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Trust for America’s Health: Deeply Disappointed Congress Utilized the Prevention Fund as a 21st Century Cures Offset

Washington, D.C., December 7, 2016 – The below is a statement from Rich Hamburg, interim president and CEO, of Trust for America’s Health (TFAH) on the 21^st Century Cures legislative package.

“TFAH is deeply disappointed Congress will utilize the Prevention and Public Health Fund as an offset for the legislative package known as 21^st Century Cures. Cutting the Prevention Fund will limit the nation’s ability to improve health and quality of life and prevent disease.

While TFAH supports aspects of this legislative package, including the much-needed funds to address the opioid epidemic, we remain opposed to using the Prevention Fund to offset the cost of this legislation.

The Prevention Fund is inextricably tied to the nation’s future ability to reign in healthcare costs. This is the nation’s first and only substantial investment in moving from our current “sick care” system to a true preventive health system. The Prevention Fund should be dedicated to its intended purpose: helping all Americans stay healthy.

Despite the exponentially growing burden of largely preventable diseases, federal disease prevention and public health programs remain critically underfunded. Public health spending is still below pre-recession levels, having remained relatively flat for years. Today, more than 12 percent of the CDC budget is supplied through Prevention Fund investments, including the 317 immunization program, epidemiology and laboratory capacity grants and the entire Preventive Health and Health Services Block Grant program—all critical to preparing for and responding to public health emergencies.

The United States spends $3 trillion annually on healthcare without much to show for it: Millions of Americans suffer from chronic diseases, which are responsible for seven out of 10 deaths and $1.3 trillion in treatment costs and lost productivity every year.

And, two-thirds of Americans are overweight or obese and nearly 20 percent of Americans smoke. Obesity costs the country $147 billion and tobacco use leads to another $130 billion in healthcare spending each year.

Time and again research shows that the vast majority of these chronic diseases can be prevented by investing in addressing the root causes. Yet, the country has repeatedly failed to do so.

The nation cannot afford to trade away our single best investment in preventing disease, preparing for and responding to infectious disease outbreaks, reducing rates of chronic illness, and saving lives and money.”

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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.

Blueprint for a Healthier America 2016: Policy Priorities for the Next Administration and Congress

Trust for America’s Health Releases “Blueprint for a Healthier America” Report Featuring High-Impact Policies for the Next Administration and Congress

Washington, D.C., October 19, 2016 – Today, the Trust for America’s Health (TFAH) released Blueprint for a Healthier America 2016: Policy Priorities for the Next Administration and Congress which calls for a new approach to health – prioritizing improving health and addressing major epidemics in the United States.

“It’s time for a sea change from our current sick care system to a true health system, where we focus on preventing disease and improving quality of life,” said Richard Hamburg, Interim CEO and President of TFAH. “In the Blueprint, we highlight high-impact policies that could help spare millions of Americans from preventable health problems and save billions in avoidable healthcare costs – if we make them a priority.”

The report highlights pressing crises and how investments could yield positive returns on investment by adopting proven health strategies. For instance:

Investing $1 in substance use prevention to realize as much as $34 in return. Deaths from prescription painkiller use have more than quadrupled in the last 15 years and deaths from heroin have tripled since 2010, contributing to higher death rates among middle-aged Whites. Five of the strongest school-based substance use prevention strategies have returns on investment ranging from $3.8:1 to $34:1.
Saving more than $16 billion through a more active and healthy population. One in three children will develop type 2 diabetes in their lifetime and one in four young adults are not healthy enough to join the military. An investment of $10 per person in proven, evidence-based community prevention programs to increase physical activity, improve nutrition and reduce tobacco use could save the country more than $16 billion annually – a $5.60:1 return.
Connecting health and social services to cut billions in costs. Health and social service coordinating systems that address gaps between medical care and effective social service programs – by connecting patients in need with programs ranging from supportive housing to food assistance – could yield between $15 billion and $72 billion in healthcare savings a year within 10 years, according to a new analysis by TFAH and Healthsperien.
Reducing the $120 billion spent annually on preventable infectious diseases. Fifteen years after 9/11 and 11 years after Hurricane Katrina, when health crises such as new infectious diseases arise, the country still scrambles to implement emergency plans and secure funding. Preventable infectious diseases cost the country more than $120 billion annually – and that cost is exponentially compounded when new diseases emerge.
Realizing a 7-10 percent annual return by investing in early childhood education. More than half of U.S. children – across the economic spectrum – experience adverse experiences, such as physical or sexual abuse, and more than 20 percent live below the poverty line, which increases their risk for “toxic stress” – living under a constant state of stressful conditions – that can contribute to a range of physical, mental and behavioral health issues. Investments in early childhood education can help mitigate against impact of these risks and increase resilience, while also providing an annual return of 7 to 10 percent per year, and supportive nurse-family home visits for high-risk families show a return of $5.70:1.

