Issue Category: Public Health Preparedness

COVID-19 Pandemic Proved that Underinvesting in Public Health Puts Lives and Livelihoods at Risk

Chronic underfunding of public health system weakened the country’s COVID-19 response

(Washington, DC – May 7, 2021) – Chronic underfunding of the public health system was a key contributing factor in the nation’s flatfooted response to the COVID-19 pandemic, according to a new report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021, released today by Trust for America’s Health.

The report discusses how the underfunding of core public health programs impeded the pandemic response and exacerbated its impacts.  According to the report’s authors, the missteps of the 2020 COVID-19 response were rooted in a public health system weakened by years of underfunding, the federal government’s failure to communicate and follow the best available science, and, health inequities that put communities of color and Tribal Nations at particular risk.

This annual report examines federal, state and local public health funding trends and recommends investments and policy actions to build a stronger public health system, prioritize prevention, and address the ways in which social and economic inequities create barriers to good health. Also highlighted is the need for the public health system to be ready to prevent and respond to a spectrum of risks, from weather-related emergencies to the rising numbers of drug overdoses, to increasing rates of obesity and resulting chronic diseases.

Response funding critical but not a long-term solution

Congress passed numerous COVID relief bills since March 2020, funding that has been critical to managing the immediate crisis.  But this one-time funding is not a solution to years of underfunding which hollowed out the system, thereby making it less able to spend emergency funds quickly and efficiently.

“What the system urgently needs is sustained, predictable funding that allows it to grow and maintain its workforce and invest in modern data systems and all-hazards preparedness planning on a year-in, year-out basis,” said John Auerbach, President and CEO of Trust for America’s Health.

CDC funding down for the year and decade

The Centers for Disease Control and Prevention (CDC) is the primary federal provider of public health funding to states. For FY 2021, CDC’s budget (aside from supplemental COVID response funding) was $7.8 billion, down 1 percent from the previous year, and continues to be insufficient to meet the country’s public health needs.  Over the last decade (FY 2012 – 21) the CDC’s core budget fell by 2 percent when adjusted for inflation. That decrease in spending happened over a 10-year period in which the U.S. population grew, the number and severity of weather-related emergencies increased, and the number of Americans grappling with substance abuse, suicide and chronic diseases also grew.  Anemic funding for CDC has meant that effective programs fail to reach all 50 states, and there has been little investment in cross-cutting infrastructure and capabilities.

CDC’s annual funding for Public Health Emergency Preparedness (PHEP) cooperative agreements, which support core emergency readiness capacity in states, territories and local areas, increased by $20 million in FY 2021.  But funding for PHEP shrank by approximating one-quarter (about half when adjusting for inflation) over the last two decades from $939 million in FY 2003 to $695 million in FY 2021.

In addition, the Hospital Preparedness Program, the main source of federal funding to help healthcare systems prepare for emergencies, has experienced a nearly 50 percent funding cut (nearly two-thirds when adjusted for inflation) over the last two decades – from $515 million in FY 2003 to $280 million in FY 2021.

At the state level, 43 states and the District of Columbia maintained or increased their public health funding in FY 2020.  In some instances, state-supported COVID response funding increased the state’s public health funding for the year but this emergency response funding is unlikely to translate into sustained funding growth.

Public health workforce is smaller than it was a decade ago

The state and local public health workforce is a critical part of the nation’ public health infrastructure.  From 2008 to 2019 the estimated number of full-time local public health agency staff decreased by 16 percent, while state health agencies lost almost 10 percent of their collective workforce between 2012 and 2019. These personnel cuts translated into fewer trained professionals available to do critical work as the COVID-19 pandemic was spreading across the country.

“For decades, public health leaders have sounded the alarm about the ways in which underfunding the public health system makes us less prepared and puts lives at risk. The COVID-19 pandemic is a stark illustration of how serious those risks are as public health departments were forced to fight the virus with antiquated tools and a depleted workforce,” said John Auerbach. “We must learn from the COVID tragedy and dramatically increase annual support of the public health workforce, programs and infrastructure.  If we fail to learn the lessons from the pandemic, we will be doomed to repeat them.”

