Issue Category: Public Health Funding

What If Congress Adequately Funded Public Health?

You know the old adage, ‘those that don’t learn from history are doomed to repeat it.’ Coming off the COVID-19 public health emergency that has thus far claimed the lives of 1.2 million Americans, there are discussions in Congress to significantly cut funding for public health initiatives to dangerously low levels – again. And it doesn’t have to be like this.

Why do we go through these bleak cycles when anchoring public health in policymaking is a win-win decision for everyone – from elected officials to individual constituents.

Federal public health funding is facing challenges on multiple fronts right now. Congress continues to negotiate appropriations bills for the 2024 fiscal year, which will have major implications for the next fiscal year and beyond. The current short-term funding agreement for Health and Human Services expires on March 22. If Congress passes another continuing resolution rather than new appropriations, it could trigger extreme, across-the-board cuts to non-defense spending.

First, continuing resolutions, which are short-term measures to fund the government at the previous year’s levels, negatively impact the systems we need to protect the nation’s health. And severe cuts triggered by failing to pass a long-term spending bill would be even more dangerous. TFAH has joined more 1,000 other organizations in urging Congress to pass a full-year funding bill using the bipartisan framework laid out in the Senate as a starting point for negotiations.

Secondly, the FY2024 bills proposed by the House and Senate for Labor, Health and Human Services, Education and Related Agencies – the main funding source for public health programs – are vastly different and neither addresses the chronic underfunding of public health. Congress has already rescinded hundreds of millions of dollars intended to shore up the public health workforce and readiness and response efforts. The Senate’s bill proposes a small cut to the Centers for Disease Control and Prevention (CDC), and the House version would cut about $1.6 billion from CDC’s budget. TFAH and partners have called for a $2.5 billion increase for CDC.

Finally, we continue to see proposals to cut the Prevention and Public Health Fund, a critical investment in programs ranging from immunizations to tobacco use prevention. If these proposals were to move forward, this would again push public health funding into the “bust” phase of a decades long “boom and bust” funding pattern.

The health, safety, and well-being of individuals and communities should be at the foundation of U.S. policy and be funded accordingly.

Imagine if we fully invested in the prevention of adverse childhood experiences, suicide, and substance misuse. Many communities would see suicide and overdose rates fall.

Imagine if we prevented the root causes of death, injury, and excess healthcare costs instead of spending trillions of dollars to treat preventable chronic conditions. Workers would be healthier and more productive, employers would face fewer financial burdens, and the nation would be more resilient and thriving.

Imagine if CDC, state, local, tribal, and territorial health departments had modern data systems instead of rudimentary spreadsheets to track the spread of diseases. This country could contain potential outbreaks in their earliest stages and save lives.

Much of our health and well-being is determined by economic, environmental, and societal factors. In the midst of a recent and troubling decrease in life expectancy, TFAH believes that investing in the foundations of public health and effective prevention programs is a critical and indispensable path forward to protecting and promoting the health of the nation.

 

 

 

 

TFAH’s President and CEO Dr. Gracia Discusses the Significance of Dr. Martin Luther King Jr. Day & National Day of Racial Healing

(Washington, DC – January 15, 2024) – This week TFAH’s President and CEO, Dr. J. Nadine Gracia and Director of Strategic Communications and Policy Research Rhea Farberman discussed the significance of two important observances, Dr. Martin Luther King Jr. Day and the National Day of Racial Healing. The conversation focused on the intersections between Dr. King’s mission to advance social justice and TFAH’s work to promote optimal health. Also discussed were the ways in which structural racism creates barriers to good health for many people of color and the policy actions needed to dismantle those barriers.

“What we know, especially in thinking about this in terms of Dr. Martin Luther King, Jr. Day and the National Day of Racial Healing, is that for too many people of color and communities of color there has been, over many decades, a disadvantage in terms of access to health promoting resources.”

“We have to act with a sense of urgency because the health, well-being and prosperity of our nation depends on it.  That’s the call that I believe Dr. King would challenge us to continue, to strive for and not relent.  That’s his legacy to us, to ensure that everyone us the opportunity to reach their full potential for health.”