The Blueprint highlights leading evidence-based strategies for improving health and policy – and models to help bring them to scale across the country. These include:

Supporting Better Health in Every Community: Federal, state and local public health programs and policies should support place-based health improvement partnerships. Doing so will help identify and elevate a local community’s top priorities and bring key partners and assets together – from public health, healthcare, social services, philanthropies, education, businesses and faith and community groups – for a greater collective impact. A network of expert institutes in each state should provide technical assistance to these multisector collaborative partnerships. In addition, the Prevention and Public Health Fund and other community-based health improvement programs should be protected and fully funded.
Modernizing the Public Health System to Be Prepared for Emergencies: The public health system must be modernized – and sufficiently funded – so that it can handle ongoing threats and new emergencies. Too often the country has been caught off guard when a new crisis emerges, diverting attention and resources. There should be 1) greater investment to improve baseline foundational capabilities in communities around the country; 2) a standing Public Health Emergency Fund to provide additional surge funds when needed; 3) improved federal leadership, such as through a Special Assistant to the President for Health Security; and 4) upgrades to out-of-date technology and surveillance systems.
Incentivizing Health Care vs. Sick Care: There should be increased incentives and mechanisms for healthcare insurers, nonprofit hospital community benefit programs and social investment funds to support health improvement strategies. Efforts such as healthcare investment in community-wide health improvement programs, “navigator plus support” health and social service integration (such as Accountable Health Communities), Community Development Financial Institutions for Health (strategic planning and financing intermediaries) and pay-for-outcome approaches should be expanded.

The report also includes a set of policy recommendations to address priority health problems that require urgent action, some highlight areas include:

Stopping the Prescription Painkiller and Heroin Epidemics
Renewing Efforts to Prevent Obesity, Diabetes and Tobacco Use
Highlighting Prevention in the National Cancer Moonshot Initiative
Ending the HIV/AIDS Epidemic
Stopping Superbugs and Antibiotic Resistance
Lowering the Rising Death Rates Among Middle-Aged Whites
Achieving Health Equity

The Blueprint was supported by grants from the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation, The California Endowment and The Kresge Foundation.

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

Washington, D.C., October 7, 2016–Today, Trust for America’s Health (TFAH) announced the selection of John Auerbach, MBA, as its new President and CEO.

Auerbach brings more than 35 years of experience as a leader in the public health field – including serving as the Commissioner of the Massachusetts Department of Health, Executive Director of the Boston Public Health Commission, and, most recently, Associate Director for Policy and Acting Director of the Office for State, Tribal, Local and Territorial Support at the Centers for Disease Control and Prevention (CDC).

“John is a true innovator in public health and we cannot be more pleased to have him as the new head of TFAH,” said Gail Christopher, board chair of TFAH and vice president for policy and senior advisor at the W.K. Kellogg Foundation. “His work embodies a transformative approach to improving health – thinking beyond medical care to support opportunities for better health in our daily lives. We share a vision where every American has the chance to be as healthy as they can be.”

At CDC, Auerbach has focused on promotion of public health and prevention as components of healthcare and payment reform and health system transformation. He also oversees key activities and technical assistance that support the nation’s health departments and the public health system.

Previously, he was, from 2012 to 2014, a distinguished professor of practice in health sciences and director of the Institute on Urban Health Research and Practice at Northeastern University. From 2007 to 2012, he was the commissioner of public health for the Commonwealth of Massachusetts. Under his leadership, the department developed innovative programs to address racial and ethnic disparities, promote wellness, combat chronic disease, and support the successful implementation of the state’s early healthcare reform initiative. He served as the President of the Association of State and Territorial Health Officials (ASTHO) in 2010-2011.