The report calls for a $4.5 billion annual investment in the nation’s core public health capabilities.  Other recommendations speak to the need to:

  • Substantially increase core funding to strengthen the public health system, including by building and supporting the workforce, modernizing the system’s data tools and increasing its surveillance capacities.
  • Strengthen public health emergency preparedness, including within the healthcare system.
  • Safeguard and improve Americans’ health by investing in chronic disease prevention and the prevention of substance misuse and suicide.
  • Take steps to advance health equity by combating the impacts of racism and addressing the social determinants that lead to poor health.

Trust for America’s Health Applauds Public Health Investments Included in President’s FY2022 Budget

(Washington, DC – April 10, 2021) — The President’s FY2022 budget request for the U.S. Department of Health and Human Services (HHS) and other federal agencies, includes a proposed 23 percent increase to HHS and an 18 percent increase to the Centers for Disease Control and Prevention (CDC).

In response, the President and CEO of Trust for America’s Health (TFAH), John Auerbach, released the following statement:

“Trust for America’s Health is encouraged to see proposed increases for public health funding in the President’s FY2022 budget request, including a $1.6 billion increase for the Centers for Disease Control and Prevention (CDC). The unprecedented events of the past year demonstrate the need for increased and sustained investments in core public health. The pandemic exposed gaps in the public health system and major underlying health inequities in our communities – deficits that made the nation particularly vulnerable.

We were pleased to see proposed increases for long-neglected public health issues, including addressing racial inequities and the social determinants of health, the impact of climate change on health, and the substance misuse epidemic. We hope that Congress follows the Administration’s lead and commits the resources that public health needs to carry out its mission. The increases proposed in the budget request are an important step forward, future budgets will also need to invest in public health and address disparities that continue to place some communities at higher risk.”

Congressional Briefing: Ready or Not 2021: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism

Ready or Not 2021: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism. A panel of subject matter experts will discuss the nation’s readiness for public health emergencies, examine the findings of the report, and discuss key recommendations for policymakers.

Resources:

Innovative RWJBarnabas Program Improves Patients’ Health Through Social Determinants of Health Screening

Most Americans think of their health as being determined by genetics, behavior and perhaps good luck. An often-unrecognized aspect of well-being are factors outside the health sector and typically beyond an individual’s control. These factors, referred to as the social determinants of health (SDOH) are the environmental conditions in which people are born, grow, live, work, and age. Such conditions include access to healthy foods, transportation, suitable healthcare, affordable and safe housing, and quality educational and employment opportunities. All of these factors are significantly impacted by socioeconomic status and their availability in particular communities can either increase or decrease health disparities.

Improving social determinants of health is a fundamental step in improving health outcomes, reducing overall healthcare spending, and addressing health inequities. Trust for America’s Health (TFAH) supports the Improving Social Determinants of Health Act of 2021 sponsored by Representative Nanette Diaz Barragan of California. The bill would create a SDOH Program at the Centers for Disease Control and Prevention (CDC) to address the social, economic, and environmental conditions that affect health. In its efforts to improve the capacity of public health nationwide, the program would support multi-sector collaborations between local health departments and community organizations and would work to advance policies to address the social determinants of health.

At the state level, New Jersey based RWJBarnabas Health system is testing an approach designed to help address the non-medical factors that impact health by providing communities with a tailored social determinants of health program. The program is designed to reduce health disparities within the health care system. In New Jersey, roughly 39% of the population cannot meet their basic needs including food, housing, transportation, healthcare, and for some, child care. A little over 10% of the population is food insecure. In an effort to leverage social determinants to improve the quality of life for individuals, RWJBarnabas Health is working to create and sustain healthy communities through innovative strategies focused on high quality patient care, education, and research. Barnabas recently launched a new initiative, Health Beyond the Hospital (HBTH), that will impact the well-being of patients both inside and outside the hospital walls by providing tailored resources to fit their needs. It will provide patients who need them resources including but not limited to: nutrition education, meal deliveries, help navigating government assistance programs, and connections to community engagement opportunities. The program is funded by the Walmart Foundation and the Robert Wood Johnson Foundation.