Dr. J. Nadine Gracia
President and CEO
Trust for America’s Health

“Listen to the full conversation”

 

Advocates Urge Congressional Leaders to Reject Massive Cuts Which Would Put Public’s Health at Risk

(Washington, DC – January 8, 2024) This week, Trust for America’s Health joined the Coalition for Health Funding and a broad, multisector group of over 1,100 organizations in a letter to Congress voicing strong concern that a full-year continuing resolution would trigger massive cuts that would be “disastrous for the capacity of the Federal government to serve the public.” The letter to Senate Majority Leader Charles Schumer, Senate Minority Leader Mitch McConnell, House Speaker Mike Johnson, and House Minority Leader Hakeem Jeffries urged policymakers to work together using the bipartisan Senate Appropriations Committee funding levels as a starting point for FY2024 negotiations moving forward.

At stake is funding for programs that are critical to safeguarding the public’s health. Examples include prevention and response to health emergencies; programs that provide nutrition assistance to young children, families, and older adults; medical care for veterans; housing and home energy assistance programs; and investments that ensure safe transportation and drinking water. These programs are a small part of the federal budget but represent major impacts on communities’ health and wellbeing.

Read the letter at: NDD United Letter, January 7, 2024 

Over 110 Organizations Call on Senate to Oppose Cuts to Prevention Fund

(Washington, DC – September 20, 2023) – Trust for America’s Health, American Public Health Association, Association of Public Health Laboratories, Big Cities Health Coalition, Campaign for Tobacco-free Kids, Council of State and Territorial Epidemiologists, National Association of County and City Health Officials, and more than 100 other organizations representing public health, healthcare, research, social services, and other sectors, today released a letter to the Senate Health, Education, Labor, and Pensions (HELP) Committee opposing a committee proposal to cut $980 million from the Prevention & Public Health Fund (“the Prevention Fund”) to pay for other health legislation.

The Prevention Fund is a critical source of funding for the Centers for Disease Control and Prevention and other agencies across Health and Human Services. The Prevention Fund invests in states and communities across the nation to strengthen systems and the workforce that allow us to provide immunizations, detect and control outbreaks, and prevent illness and early deaths from tobacco and chronic diseases. It supports activities outside one’s doctor’s office – separate and distinct from individual health concerns and treatments.

In an already challenging budget environment, this would further endanger the health of Americans. These cuts would impact not only health programs, but also labor and education, as it will leave a significant gap in base appropriations for the Labor-HHS-Education spending bill that will need to be backfilled. This pay-for has far reaching consequences for all ofthe  programs that fall under the spending bill’s purview.

The letter in part reads:

“The nation can no longer afford to underfund public health…. Despite spending more than any other high-income nation on treating disease, the U.S. has substantially worse health outcomes, with life expectancy declining in recent years. Now is the time to invest in public health and prevention…

Cuts to the Prevention Fund will translate into funding shortfalls in programs that states have long relied upon to keep their residents healthy and safe. In its first 14 years (FY2010–23), the Prevention Fund has invested more than $12.3 billion in resources to states, localities, and tribal and community organizations in support of critical prevention and public health programs. These investments include the 317 immunization program that enables prevention of outbreaks, epidemiologists and public health laboratory grants in every state and territory to detect and investigate outbreaks and prevent further infections, the Preventive Health and Health Services (Prevent) Block Grant that enables states and localities to address their most pressing health concerns, supporting cancer screenings, and other critically important programs. Across the U.S. Department of Health and Human Services, the Prevention Fund supports programs such as suicide prevention, Alzheimer’s disease prevention, and chronic disease self-management.

Funding prevention not only saves lives, but it also saves money. The Prevention Fund’s Tips from Former Smokers Campaign alone saved an estimated $7.3 billion in smoking-related healthcare costs from 2012 to 2018 and helped more than one million Americans quit smoking for good. Public health funding has not kept up with the range of threats that public health must address. For many of these conditions, we know what works, but public health does not have the resources to address these growing health threats.”

The full text of the letter is linked here.

Information about the Prevention and Public Health Fund can be found here.

