Issue Category: Public Health Funding

May is National Physical Fitness & Sports Month

Physical activity across the lifespan supports good health and well-being and is a key health behavior for healthy aging. For National Physical Fitness & Sports Month Trust for America’s Health (TFAH) is sharing the following reports and resources with a focus on evidence-based programs and policies that if enacted or expanded will help all residents be physically active and enjoy optimal health and well-being.

The State of Obesity: Better Policies for a Healthier America, 2018: This report highlights the latest obesity trends, policies, programs, and practices that can reverse the obesity epidemic, and includes key recommendations for specific actions. New studies documenting national obesity rates and trends reinforce what we already know: obesity rates are alarmingly high; sustained, meaningful reductions have not yet been achieved nationally; and racial, ethnic, and geographic disparities persist. Policies and programs like the National Diabetes Prevention Program, community-based programs, safe routes to school, school-based physical education and physical activity, and complete streets policies play a key role in increasing physical activity and reversing the obesity epidemic.

Promoting Health and Cost Control: How States Can Improve Community Health and Well-Being Through Policy Change: This new report considers the important ways life circumstances outside the healthcare sector impact health. It recommends 13 policy actions that data show if enacted by states would improve health and well-being for community residents. Complete street polices are one way to promote physical activity and connectedness. Complete streets are streets that provide safe and comfortable means of transport for all users including walkers, bikers and people driving cars. Moreover, enacting complete streets and other complementary streetscape design policies can not only improve the physical well-being of individuals, but also help avoid costs for public (Medicaid and Medicare) and private payers.

Countering Childhood Obesity in Georgia: Georgia Shape, a statewide multifaceted initiative, seeks to advance the health and well-being of children by utilizing a cross-sectors approach to tackle childhood obesity in the state. Through the development of community-wide interventions, particularly Georgia Shapes’ ‘Power Up for 30’ program, rates of childhood obesity in Georgia have started to decrease. The Center for Disease Control and Prevention recognizes school-based programs to increase physical activity, such as ‘Power Up for 30’, as one of fourteen non-clinical community-wide interventions that can lead to cost-effective and cost-saving health outcomes within five years.

President’s Proposed FY20 Budget Will Harm the Nation’s Public Health

Washington, D.C., March 11, 2019 – Statement from John Auerbach, president and CEO, Trust for America’s Health (TFAH).

Auerbach on the President’s Budget Proposal:

“The President’s proposed budget – which includes a 12 percent cut to the Department of Health and Human Services (HHS) budget and an approximate 10 percent cut to the CDC – would be harmful to the nation’s public health and safety.  States and communities are grappling with increasing healthcare costs, rises in premature deaths due to chronic disease, substance misuse and suicide, and an increased threat of weather-related emergencies.  These realities have created unprecedented demands on our already under-resourced public health infrastructure. Now is the time to strategically increase investments in public health programs and infrastructure, not cut them.”

Auerbach on the consequences of spending caps:

“This proposed budget shows the potential consequences if Congress fails to raise spending caps this year. Health agencies and programs are a continuum.  If we decrease investments in prevention and detection of diseases, we can expect higher costs for treatment and response. We urge Congress to reject the proposed budget and work toward a spending package that invests in America’s health.”

Auerbach on diverted resources:

“We are also deeply concerned by the recent report that HHS has diverted an additional $385 million from other programs to increase shelter capacity for unaccompanied migrant children. These programs can’t afford any further diversions. The $14 million being taken from the Centers for Disease Control and Prevention (CDC), for example, is more than the agency’s budget for activities around climate change, unintentional injuries, or healthcare associated infections.”

TFAH urges Congress and the Administration to work to raise the budget caps and enact appropriations bills that reflect the health needs of our population.  Our specific concerns about the proposed budget include:

An approximate 10 percent reduction to CDC’s overall program budget. The budget request proposes about $750 million in spending cuts to CDC’s program level, compared with FY19.

Proposed CDC program cuts include:

  • Cuts to programs to prevent chronic conditions down by approximately 20 percent – including programs to address obesity, diabetes, cancer, heart disease and stroke. These diseases are the leading causes of death and healthcare costs in the U.S.; decreasing our investment in their prevention would be short-sighted.
  • Cuts to programs to protect health from environmental threats such as lead poisoning and asthma made worse by air quality – down approximately 25 percent.
  • Cuts to programs to prevent birth defects down by approximately 28 percent.
  • Inadequate funding to prevent substance misuse and suicide – Deaths from alcohol, drugs and suicide are at an all-time high,1 yet the budget proposes cuts or level funding for many substance misuse and suicide prevention activities at the Substance Abuse and Mental Health Services Administration and CDC.

