Today, the Administration released the President’s FY2021 budget request for the U.S. Department of Health and Human Services (HHS) and other federal agencies, including a proposed 10 percent cut to HHS and a 9 percent cut to the Centers for Disease Control and Prevention (CDC).
In response, the President and CEO of Trust for America’s Health, John Auerbach, released the following statement:
“Public health is battling threats on multiple fronts, from coronavirus, to natural disasters, to opioids to chronic diseases like diabetes. Every year, public health is asked to do more with less, often fighting a growing number of 21st century problems with an insufficient set of 20th century tools.
We are concerned that this budget request, if adopted by Congress, would cut public health funding amid multiple outbreaks and epidemics that threaten the health and safety of the American people.
Such budget cuts would add to the impact of years of stagnant or decreased funding. CDC’s budget is already 10% lower than it was 10 years ago, when inflation is factored in. And since most of CDC’s funding is distributed to states and local communities, this loss is directly felt throughout the nation. The consequences are troubling. For example, only 16 states are funded to fight the obesity epidemic, yet nearly 40% of American adults have obesity. This costs our healthcare system an excess $149 billion per year. In addition, CDC’s emergency preparedness line item has been cut by a third in the last several years. The proposed budget would sustain or cut these programs even further.
We urge Congress and the Administration to work to ensure public health has the tools and resources it needs to prevent disease and safeguard the health of all communities.”
A medida que aumentan las amenazas, la evaluación anual determina que el nivel de preparación de los estados para emergencias sanitarias está mejorando en algunas áreas, pero está estancado en otras
(Washington, DC) – Veinticinco Estados y el Distrito de Columbia tuvieron un alto desempeño en una medida de tres niveles de preparación de los Estados para proteger la salud public durante una emergencia, según un nuevo informe publicado hoy por Trust for America’s Health (TFAH, por su sigla en inglés). El informe anual, Ready or Not 2020: Proteging the Public’s Health from Diseases, Disasters and Bioterrorism, encontró una mejora año tras año entre las 10 medidas de preparación para emergencias, pero también señala áreas que necesitan mejoras. El año pasado, 17 Estados se clasificaron en el nivel superior del informe.
Para 2020, 12 Estados se ubicaron en el nivel de rendimiento medio, por debajo de 20 Estados y el Distrito de Columbia en el nivel medio el año pasado, y 13 se ubicaron en el nivel de rendimiento bajo, el mismo número que el año pasado.
El informe encontró que el nivel de preparación de los estados ha mejorado en áreas claves, que incluyen fondos de salud pública, participación en coaliciones y pactos de atención médica, seguridad hospitalaria y vacunación contra la gripe. Sin embargo, otras medidas clave de seguridad de la salud, que incluyen garantizar un suministro de agua seguro y acceso a tiempo libre remunerado, está estancado o perdido.
Nivel de Rendimiento
Estados
Numero de Estados
Alto
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, W
El informe mide el desempeño anualmente de los Estados utilizando 10 indicadores que, en conjunto, proporcionan una lista de verificación del nivel de preparación de una jurisdicción para prevenir y responder a las amenazas a la salud de sus residentes durante una emergencia. Los indicadores son:
Indicadores de Preparación
1
Gestión de incidentes: adopción del Pacto de licencia de enfermería
6
Seguridad del agua: Porcentaje de la población que utilizó un sistema de agua comunitario que no cumplió con todos los estándares de salud aplicables.
2
Colaboración comunitaria intersectorial: porcentaje de hospitales que participan en coaliciones de atención médica.
7
Resistencia laboral y control de infecciones: porcentaje de población ocupada con tiempo libre remunerado.
3
Calidad institucional: acreditación de la Junta de Acreditación de Salud Pública
8
Utilización de contramedidas: porcentaje de personas de 6 meses o más que recibieron una vacuna contra la gripe estacional.
4
Calidad institucional: acreditación del Programa de acreditación de gestión de emergencias.
9
Seguridad del paciente: porcentaje de hospitales con una clasificación de alta calidad (grado “A”) en el grado de seguridad del hospital Leapfrog.
5
Calidad institucional: tamaño del presupuesto estatal de salud pública, en comparación con el año pasado.
10
Vigilancia de la seguridad de la salud: el laboratorio de salud pública tiene un plan para un aumento de la capacidad de prueba de seis a ocho semanas.