Organizations Joining the Letter:

ADAP Advocacy

American Academy of Pediatrics

American Association on Health and Disability

American College of Clinical Pharmacy

American College of Obstetricians and Gynecologists

American College of Physicians

American College of Preventive Medicine

American College of Sports Medicine

American Heart Association

American Lung Association

American Public Health Association

American Society for Microbiology

American Society on Aging

American Statistical Association

Association for Prevention Teaching and Research

Association for Professionals in Infection Control and Epidemiology

Association of American Medical Colleges

Association of Immunization Managers

Association of Maternal & Child Health Programs

Association of Pathology Chairs

Association of Public Health Laboratories

Association of Schools and Programs of Public Health

Association of State and Territorial Health Officials

Asthma and Allergy Foundation of America

Big Cities Health Coalition

CAEAR Coalition

Campaign for Tobacco-Free Kids

Center for Advocacy for the Rights and Interests of Elders (CARIE)

Children’s Environmental Health Network

Christian Council of Delmarva

City-County Health District

Colorado Public Health Association

Community Access National Network

Connecticut Public Health Association

Cook County Department of Public Health

Council of State and Territorial Epidemiologists

Dorchester County Health Department

Early Impact Virginia

Endocrine Society

Eta Sigma Gamma

Foundation for Healthy Generations

Futures Without Violence

GLMA: Health Professionals Advancing LGBTQ+ Equality

GO2 for Lung Cancer

Green & Healthy Homes Initiative, Inc

Health Promotion Consultants

Healthy Weight Partnership Inc.

HIV Medicine Association

HLN Consulting, LLC

Illinois Society for the Prevention of Blindness

Immunize.org

Institute for Public Health Innovation

International WELL Building Institute

Johns Hopkins Center for Health Security

Kansas Breastfeeding Coalition

Kentucky Voices for Health

Kids and Car Safety

Lakeshore Foundation

Linn County Public Health

Maine Public Health Association

March of Dimes

Marked By Covid

MaryCatherine Jones Consulting, LLC

Mel Leaman Free Clinic

Mental Health America

Minnesota Public Health Association

NASTAD

National Alliance of Public Health Students and Alums

National Association of Chronic Disease Directors

National Association of County and City Health Officials

National Association of Social Workers

National Center for Healthy Housing

National Center on Domestic and Sexual Violence

National Network of Public Health Institutes

National Nurse-Led Care Consortium

National Prevention Science Coalition

Nemours Children’s Health

New Jersey Public Health Association

New York State Public Health Association

Oregon Coalition of Local Health Officials

Peggy Lillis Foundation

Pennsylvania Public Health Association

Population Association of America

Prevent Blindness

Prevent Blindness Georgia

Prevent Blindness Ohio

Prevent Blindness Wisconsin

Prevent Child Abuse America

Prevention Institute

Public Health Foundation

Public Health Institute

Redstone Global Center for Prevention and Wellness

Resolve to Save Lives

RiverStone Health

Safe States Alliance

Society for Healthcare Epidemiology of America

Society for Maternal-Fetal Medicine

Society for Public Health Education

Society for Women’s Health Research

Sound Generations

Sound Generations – Project Enhance

Spina Bifida Association

Task Force for Global Health

The 317 Coalition

The Foundation for Sustainable Communities

The Gerontological Society of America

Trust for America’s Health

USAging

Vaccinate Your Family

Voices for Vaccines

Washington State Association of Local Public Health Officials

Washington State Public Health Association

Well-Being and Equity in the World

Wisconsin Public Health Association

YMCA of the USA

 

 

 

At One Year Mark Data Show 988 Suicide and Crisis Lifeline Has Improved Crisis Care Access and Response, and that Sustained and Increased Funding is Needed

This month marks the one-year anniversary of the 988 Suicide and Crisis Lifeline, which replaced the previous National Suicide Prevention Lifeline with a single three-digit number for mental health, substance misuse, and crisis services. With oversight and funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) and assistance from partners like Crisis Text Line and The Trevor Project, 988 consists of independently operated and funded call and text/chat centers across the country. When individuals in crisis contact 988, trained crisis counselors at these centers listen, provide support, and share resources if necessary. Access to 988 can play a critical role in improving depressed, suicidal, or overwhelming feelings—in fact, SAMHSA estimates that 98% of individuals contacting 988 receive the crisis support they need in the moment. SAMHSA has also identified the current 988 system as a first step toward evolving crisis care to include mobile crisis units, which provide in-person responses, and stabilization centers, which provide a safe place to stay for individuals in crisis.