The creation of a comprehensive HIV strategy.

Trust for America’s Health applauds the bold goal to end the U.S. HIV epidemic by 2030, but an increased investment in the domestic response to HIV should not come at the expense of efforts to combat other infectious diseases, chronic diseases or environmental threats. At the same time, administrative and legal changes to the ACA and Medicaid are likely to reduce HIV patient access to care.

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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.

1. Trust for America’s Health and Well Being Trust. Pain in the Nation Update: While Deaths from Alcohol, Drugs, and Suicide Slowed Slightly in 2017, Rates Are Still at Historic Highs, March 5, 2019. https://www.tfah.org/report-details/pain-in-the-nation-update-while-deaths-from-alcohol-drugs-and-suicide-slowed-slightly-in-2017-rates-are-still-at-historic-highs/

TFAH Applauds Passage of FY19 Labor-HHS-Education Appropriations Bill

September 26, 2018 — Trust for America’s Health (TFAH) applauds Congress for today’s passage of the FY19 Labor-HHS-Education Appropriations bill, which includes a $126 million increase for the Centers for Disease Control and Prevention (CDC). By completing the bill before the end of the fiscal year, Congress is ensuring that state and local health departments and other grantees can continue their critical work protecting the public’s health without fear of gaps in their grant cycles.

The now passed FY19 funding will enable CDC to continue its important work helping communities prepare for natural disasters and other emergencies, as is happening now in the aftermath of Hurricane Florence. The appropriations include a small increase to enable communities to continue working to address health disparities through the Racial and Ethnic Approaches to Community Health (REACH) program. It also continues funding focused on environmental health, and for the CDC’s critical work addressing the substance misuse crisis.

“By working together on a bipartisan basis Congress has provided a much-needed funding increase to the Centers for Disease Control and Prevention. This increase is an important down payment on the investment required to ensure the public health system is fully prepared to tackle the health threats facing the nation,” said John Auerbach, TFAH’s President and CEO.

For years we have underfunded our nation’s public health system, which only leads to increased healthcare spending when illness and injury occur. According to TFAH’s report, A Funding Crisis for Public Health and Safety, core funding for disease prevention and health promotion programs has declined by approximately $580 million federally and has remained flat in states since 2010.

“The country needs a long-term commitment to rebuilding the nation’s public health capacity. Not just to filling some of the more dangerous gaps, but to ensuring that all communities are prepared and resilient when emergencies happen. TFAH hopes that Congress will work together again next year to raise the budget caps which kept critically important health spending at levels below those of fiscal year 2010,” Auerbach said.

Earlier this year, Auerbach testified before the House Labor-HHS Appropriations Committee about the importance of public health funding. His testimony can be found here.

The Draft House Farm Bill Will Harm Nation’s Most Vulnerable

Washington, D.C., April 12, 2018 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH) on release of “Farm Bill” draft legislation (the Agriculture and Nutrition Act of 2018 (H.R. 2)) to reauthorize key federal agricultural and nutrition programs.

“The Trust for America’s Health is seriously concerned about the draft Farm Bill legislation released today by the House Agriculture Committee, noting that many proposals could weaken or eliminate coverage and benefits under the Supplemental Nutrition Assistance Program (SNAP).

While immediate savings may seem beneficial now, they will evaporate quickly when the nation gets the bill for poor health and nutrition. In addition, when children are hungry they do more poorly in schools and, when adults are under-nourished, they are less productive in their jobs.   As such, SNAP and other nutrition assistance programs can help curb healthcare costs in the future while providing immediate economic benefits to communities.

Increasingly, states, cities and other partners are piloting and scaling programs and policies that help SNAP recipients access healthier food options. Proposals that would roll back eligibility and otherwise shrink enrollment will create new health risks for a population of Americans that are already at greater risk of malnutrition. And, without nutrition supplemental programs like SNAP there may actually be increases in obesity because families will be forced to buy the least expensive food, which are often filled with excess calories and have low nutritional value.

