and programs that reduce traumatic and adverse experiences—such as exposure to violence, unstable housing, racial and ethnic discrimination, and implicit bias—which have profound long-term impacts on later substance use and mental health.
  • Integrating, increasing access to, and improving healthcare by engaging all sectors of society in addressing mental health and substance use disorders. Schools, workplaces, community centers, libraries, and public-facing programs should all incorporate ways to address mental health and addictions issues, from boosting awareness and reducing stigma, to providing crisis intervention training and facilitating referrals, and even integrating healthcare into their programming where possible.
  • Limiting access to lethal means of suicide. Promote safe storage of medications and firearms by providing public education; restricting access to firearms for children and individuals in crisis or at risk of suicide; and creating protocols for health care providers, counselors, and first responders on how to interact with and counsel patients and families to create safe environments. Implement universal background checks for gun purchases and extreme-risk protection orders nationwide, and expand programs to engage stakeholders—like the Gun Shop Project, which educates gun store staffs on suicide prevention.

2018 Data Summary

Deaths by Drug Type

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

Cocaine Overdose Deaths – 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 Overdose Deaths – 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 (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).

State Trends

Between 2017 and 2018, 27 states experienced higher rates (above 0.04%) of alcohol, drug and suicide deaths. 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) and Alaska (67.8 per 100,000).

States with the lowest alcohol, drug and suicide rates in 2018 were: Texas (31.7 per 100,000), Mississippi (31.7 per 100,000) and Hawaii (34.6 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. Twitter:@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