Cuatro Estados (Delaware, Pensilvania, Tennessee y Utah) pasaron del nivel de bajo rendimiento en el informe del año pasado al nivel alto en el informe de este año. Seis Estados (Illinois, Iowa, Maine, Nuevo México, Oklahoma, Vermont) y el Distrito de Columbia pasaron del nivel medio al nivel alto. Ningún Estado cayó del nivel alto al bajo, pero seis pasaron del nivel medio al bajo: Hawaii, Montana, Nevada, New Hampshire, Carolina del Sur y Virginia Occidental.
“El creciente número de amenazas para la salud de los estadounidenses en 2019, desde inundaciones hasta incendios forestales y vapeo, demuestra la importancia crítica de un sistema de salud pública sólido. Estar preparado es a menudo la diferencia entre daños o no daños durante emergencias de salud y requiere cuatro cosas: planificación, financiamiento dedicado, cooperación interinstitucional y jurisdiccional, y una fuerza laboral calificada de salud pública “, dijo John Auerbach, presidente y CEO de Trust for America’s Health.
“Si bien el informe de este año muestra que, como nación, estamos más preparados para enfrentar emergencias de salud pública, todavía no estamos tan preparados como deberíamos estar”. Se necesita más planificación e inversión para salvar vidas”, dijo Auerbach.
El análisis de TFAH encontró que:
La mayoría de los Estados tienen planes para expandir la capacidad de atención médica en una emergencia a través de programas como el Pacto de Licencias de Enfermería u otras coaliciones de atención médica. Treinta y dos Estados participaron en el Pacto de Licencias de Enfermeras, que permite a las enfermeras licenciadas practicar en múltiples jurisdicciones durante una emergencia. Además, el 89 por ciento de los hospitales a nivel nacional participaron en una coalición de atención médica, y 17 estados y el Distrito de Columbia tienen participación universal, lo que significa que todos los hospitales del estado (+ DC) participaron en una coalición. Además, 48 Estados y DC tenían un plan para aumentar la capacidad del laboratorio de salud pública durante una emergencia.
La mayoría de los Estados están acreditados en las áreas de salud pública, manejo de emergencias o ambos. Dicha acreditación ayuda a garantizar que los sistemas necesarios de prevención y respuesta ante emergencias estén implementados y que cuenten con personal calificado.
La mayoría de las personas que tienen agua de su hogar a través de un sistema de agua comunitario tenían acceso a agua segura. Según los datos de 2018, en promedio, solo el 7 por ciento de los residentes estatales obtuvieron el agua de su hogar de un sistema de agua comunitario que no cumplía con los estándares de salud aplicables, un poco más del 6 por ciento en 2017.
Las tasas de vacunación contra la gripe estacional mejoraron, pero aún son demasiado bajas. La tasa de vacunación contra la gripe estacional entre los estadounidenses de 6 meses en adelante aumentó del 42 por ciento durante la temporada de gripe 2017-2018 al 49 por ciento durante la temporada 2018-2019, pero las tasas de vacunación todavía están muy por debajo del objetivo del 70 por ciento establecido por Healthy People 2020.
En 2019, solo el 55 por ciento de las personas empleadas tenían acceso a tiempo libre remunerado, el mismo porcentaje que en 2018. Se ha demostrado que la ausencia de tiempo libre remunerado exacerba algunos brotes de enfermedades infecciosas. También puede evitar que las personas reciban atención preventiva.
Solo el 30 por ciento de los hospitales, en promedio, obtuvieron las mejores calificaciones de seguridad del paciente, un poco más que el 28 por ciento en 2018. Los puntajes de seguridad hospitalaria miden el desempeño en temas tales como las tasas de infección asociadas a la atención médica, la capacidad de cuidados intensivos y una cultura general de prevención de errores. Dichas medidas son críticas para la seguridad del paciente durante los brotes de enfermedades infecciosas y también son una medida de la capacidad del hospital para funcionar bien durante una emergencia.
Otras secciones del informe describen cómo el sistema de salud pública fue fundamental para la respuesta a la crisis de vapeo, cómo las inequidades en salud ponen a algunas comunidades en mayor riesgo durante una emergencia y las necesidades de las personas con discapacidad durante una emergencia.
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
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
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.