Prior to that, Auerbach was the executive director of the Boston Public Health Commission for nine years during which health equity, emergency preparedness, and tobacco prevention became priorities. In addition to Boston’s public health programs, he oversaw its emergency medical, homeless, and substance abuse services. Throughout his tenure as the city commissioner, Auerbach served as a member of the Board of Directors at the National Association of County and City Health Officials (NACCHO).

Earlier in his career Auerbach worked at the state health department for a decade, first as chief of staff and later as an assistant commissioner overseeing the HIV/AIDS Bureau during the early years of the epidemic. He was a founding member and the second president of the National Association of State and Territorial AIDS Directors (NASTAD).

“I’ve had a lifelong commitment to health and social justice, from the start of my career as a community health worker in one of the earliest community health centers to having the privilege of managing city, state and federal efforts,” said Auerbach. “We’re in a unique moment to define the next generation of health and healthcare – and I am excited to be joining TFAH and being at the leading edge of efforts to advance the mission of creating a healthier America.”

Auerbach will start in his role January 1, 2017. TFAH’s previous executive director, Jeffrey Levi, PhD, is now serving as Professor of Health Policy and Management at the Milken Institute School of Public Health at the George Washington University.

Richard Hamburg, who has been Interim President and CEO at TFAH, will be assuming the position of Executive Vice President and Chief Operating Officer.

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Trust for America’s Health Conducts Social Media Awareness Campaign in Support of Emergency Funding for Zika Prevention and Response

September 12, 2016

Washington, D.C., September 12, 2016 –Trust for America’s Health (TFAH) has released the first in a series of creative cartoons and editorials in support of emergency funding to prevent, mitigate and respond to the disastrous effects of Zika.

The first editorial details the price of inaction, concluding that “with broad support from the American people, it’s time for our leaders to decide whether to heed the warnings and invest in solutions now, or leave the country with a devastating bill later.” The first image is available for anyone to use on Facebook, Twitter or other social media platforms.

“Unfortunately, considerable Zika-related damage has already been done to our nation—and it is likely irreversible,” said Richard Hamburg, interim president and CEO of TFAH. “Our nation’s failure to act severely hampers the full response that is greatly needed. However, the sooner we do act, the sooner we can prevent further damage and destruction to our nation’s most vulnerable: our newborns.”

During the next few weeks, TFAH will release additional editorials and cartoons to underscore the urgent need for the nation to provide support for communities to prevent, control and mitigate complications arising from Zika.

“Without additional support, health departments and communities are on their own. Either resources will be shifted from other pressing needs or communities will have insufficient means to perform mosquito testing, infection prevention, disease tracking and other actions to protect against this devastating virus,” said Hamburg.

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Investing in America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts

TFAH Calls for Additional Policies, Research, Funding and Public Health Capacity to Prepare for Zika and Other Emerging Outbreaks

February 11, 2016

Washington, D.C., February 11, 2016 – Trust for America’s Health (TFAH) calls on U.S. policymakers to take additional steps to respond to the Zika virus in the Americas and its potential continued spread in the United States. The Centers for Disease Control and Prevention (CDC) has warned that there will likely be more cases within the U.S., but at this time they do not believe there will be the kind of widespread outbreaks here as there have been in South America.

President Obama has requested $1.8 billion in emergency funding in his Fiscal Year 2017 budget to prepare for and respond to the Zika virus. The Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies is holding a hearing today to review the request. TFAH supports the request for emergency funding, but emphasizes the need for consistent support for the nation’s public health infrastructure.

“The reports that the Zika virus may be related to a steep increase in birth defects in infants born to mothers who were infected during pregnancy in areas of the Americas are frightening,” said Richard Hamburg, Interim President and CEO of TFAH. “While scientists and public health officials are still learning about the virus and the threat it poses to the public’s health, what we do know is that Zika, Ebola, MERS-CoV and other public health threats require constant vigilance. We simply can’t jump from one supplemental funding vehicle to another as a substitute for true public health capacity. There is a lot more the country could be doing to be better prepared for the range of threats we face.”