The program will screen every patient for social determinants of health and refer them to external or internal social services if determined to be appropriate. Patients will be assessed for food insecurity, access to housing, education, and transportation, and for smoking and substance abuse issues.  To ensure efficiency in the referral process, RWJBarnabas Health has partnered with NowPow, a community referral platform, and ConsejoSano, a multicultural patient engagement software platform.

“We’re deeply grateful for the Walmart Foundation and the Robert Wood Johnson Foundation’s faithful support,” said DeAnna Minus-Vincent, Senior Vice President and Chief Social Integration and Health Equity Strategist at RWJBarnabas Health. “By combining our resources, we’re able to offer New Jersey communities a unique program that promotes health equity and eliminates health disparities.”

Health Beyond the Hospital RWJBarnabas Health initiative to address the needs of all clients and patients in a culturally competent and efficient manner. Playing a critical role in patient follow up, ConsejoSano helps reach RWJBarnabas Health patients in the way that makes the most sense for each individual, culturally and linguistically tailored to meet their needs. Using NowPow, the program will be able to connect people with personalized services that are highly matched to their health and social needs including age, gender, eligibility, location, languages spoken, and insurance coverage. NowPow supports communities by providing referral services of primary care, food and housing, childcare, chronic disease prevention, support services, and more. Together, the organizations will provide a substantial collection of networks to minimize health barriers.

 “Health Beyond the Hospital is the first program of its kind and the first universal SDOH screening initiative. By incorporating social determinants of health assessment into routine care for all patients, we’re able to diagnose and treat the social factors that influence health outcomes alongside the clinical conditions,” said Minus-Vincent. “To truly uplift individuals and build long-term, equitable health in our communities, we have to tackle barriers to care from the ground up. That starts with identifying and improving the day-to-day realities like food access and living environment that are proven to inform wellbeing.”

“Advancing health outcomes and creating meaningful, sustainable change for our patients requires a comprehensive approach,” Minus-Vincent said. “With NowPow and ConsejoSano, we’re addressing all aspects of the clinical experience, from the cultural nuances of how we communicate with patients to connecting them with resources and support programs.”

Within RWJBarnabas Health, selected sites are being piloted in order to test the comprehensiveness of the program. According to RWJBarnabas officials, the program will be the “nation’s first end-to-end, universally applied, and culturally tailored program”. If results from piloted sites show that the program has the desired impact, it will be implemented to all sites within the RWJBarnabas system by the end of 2021.

Learn more about the RWJBarnabas Health and the Health Beyond the Hospital initiative.

 

Nuevo informe encuentra lagunas en la preparación de los estados para emergencias de salud pública

La COVID-19 muestra daño crítico de subinversión en infraestructura de salud pública

(Washington, DC) — 10 de marzo de 2021 – La pandemia de COVID-19 ha demostrado claramente que la inversión insuficiente en la preparación para responder a emergencias de salud pública puede costar cientos de miles de vidas y causar estragos en la economía. Un nuevo informe publicado hoy por Trust for America’s Health (TFAH) midió el desempeño de los estados en 10 indicadores clave de preparación para emergencias y encontró espacio para mejorar en todas las jurisdicciones.

El informe Ready or Not 2021: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism midió la preparación de los estados para emergencias de salud de cualquier tipo (no solo la crisis del COVID-19).  Este informe colocó a 20 estados y al Distrito de Columbia en una categoría de alto nivel de preparación, 15 estados en un nivel de preparación medio y 15 estados en un nivel de preparación bajo.

Durante casi dos décadas, TFAH ha examinado la preparación para emergencias de salud pública de la nación en este informe anual. Durante ese tiempo, todos los estados han mejorado su preparación para emergencias, pero todos continúan teniendo espacio para un fortalecimiento adicional de sus programas de respuesta de salud pública.