(Washington, DC – January 30, 2020) Newly released mortality data from 2018 show the first increase in Americans’ life expectancy since 2014, and the first decline in the rate of drug overdose deaths, including opioid overdoses, since 2012. The year also saw an increase in suicide and in overdose deaths involving synthetic opioids, cocaine, and psychostimulants (a category that includes drugs like methamphetamine, amphetamine, and methylphenidate). The topline trends on mortality and opioids—released by the National Center for Health Statistics on January 30—are heartening after years of alarming trends, but suicides continue to rise, and drug overdoses remain a major public health issue that requires vigilance from policymakers to ensure sustained gains.
Key findings from today’s reports:
Life expectancy: American’s life expectancy was 78.7 years in 2018, compared with 78.6 years in 2017. Life expectancy in the United States peaked in 2014 at 78.9 years.
Suicide deaths: 48,344 Americans died from suicide in 2018, a rate of 14.2 deaths per 100,000. That’s a rate 2 percent higher than 2017 when 47,173 Americans died from suicide (14.0 deaths per 100,000).
Overall drug overdoses deaths: 67,367 Americans died from drug overdoses in 2018, a rate of 20.7 deaths per 100,000. This is a rate 5 percent lower than over 2017 when 70,237 Americans died of drug overdoses (21.7 deaths per 100,000). Even with the decline, the 2018 rate of drug overdoses is still 74 percent higher than 2008.
Opioid overdose deaths: 46,802 Americans died from opioid overdoses in 2018, a rate of 14.6 deaths per 100,000. That’s a rate 2 percent lower than 2017 when 47,600 Americans died of opioid overdoses (14.9 deaths per 100,000). Even with the decline, the rate of opioid overdose deaths has more than doubled in the last decade.
Synthetic opioid overdose deaths: 31,335 Americans died from synthetic opioid overdoses in 2018, a rate of 9.9 deaths per 100,000. That’s a rate 10 percent higher than 2017 when 28,466 Americans died of synthetic opioids overdoses (9.0 deaths per 100,000). The rate of synthetic opioid overdose deaths has increased almost 900 percent over the last five years.
Cocaine overdose deaths: 14,666 Americans died from cocaine overdoses in 2018, a rate of 4.5 deaths per 100,000. That rate is 5 percent higher than 2017, when 13,942 Americans died of cocaine overdoses (4.3 deaths per 100,000). The rate of cocaine overdose deaths has increased by almost three-fold over the past five years.
Psychostimulant overdose deaths: 12,676 Americans died from psychostimulants in 2018, a rate of 3.9 deaths per 100,000. That’s a rate 22 percent higher than 2017, when 10,333 Americans died from psychostimulant overdoses (3.2 deaths per 100,000). The rate of psychostimulants overdose death has increased by more than three-fold over the past five years.Additional annual data (1999-2018) and state-level data on drug overdose death can be found below.“While we have some cause for celebration, now is not the time to become complacent,” said Benjamin F. Miller, PsyD, chief strategy officer, Well Being Trust. “It’s been important to focus on harm reduction and saving lives—but policy and investments must go further to reduce what’s driving despair and prevent substance misuse issues and suicidal ideation from developing in the first place. No one policy will solve this crisis we’re facing as a country—what is need is a comprehensive, actionable framework for policy makers.”“These new data suggest efforts to reduce opioid deaths are starting to take hold, particularly by reducing inappropriate opioid prescribing and expanding treatment options,” said John Auerbach, President and CEO of the Trust for America’s Health. “These data show we can make a positive difference when we adopt evidence-based approaches and expand the available resources. But we need to expand that approach to prevent suicides and address all forms of substance misuse. That requires a comprehensive approach that pays attention to the upstream root causes, like childhood trauma, poverty and discrimination,”Over the last four years, Trust for America’s Health (TFAH) and Well Being Trust (WBT) have released as series of reports on “deaths of despair” called Pain in the Nation: The Drug, Alcohol and Suicides Epidemics and the Need for a National Resilience Strategy, which include data analysis and recommendations for evidence-based policies and programs that federal, state, and local officials.