Although not a new virus, 2015 marked the first widespread transmission of the Zika virus in the Americas. The virus is spread primarily by mosquitoes and usually causes only mild illness or no symptoms, but experts are investigating how it is linked to the rise in birth defects in infants born to mothers who were infected during pregnancy and to cases of Guillaun-Barré syndrome. In January 2016, CDC warned women who are pregnant or trying to become pregnant to avoid travel to regions and countries with widespread Zika transmission or to prevent being bitten by mosquitoes there. The World Health Organization (WHO) has declared the Zika virus and its suspected link to birth defects a public health emergency of international concern.

In response to the Zika virus and other emerging health threats, TFAH recommends the need for:

Policies and communications driven by best available science: When a situation is uncertain and evolving, accompanied by a great deal of fear in the community, policy and communications decisions must be based on the best available science. In recent outbreaks, some policies, such as quarantine decisions, may have been driven by fear or politics. Policymakers should work with public health on risk communications and policies that acknowledge concern among the public and ensure accurate, appropriate information.
Support for research and development of medical countermeasures: There is an urgent need for diagnostics, treatments and vaccines for Zika and other emerging threats. Congress should provide adequate funds to the Biomedical Advanced Research and Development Authority (BARDA), the Strategic National Stockpile and Project BioShield to accelerate development, purchase and stockpiling of medical countermeasures for public health emergencies.
Public health capacity to detect and contain the virus in the U.S.: Federal, state and local health departments must receive a sufficient, stable annual level of funding to meet and maintain a core set of capabilities to respond to emerging and ongoing threats. Modern laboratory, epidemiological and surveillance capacity, as well as the ability to distribute medical countermeasures if needed, are key to containing an infectious disease threat. The Public Health Emergency Preparedness cooperative agreement is an important source of funding for the domestic preparedness infrastructure.
Enhanced health system preparedness for infectious diseases: We must build all-hazards preparedness and infection control protocols into the healthcare delivery system, including coordination between healthcare facilities and with public health and enabling providers to screen and respond to potential cases. The Hospital Preparedness Program provides vital support to the healthcare preparedness system, but funding has dwindled in recent years.
Strengthening the global health infrastructure: Infectious disease control strategies rely on the ability to detect and contain diseases as quickly as possible – which means working with other countries and across borders to contain threats globally. The United States must provide ongoing support for the Global Health Security Agenda and activities such as CDC’s Global Disease Detection program, which build the capacity and coordination needed to identify and contain emerging infectious diseases around the world.

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Report Finds Major Gaps in Country’s Ability to Prevent and Control Infectious Disease Outbreaks

28 States and Washington, D.C. Reach Half or Fewer of Key Indicators

Washington, D.C., December 17, 2015 – A new report released today found that more than half (28) of states score a five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks. The report, from Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), concluded that the United States must redouble efforts to better protect the country from new infectious disease threats, such as MERS-CoV and antibiotic-resistant superbugs, and resurging illnesses like whooping cough, tuberculosis and gonorrhea.

Five states—Delaware, Kentucky, Maine, New York and Virginia—tied for the top score, achieving eight out of 10 indicators. Seven states—Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah—tied for the lowest score at three out of 10.

“The overuse of antibiotics and underuse of vaccinations along with unstable and insufficient funding have left major gaps in our country’s ability to prepare for infectious disease threats,” said Jeffrey Levi, PhD, executive director of TFAH. “We cannot afford to continue to be complacent. Infectious diseases – which are largely preventable – disrupt the lives of millions of Americans and contribute to billions of dollars in unnecessary healthcare costs each year.”

Some key findings from the Outbreaks: Protecting Americans from Infectious Diseases report include:

Healthcare-associated Infections: Around one out of every 25 people who are hospitalized each year contracts a healthcare-associated infection, leading to some 75,000 deaths a year.
- Only nine states reduced the standardized infection ratio (SIR) for central line-associated blood stream infections (CLABSI) between 2012 and 2013.