Even its current form, however, 988 represents a momentous advancement in the effort to connect more Americans with crisis services. In May 2023, for example, 988 answered 45% more calls, 52% more chats, and 938% texts compared to the previous lifeline in May 2022. In total, 988 answered nearly 160,000 more contacts in May 2023 compared to May 2022, and the average time to answer these contacts decreased from 140 seconds to 35 seconds. 988 has also launched specialized services for the LGBTQ+ population, and SAMHSA just announced the addition Spanish language text and chat services. Other specialized services will likely follow for hearing impaired individuals and American Indian/Alaska Native people.

 

In 2022, Congress supplemented the establishment of 988 with several pieces of legislation containing significant investments and policies to advance behavioral health. The Bipartisan Safer Communities Act (BSCA), passed in June 2022, for example, provided onetime support for 988 and increased support for the National Child Traumatic Stress Network. The BSCA also provided funding for Project AWARE at SAMHSA, which empowers education agencies through training for school personnel, increases awareness and detection of mental health issues, and connects youth and families to needed services. In addition, Congress directed the Centers for Medicare and Medicaid Services to assist schools with expanding school-based health services through Medicaid and funded initiatives at the U.S. Department of Education to hire and retain mental health professionals providing these services.

 

In the Consolidated Appropriations Act (CAA), enacted in December 2022, Congress built on these accomplishments by reauthorizing the Garrett Lee Smith Suicide Prevention Program, which funds mental health programs for college-age students, as well as several programs to improve the behavioral health workforce. The CAA also bolstered crisis-intervention programs by directing guidance and funding to providers and improving payment for their services.

 

The U.S. Department of Health and Human Services (HHS) also acted throughout 2022 to expand access to community-based mental health services. In partnership with the Department of Education, for example, HHS has worked to facilitate the use of Medicaid and Children’s Health Insurance Program funds to support school-based behavioral health services. SAMHSA also launched the Mental Health Crisis Response Partnership Pilot Program to improve access to mobile crisis services in high-need areas.

988 is part of a series of investments to address Americans’ mental health needs

Despite this progress, significant challenges remain in the effort to strengthen 988 and connect individuals in crisis to behavioral health services. For example, although state governments carry the responsibility for funding and operating 988 call centers, only a handful of states have passed legislation to secure long-term financial support for the lifeline through telecommunications fees. A recent study, moreover, found that only around half of states have earmarked sufficient funding to meet increased 988 center costs. Due in part to insufficient funding, call centers can also struggle to hire and retain qualified staff and answer rates can vary significantly by state. Improved data collection and analysis concerning 988 services is also necessary to help identify gaps in crisis care and improve lifeline implementation.

On the federal level, ongoing negotiations in Congress could result in cuts to appropriations for 988, which is an alarming prospect given that SAMHSA estimates outreach to the lifeline will increase by up to 50%—to a total of around 9 million contacts—in FY 2024. States will also require additional federal support to develop and implement mobile responses and stabilization units and publicize the full range of 988 services. A recent survey by the Pew Charitable Trusts, for example, found that only 13% of U.S. adults knew about the existence and purpose of 988; awareness was higher among white adults and individuals with a college education compared to Black adults and individuals with a high school degree or less.

Trust for America’s Health (TFAH) will continue to advocate for additional funding and resources to bolster the 988 lifeline and transform the behavioral health crisis system more broadly. Continued bipartisan support is necessary not only to ensure access to existing services, but also to build the next generation of care to meet the growing demand from Americans in crisis.

Recommendations for addressing Americans’ mental health needs and other issues are available in TFAH’s 2023 Pain in the Nation report.