Drug Overdose Deaths, 1999-2018 (Rates age-adjusted)
Year
Deaths
Deaths per 100,000
1999
16,849
6.1
2000
17,415
6.2
2001
19,394
6.8
2002
23,518
8.2
2003
25,785
8.9
2004
27,424
9.4
2005
29,813
10.1
2006
34,425
11.5
2007
36,010
11.9
2008
36,450
11.9
2009
37,004
11.9
2010
38,329
12.3
2011
41,340
13.2
2012
41,502
13.1
2013
43,982
13.8
2014
47,055
14.7
2015
52,404
16.3
2016
63,632
19.8
2017
70,237
21.7
2018
67,367
20.7
Source National Vital Statistics System, National Center for Health Statistics
2018 Drug Overdose Deaths by State
State
Deaths
Deaths per 100,000
Alabama
775
16.6
Alaska
110
14.6
Arizona
1670
23.8
Arkansas
444
15.7
California
5348
12.8
Colorado
995
16.8
Connecticut
1069
30.7
Delaware
401
43.8
DC
254
35.4
Florida
4698
22.8
Georgia
1404
13.2
Hawaii
213
14.3
Idaho
250
14.6
Illinois
2722
21.3
Indiana
1629
25.6
Iowa
287
9.6
Kansas
345
12.4
Kentucky
1315
30.9
Louisiana
1140
25.4
Maine
345
27.9
Maryland
2324
37.2
Massachusetts
2241
32.8
Michigan
2591
26.6
Minnesota
636
11.5
Mississippi
310
10.8
Missouri
1610
27.5
Montana
125
12.2
Nebraska
138
7.4
Nevada
688
21.2
New Hampshire
452
35.8
New Jersey
2900
33.1
New Mexico
537
26.7
New York
3697
18.4
North Carolina
2259
22.4
North Dakota
70
10.2
Ohio
3980
35.9
Oklahoma
716
18.4
Oregon
547
12.6
Pennsylvania
4415
36.1
Rhode Island
317
30.1
South Carolina
1125
22.6
South Dakota
57
6.9
Tennessee
1823
27.5
Texas
3005
10.4
Utah
624
21.2
Vermont
153
26.6
Virginia
1448
17.1
Washington
1164
14.8
West Virginia
856
51.5
Wisconsin
1079
19.2
Wyoming
66
11.1
Source National Vital Statistics System, National Center for Health Statistics
# # #
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. @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 @WellBeingTrust
On November 18th, 2019, Trust for America’s Health held a briefing for congressional staff and partners that reviewed the latest obesity rates and trends, the role of public health and other stakeholders in preventing, treating and responding to obesity and its comorbidities, highlighted promising approaches to ensure healthy communities, and offered evidence-based policy recommendations that could help all Americans lead healthier lives.
Briefing speakers included:
John Auerbach, MBA, President and CEO, Trust for America’s Health
Devita Davison, Executive Director, FoodLab Detroit
Martha Halko, MS, RD, LD, Deputy Director of Prevention & Wellness, Cuyahoga County (Ohio) Board of Health
Ruth Petersen, MD, MPH, Director, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control & Prevention (CDC)
Vaping among teens also increasing at an alarming rate.
(Washington, DC and Oakland, CA – October 29, 2019) – Adolescent suicides have spiked over the last decade and substance misuse including vaping is exacting a heavy toll on teens according to a report released today by Trust for America’s Health (TFAH) and Well Being Trust (WBT).
Suicide rates among 12- to 19-year-olds have increased 87 percent between 2007 and 2017 (when the most recent data is available) – making suicide the second leading cause of death among adolescents. In 2017, 7.4 percent of high schoolers nationwide attempted suicide within the preceding 12 months – a 17 percent increase from the previous year. Nearly 3,000 12- to 19-year-olds died by suicide in 2017.
“We know strategies that are proven to work and can improve mental health and well-being among our young people,” said Benjamin F. Miller, PsyD, chief strategy officer, WBT. “From Zero Suicide to Youth Mental Health First Aid to LifeSkills Training programs and dozens of other initiatives, there are solutions out there – why this is not the first question of every Presidential debate, prioritized in Congress, and in every state legislature is beyond me. Our country has failed to devote the time, energy, and resources to our youth.”
An additional area of concern threatening youth well-being is vaping—with rates of use among adolescents climbing dramatically. In just one year, 2017 to 2018, e-cigarette use by high school students increased by 78 percent and by 48 percent among middle school students. More teens are also reporting vaping marijuana.
While there is some good news – rates of illicit or injection and prescription drug use among adolescents have declined or held steady among 12- to 17-year-olds since 2002 – but those rates are still too high and cause serious harm and disruption to young lives. In 2017, 5,455 young people between the ages of 15 to 24 died due to a drug overdose.