According to State of Obesity, obesity remains a significant public health crisis and a national security issue—being overweight or obese is the leading cause of medical disqualifications for military service, with nearly one-quarter of applicants being rejected for exceeding the weight or body fat standards.

Quite simply, while this legislation will directly harm our nation’s most valuable and vulnerable, everyone will shoulder the pain—from lack of education attainment to lack of economic development to lack of national security.

TFAH looks forward to working with Congress and partners to help develop a Farm Bill that will benefit, not harm, Americans’ health.”

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

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New Report: Funding for Public Health Has Declined Significantly since the Great Recession

Core Federal Emergency Preparedness Funding has been cut by More than One-Third Since FY 2002

Washington, D.C., March 1, 2018 – A new Trust for America’s Health (TFAH) analysis—A Funding Crisis for Public Health and Safety: State-by-State and Federal Public Health Funding Facts and Recommendations—finds spending on public health is insufficient.

“A healthy United States is a strong United States. A prepared nation is a safe nation. But persistent underfunding of the country’s public health system has left the nation vulnerable,” said John Auerbach, president and CEO, of TFAH. “The country needs a long-term commitment to rebuild the nation’s public health capabilities – not just to plug some of the more dangerous gaps but to make sure each community will be prepared, responsive and resilient when the unexpected occurs.”

Flat Federal Funding

In Fiscal Year (FY) 2017, the U.S. Centers for Disease Control and Prevention’s (CDC) budget was $7.1504 billion ($21.95 per person). Adjusting for inflation, CDC’s core budget—not including the Prevention and Public Health Fund—has been essentially flat for the last decade.

Because much of CDC’s budget is distributed to states and localities, the impact of budget cuts is experienced directly at the state and local level. Of the roughly 75 percent of CDC funds that go to states and local communities, support ranges from a low of $5.74 per person in Missouri to a high of $114.38 per person in Alaska.

In addition, 12 percent of CDC’s budget consists of the Prevention and Public Health Fund, with about $625 million a year of that directed to state and local efforts. From FY 2013 through FY 2027, the Prevention Fund will receive nearly $12 billion less than the law intended.

Within CDC, the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Program is the only federal program that supports the work of state and local health departments to prepare for and respond to emergencies. Except for one- time, short-term funding to contain the Ebola and Zika viruses, core emergency preparedness funding has been cut by more than one-third (from $940 million in FY 2002 to $667 million in FY 2017) since the program was established.

State Public Health Funding Declining

Spending for public health by states has been declining.  Based on a TFAH analysis (adjusted for inflation), 31 states made cuts to their public health budgets from FY 2015-2016 to FY 2016-2017.  Only 19 states and Washington, D.C. maintained or increased their budgets, making it hard for states to compensate for reduced federal funding.

According to the report, state public health spending is actually lower in 2016-2017 than it was in 2008-2009, as some of the funding cuts that occurred during the Great Recession have not been fully restored—and federal funding has been essentially flat (almost half of state public health spending comes from federal funds).

Local Public Health Funding Decreasing

Since 2008, local health departments (LHDs) have lost 55,590 staff due to layoffs or attrition. In addition, about 25 percent of LHDs reported a lower FY 2016 budget than the previous year, with fewer LHDs reporting an increase in their budget for the current year as compared to the previous.

Recommendations

“Each year, we issue this report to examine the amount of public health funding each state receives and provide an independent analysis of how communities protect the public’s health. With life expectancy declining in the U.S. for the second year in a row—something unheard of in recent memory—policymakers must take the public’s health seriously and allocate the funds needed to improve well-being and prevent illness and injury,” said Auerbach.

The report includes eight key recommendations:

  1. Increase Funding for Public Health – at the Federal, State and Local Levels
  2. Preserve the Prevention and Public Health Fund
  3. Prepare for Public Health Emergencies and Pandemics
  4. Establish a Standing Public Health Emergency Response Fund
  5. Build a National Resilience Strategy to Combat Deaths of Despair
  6. Prevent and Reduce Chronic Disease
  7. Support Better Health and Top Local Priorities in Every Community
  8. Expand the Use of Evidence-Based, High-Impact Strategies to Improve Health in Every Community

The brief was supported by a grant from the Robert Wood Johnson Foundation (RWJF).

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

 

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