Childhood Vaccinations: In 2014, there were more than 600 cases of measles and nearly 33,000 cases of whooping cough reported. While more than 90 percent of all U.S. kindergarteners receive all recommended vaccinations, rates are lower in a number of communities and states. More than 28 percent of preschoolers do not receive all recommended vaccinations.
- 20 states have laws that either exclude philosophical exemptions entirely or require a parental notarization or affidavit to achieve a religious or philosophical exemption for school attendance.

Flu Vaccinations: Based on the severity of the strain, the flu can cause 3,000 to 49,000 deaths a year, more than $10 billion in direct medical expenses and more than $16 billion in lost earnings.
- 18 states vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2014 to Spring 2015. The national average is 47.1 percent. Rates are lowest among young and middle age adults (only 38 percent of 18- to 64-year-olds are vaccinated).

Hepatitis C and HIV/AIDS: Of the more than 1.2 million Americans living with HIV, almost one in eight do not know they are infected. Hepatitis C infections—related to a rise in heroin and injection drug use from people transitioning from prescription painkillers—increased more than 150 percent from 2010 to 2013.
- 16 states and Washington, D.C. explicitly authorize syringe exchange programs.
- 43 states and Washington, D.C. require reporting all (detectable and undetectable) CD4 cell count (a type of white blood cell) and HIV viral load data to their state HIV surveillance program, as of July 2013.

Food Safety: Around 48 million Americans get sick from a foodborne illness each year.
- 39 states met the national performance target of testing 90 percent of E.coli O157 cases within four days (in 2013).

Preparing for Emerging Threats: Significant advances have been made in preparing for public health emergencies, including potential bioterror or natural disease outbreaks, since the September 11, 2001 and anthrax attacks. Gaps remain, however, and have been exacerbated as resources have been cut.
- 36 states have a biosafety professional in their state public health laboratories – which are responsible for helping detect, diagnose and contain disease outbreaks.
- 15 states have completed climate change adaption plans that include the impact on human health.

Superbugs: More than two million Americans contract antibiotic-resistant infections each year, leading in excess of 23,000 deaths, $20 billion in direct medical costs and more than $35 billion in lost productivity.

“America’s investments in infectious disease prevention ebb and flow, leaving our nation challenged to sufficiently address persistent problems,” said Paul Kuehnert, a Robert Wood Johnson Foundation director. “We need to reboot our approach so we support the health of every community by being ready when new infectious threats emerge.”

The Outbreaks report features priority recommendations, including:

Increase resources to ensure every state can maintain and modernize basic capabilities – such as epidemiology and laboratory abilities – that are needed to respond to new and ongoing outbreaks;
Update disease surveillance to be real-time and interoperable across communities and health systems to better detect, track and contain disease threats;
Incentivize the development of new medicines and vaccines, and ensure systems are in place to effectively distribute them when needed;
Decrease antibiotic overuse and increase vaccination rates;
Improve and maintain the ability of the health system to be prepared for a range of potential threats – such as an influx of patients during a widespread outbreak or the containment of a novel, highly infectious organism that requires specialty care;
Strengthen efforts and policies to reduce healthcare-associated infections;
Take strong measures to contain the rising hepatitis C epidemic and other sexually transmitted infections, particularly among young adults; and
Adopt modern strategies to end AIDS in every state and city.

The indicators represent examples of important capabilities, policies and trends, and were selected in consultation with leading public health and healthcare officials.

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s website. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator, with zero the lowest possible overall score and 10 the highest. The data for the indicators are from publicly available sources or were provided from public officials.

8 out of 10: Delaware, Kentucky, Maine, New York and Virginia

7 out of 10: Alaska, California, Maryland, Massachusetts, Minnesota and Nebraska

6 out of 10: Arkansas, Illinois, Iowa, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Vermont, West Virginia and Wisconsin

5 out of 10: Arizona, Colorado, Connecticut, Georgia, Hawaii, Mississippi, Missouri, Montana, Pennsylvania, Rhode Island, Texas and Washington

4 out of 10: Alabama, District of Columbia, Florida, Indiana, Louisiana, Nevada, South Carolina, South Dakota, Tennessee and Wyoming

3 out of 10: Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah

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For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

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