Alcohol use among adolescents has also declined. Past month alcohol use among 12- to 17-year-olds declined from 18 percent in 2002 to 10 percent in 2017 and lifetime alcohol use among high school students has declined from 82 percent in 1991 to 60 percent in 2017.
Substance misuse and suicide disproportionately affect adolescents from certain population groups
Of additional concern are large disparities in substance misuse rates and suicide based on teens’ race, ethnicity, socioeconomic status, sexual orientation/gender identification or where they live. Most striking is the high risk for substance misuse and suicide-related behaviors among gay, lesbian and bisexual adolescents. Forty-eight percent of gay, lesbian and bisexual adolescents report considering or attempting suicide as compared to 13 percent of their heterosexual peers. These high rates of suicide risk for sexual minority teens are likely due to stressors they experience including discrimination, bullying, violence and family rejection, according to the report.
American Indian/Alaskan Native teens experience the highest rates of suicide among any race and ethnicity in the United States: 16 suicides per 100,000 15- to 19-years-olds in 2016 – a rate 60 percent higher than the national average for all teens. The high rates of substance misuse and suicide among American Indian/Alaskan Native teens are likely associated with the historical and intergenerational trauma experienced by their community as well as the lack of education and economic opportunities typically available to them.
Solutions do exist and need implementation
Adolescence is a critical juncture in teens’ lives. This report highlights the many opportunities to set youth on healthy pathways be increasing the life circumstances that protect them from harm.
The report highlights dozens of evidence-based programs in place in communities across the country that help reduce risk and build protective factors in teens’ lives by strengthening families, providing counseling and mentorship, teaching social and emotional skills, fostering connectedness, particularly in schools, and working across sectors. Most importantly, addressing the factors that create or reduce risk for substance misuse or mental health issues will not only reduce negative impact on teens’ health, it will also improve outcomes in other sectors such as high school graduation rates or involvement with the juvenile justice system.
“Adolescence is a challenging time when the impact of poverty, discrimination, bullying and isolation can be intense,” said John Auerbach, President and CEO of Trust for America’s Health. ” Fortunately, there are policies and programs that can reduce some of these circumstances and the risks associated with them by strengthening teens’ coping and emotional skills – skills that can improve their health and lead to their succeeding in school.”
Recommendations for programs and policy actions
The report includes recommendations for policy actions at the federal, state and local level.
Among the specific recommendations are:
The federal government and state legislatures should create and/or scale up policies that support families including increases to federal and state earned income tax credits and programs that provide access to health insurance and affordable housing.
Congress should increase funding for substance misuse and suicide prevention including Project AWARE and the Garrett Lee Smith State/Tribal Youth Suicide Prevention and Early Intervention Grant program.
States should expand Medicaid services in schools using flexible models such as school-employed providers, school-based health centers and telehealth.
Congress should increase investments in the Centers for Disease Control and Prevention’s Division of Adolescent and School Health.
All youth-serving systems should adopt trauma-informed and culturally competent policies and practices and should engage youth leaders in program development.
Federal, state and local efforts to improve school safety should include strategies to prevent school violence by investing in safe and supportive school environments and mental health services.
Public and private funders should incentivize strategies that address common risk/protective factors across all adolescent serving sectors.
The report is part of the TFAH/WBT Pain in the Nation publication series, launched in 2017 and examining substance misuse and suicide trends and evidence-based policies and programs in an effort to promote a comprehensive approach to solving the nation’s deaths of despair crisis. The report series is designed to focus attention on the need for national resilience strategy.
####
Trust for America’s Healthis 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
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.
Healthy eating among families and communities promotes optimal health and well-being. However, approximately three-fourths of Americans do not consume the recommended amounts of healthy foods, such as fruits and vegetables, set by the 2015-2020 Dietary Guidelines for Americans.
A healthy daily diet is linked to reduced risk for obesity, diabetes, hypertension, and other preventable chronic illnesses. But, despite efforts to promote healthy eating, communities across the U.S. continue to face barriers to accessing healthy foods.
Produce Rx
In 2012, DC Greens, a food justice non-profit located in Washington, DC, launched a pilot program called Produce Rx which began as a small-scale partnership between health care clinics and local farmer’s markets. The vision, like that of similar efforts across the country, was to increase patients’ access to fresh produce and empower them to make healthier food choices in order to manage and improve their health.
A sample prescription a doctor might provide for Produce Rx.
As part of the program, patients facing food insecurity and living with diet-related chronic disease enrolled in a six-month group nutrition class at a local health clinic, where they received monthly nutrition education and seasonal recipe demonstrations and had a check-in with a healthcare provider. Additionally, they received a “prescription” in the form of a voucher from the healthcare provider to purchase fresh produce from their local farmer’s market.
Community members who participated in the Produce Rx program showed significant improvements in health outcomes, such as lower BMI among 50 percent of the participants. In addition, 85 percent of the program participants reported improved patient-provider relationships.
Expansion and Growth
In March 2019, DC Greens, with funding support from the DC Department of Health and AmeriHealth Caritas, the largest Medicaid managed care organization in the District with more than 100,000 members, established a new partnership with Giant Food – the only grocery store located in D.C.’s Ward 8. The Ward 8 neighborhood has some of the highest income, educational, health, and racial and ethnic disparities among all of the District’s 8 wards – creating an opportunity to support D.C. residents with the greatest need through a new expanded model of the Produce Rx program.
D.C.’s Ward 8 is known as a “food desert” due to the limited number of retailers selling fresh, affordable produce, and the fact that the community faces disproportionate rates of people with diet-related chronic conditions. Moreover, Ward 8 has the highest rates of death due to diabetes and heart disease within the city.
“There is a myth that people living in poverty don’t want healthy food. We know this isn’t true,” says Lauren Shweder Biel, Executive Director of DC Greens. “people simply lack the resources to get the healthy foods that they want and that they need. With Produce Rx, we’ve been able to give patients a way to follow their doctors’ medical advice.”
“Giant Food is excited about the positive impact the Produce Rx program has had at our Alabama Avenue store,” said Ira Kress, interim President at Giant Food. ” As a food retailer, with roots in Washington, D.C. dating back 83 years, we recognize the important role we can play in the access to healthy foods and health education in our community, and this program has been a natural fit.”
With the new partnership Produce Rx participants will have access to fresh fruit and vegetables year-round. The program will expand its services to 500 AmeriHealth Medicaid participants who will receive a $20 voucher every week to purchase produce at their neighborhood Giant.
Produce Rx patient Adrienne Dove exchanges her prescription for a voucher for produce from Giant Food Pharmacy Manager Adaoma Chinweuba.
“AmeriHealth Caritas DC is committed to helping our members, especially those with chronic health conditions, improve their overall health by adding more fruits and vegetables to their daily diet,” said Keith Maccannon, Director of Community Relations and Outreach at AmeriHealth Caritas DC. “Collaboration with community-based organizations and businesses like DC Greens and Giant Food are a key component of our strategy in this area.”
Participants in this program will also have access to personal-level nutrition education at their health clinic and through Giant’s in-store nutritionist and AmeriHealth’s nutrition and wellness programs.
“Pairing nutrition education with produce access is essential for helping our customers unlock the power of produce,” said Jillian Griffith, Giant Food in-store nutritionist. “It is one thing to be instructed by a medical provider to eat more fruits and vegetables, but it’s another to have an in-store nutritionist available to share plant-based recipe ideas or new produce pairings for traditional family favorites. I am so grateful for the opportunity to teach Produce Rx participants the role food plays in their overall health while empowering them with the “produce tools” needed to meet dietary recommendations.”
Through these services, Produce Rx is making healthy food options more affordable and accessible for both individuals and their families.
“The program has impacted me and my family because we found we are eating healthier, losing more weight, and needing less medication than we used to,” said Adrienne Dove, a participant in the program. “I count my spending to make sure I don’t go over on food, but now I can buy healthier options, like spinach and broccoli, that my son wants to try, from the grocery store right around the corner.”
Next Steps
This next iteration of Produce Rx will run for a year, allowing DC Greens to conduct a robust evaluation of its effectiveness by measuring key behavior changes, health outcomes, and tracking health care costs among program participants. Currently, DC Greens administers Produce Rx but with this evaluation they hope to build the case for scalable and sustainable investments in these programs by the healthcare system.
(From left to right) Kevin O’Donnell (Giant Food District Pharmacy Manager), Adaoma Chinweuba (Giant Food Pharmacy Manager), Adrienne Dove (Produce Rx Patient) Samir Balile (Giant Food Clinical Programs Specialist).
“We are working to integrate ‘food as medicine’ as a key component of clinical care, but we know that the only way to truly scale a program like this is to prove a return on investment for the healthcare system,” says Biel. “With AmeriHealth Caritas and DC Health at our side, we believe this program is poised to demonstrate the impact that ‘food as medicine’ can have on individual health and patient utilization of the healthcare system.”
More Investment in Policies and Programs to Support Food Access and Healthy Choices is Needed
Continued investments in local, state, and federal policies and programs are critical for improving nutrition and health, especially among low-income and underserved communities that face limited access to affordable, fresh produce. More research is needed to definitively demonstrate the impact that DC Greens Produce Rx and other innovative programs are having on health and healthcare services usage. But the preliminary findings are promising.
“With the obesity crisis getting worse, we need to have a comprehensive and multi-faceted approach to changing the conditions that make it difficult for people to eat a healthful diet. Such an approach includes initiatives like DC Produce Rx with its focus on reducing the financial barriers to accessing healthy foods as well as providing culturally and linguistically tailored educational information,” said John Auerbach, President and CEO of Trust for America’s Health.
From community-based programs that test new strategies like Produce Rx to federal programs such as the Supplemental Nutrition Assistance Program for Woman, Infants, and Children (WIC) access to nutritious, affordable foods can help communities live healthier lives. As the nation experiences growing rates of obesity and other chronic diseases, it’s important for policymakers to continue supporting innovative solutions that address the root causes of preventable disease.
Report Calls for Sugary Drink Taxes, Expanded SNAP and WIC Nutrition Support Programs and a built environment that encourages physical activity to Help Address Health Crisis
(Washington, DC – September 12, 2019) – Nine U.S. states had adult obesity rates above 35 percent in 2018, up from seven states at that level in 2017, an historic level of obesity in the U.S., according to the 16th annual State of Obesity: Better Policies for a Healthier America report released today by the Trust for America’s Health (TFAH).
The report based in part on newly released data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), and analysis by TFAH, provides an annual snapshot of obesity rates nationwide. The State of Obesity series and this report were made possible by funding from the Robert Wood Johnson Foundation.
Obesity has serious health consequences including increased risk for type 2 diabetes, high blood pressure, stroke and many types of cancers. Obesity is estimated to increase national healthcare spending by $149 billion annually (about half of which is paid for by Medicare and Medicaid) and being overweight or obese is the most common reason young adults are ineligible for military service.
Obesity rates vary considerably between states with Mississippi and West Virginia having the highest level of adult obesity in the nation at 39.5 percent and Colorado having the lowest rate at 23.0 percent.
For the first time, adult obesity rates were above 35 percent in nine states in 2018: Alabama, Arkansas, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota and West Virginia.
As recently as 2012, no state had an adult obesity rate over 35 percent and within the last five years (2013 and 2018) 33 states had statistically significant increases in their rates of adult obesity.
“These latest data shout that our national obesity crisis is getting worse,” said John Auerbach, President and CEO of Trust for America’s Health. “They tell us that almost 50 years into the upward curve of obesity rates we haven’t yet found the right mix of programs to stop the epidemic. Isolated programs and calls for life-style changes aren’t enough. Instead, our report highlights the fundamental changes that are needed in the social and economic conditions that make it challenging for people to eat healthy foods and get sufficient exercise.”
Differential Impact Amongst Minority Populations
The report highlights that obesity levels are closely tied to social and economic conditions and that individuals with lower incomes are more at risk. People of color, who are more likely to live in neighborhoods with few options for healthy foods and physical activity, and, are the target of widespread marketing of unhealthy foods, are at elevated risk.
As of 2015-2016, the latest available data, nearly half of Latino (47 percent) and Black adults (46.8) had obesity while adult obesity rates among White and Asian adults were 37.9 percent and 12.7 percent respectively. Incidence of childhood obesity was highest amongst Latino children at 25.8 percent while 22 percent of Black children had obesity, 14 percent of White children had obesity and 11 percent of Asian children had obesity.
What Could Work?
While the obesity rates are alarming, there are new data offering the promise of policies that combat the epidemic, namely promoting healthier food for children through revamped WIC food packages and fostering behavior change through taxes on sugary drinks.
Obesity rates for children enrolled in WIC (Special Supplemental Nutrition Program for Women, Infants and Children) continue to decline, from 15.9 percent in 2010 to 13.9 percent in 2016. In 2009, the USDA updated WIC food packages to more closely meet recommended national dietary guidelines including the addition of more fruits, vegetables and whole grains and reduced fat levels in milk and infant formula. A Los Angeles County study published this year found that 4-year-olds who had received the revised WIC food package since birth had reduced risk for obesity.
A number of U.S. cities and the Navajo Nation have passed local taxes on sugary drinks that are showing promise as a means to change consumers’ beverage habits. Studies of a 1-cent per ounce tax in Berkeley, California and a 1.5 cent per ounce tax in Philadelphia, Pennsylvania found that the consumption of sugary drinks decreased significantly after the tax was imposed.
“Policies such as these are proving effective in changing behavior. But, no single solution – however promising – is sufficient. Obesity is a complex problem and will need multi-sector, multi-factor solutions,” said TFAH’s Auerbach.
“Creating the conditions that allow people to more easily make healthy choices is central to preventing obesity, as is prioritizing investment in those communities most affected by the crisis,” Auerbach said.
Recommendations for Policy Action
The report includes 31 recommendations for policy action by federal, state and local government, across several sectors, designed to improve access to nutritious foods and provide safe opportunities for physical activity, while minimizing harmful marketing and advertising tactics.
Among the report’s recommendations for policies to address the obesity crisis are:
Expand the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) to age 6 for children and for two years postpartum for mothers and 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.
Ensure that CDC has enough funding to grant every state appropriate funding to implement evidence-based obesity prevention strategies (currently, CDC only has enough funding to work with 16 states).
Make it more difficult to market unhealthy food to children by ending federal tax loopholes and business costs deductions related to the advertising of such foods to young audiences.
Fully fund the Student Support and Academic Enrichment program and other federal programs that support student physical education.
Encourage safe physical activity by funding Safe Routes to Schools (SRTS), Complete Streets, Vision Zero and other pedestrian safety initiatives through federal transportation and infrastructure funding.
Ensure that anti-hunger and nutrition-assistance programs, like the Supplemental Nutrition Assistance Program (SNAP), WIC, and others follow the Dietary Guidelines for Americans and make access to nutritious food a core program tenet.
Strengthen and expand school nutrition programs beyond federal standards to include universal meals, flexible breakfasts and eliminate all unhealthy food marketing to students.
Enforce existing laws that direct most health insurers to cover obesity-related preventive services at no-cost sharing to patients.
Cover evidence-based comprehensive pediatric weight management programs and services in Medicaid.
State by State rates of adult obesity – highest to lowest
Tie: Mississippi and West Virginia (39.5%), 3. Arkansas (37.1%), 4. Louisiana (36.8%), 5. Kentucky (36.6%), 6. Alabama (36.2%), 7. Iowa (35.3%), 8. North Dakota (35.1%), 9. Missouri, (35.0%), 10. –Tie: Oklahoma and Texas (34.8%), 12. – Tie: Kansas and Tennessee (34.4%), 14. South Carolina (34.3 %), 15. –Tie: Indiana and Nebraska (34.1%), 17. Ohio (34.0%), 18. Delaware (33.5%), 19 –Tie: Michigan, North Carolina (33.0), 21. Georgia (32.5%), 22. New Mexico (32.3%), 23. Wisconsin (32.0%), 24. Illinois (31.8%), 25. –Tie: Maryland and Pennsylvania (30.9%), 27. Florida (30.7%), 28 –Tie: Maine and Virginia (30.4%), 30.Tie: Minnesota and South Dakota (30.1%), 32. Oregon (29.9 %), 33. New Hampshire (29.6%), 34.Three-way Tie: Alaska, Arizona and Nevada (29.5%), 37. Wyoming (29.0%), 38. Washington (28.7%), 39. Idaho (28.4%), 40. Utah (27.8%), 41. Rhode Island (27.7%), 42. New York (27.6%), 43. Vermont (27.5%), 44. Connecticut (27.4%), 45. Montana (26.9%), 46. California (25.8%), 47. –Tie: Massachusetts and New Jersey (25.7%), 49. Hawaii (24.9%), 50. District of Columbia (24.7%), 51. Colorado (23.0%).
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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