 

Rendimiento estatal, por nivel de puntuación, 2020

Performance Tier States Number of States
High Tier CO, CT, DC, DE, GA, ID, KS, MA, MD, ME, MS, NC, NE, NM, OK, RI, UT, VA, VT, WA, WI 20 states and DC
Middle Tier AL, CA, FL, IA, IL, KY, LA, MI, MN, MT, ND, NJ, OR, TN, TX 15 states
Low Tier AK, AR, AZ, HI, IN, MO, NH, NV, NY, OH, PA, SC, SD, WV, WY 15 states

“La importancia de este informe es que brinda a los estados datos procesables para adoptar políticas que salven vidas. La crisis de COVID-19 muestra que tenemos mucho más trabajo por hacer para proteger a los estadounidenses de las amenazas a la salud, particularmente en las formas en que el racismo estructural crea y exacerba los riesgos para la salud dentro de las comunidades de color ”, dijo John Auerbach, presidente y director ejecutivo de Trust for Salud de Estados Unidos. “Los estados deben tomar medidas enérgicas para apuntalar su preparación para todo tipo de emergencias de salud pública”.

Si bien los hallazgos del informe no son una medida de la respuesta COVID-19 de ningún estado, demuestran que si bien la preparación de los estados es importante, las emergencias de salud nacionales en la escala de una pandemia requieren un liderazgo y una coordinación federales fuertes, e inversiones a largo plazo en salud pública. infraestructura y mano de obra. Los estados por sí solos, incluso aquellos que ocupan un lugar destacado en este informe, no están lo suficientemente equipados para responder a una pandemia sin ayuda federal, dicen los autores del informe.

El informe encontró:

La mayoría de los estados han hecho preparativos para expandir la atención médica y las capacidades de salud pública en una emergencia, a menudo a través de la colaboración. Treinta y cuatro estados participaron en el Nurse Licensure Compact, en comparación con 26 en 2017. El pacto permite a las enfermeras registradas y las enfermeras prácticas o vocacionales con licencia ejercer en múltiples jurisdicciones con una sola licencia. En caso de emergencia, esto permite a los funcionarios de salud aumentar rápidamente sus niveles de personal. Además, los hospitales de la mayoría de los estados tienen un alto grado de participación en coaliciones de salud. En promedio, el 89 por ciento de los hospitales estaban en una coalición y 17 estados y el Distrito de Columbia tenían participación universal, lo que significa que todos los hospitales de la jurisdicción eran parte de una coalición. Dichas coaliciones unen a los hospitales y otras instalaciones de atención médica con la gestión de emergencias y los funcionarios de salud pública para planificar y responder a los incidentes. Finalmente, todos los estados y el Distrito de Columbia tenían laboratorios de salud pública que tenían planes para una gran afluencia de necesidades de pruebas. Esta capacidad de aumentar la capacidad de prueba de laboratorio durante la crisis de COVID-19 fue extremadamente crítica.

La mayoría de los estados están acreditados en las áreas de salud pública, manejo de emergencias o ambos. A diciembre de 2020, la Junta de Acreditación de Salud Pública (PHAB) o el Programa de Acreditación de Gestión de Emergencias (EMAP) acreditaron 42 estados y el Distrito de Columbia; 29 estados y el Distrito de Columbia fueron acreditados por ambos grupos, un aumento neto de uno desde noviembre de 2019. Ambos programas ayudan a garantizar que los sistemas necesarios de preparación y respuesta ante emergencias estén en su lugar y con personal calificado.

Las tasas de vacunación contra la influenza estacional, aunque aún son demasiado bajas, han aumentado significativamente. La tasa de vacunación contra la influenza estacional entre los estadounidenses de 6 meses o más aumentó del 42 por ciento durante la temporada 2017-2018 al 52 por ciento durante la temporada 2018-2019, pero aún está por debajo de la tasa de vacunación objetivo del 70 por ciento establecida por Healthy People 2030.

En 2019, solo el 55 por ciento de los residentes estatales empleados, en promedio, usaron tiempo libre remunerado, el mismo porcentaje que en 2018. Aquellos sin licencia remunerada tienen más probabilidades de trabajar cuando están enfermos y corren el riesgo de propagar la infección. Esto se volvió particularmente relevante durante la pandemia de COVID-19, ya que el aislamiento y la cuarentena son herramientas importantes para controlar el brote.

La mayoría de los residentes que obtuvieron el agua de su hogar a través de un sistema de agua comunitario tenían acceso a agua potable. En promedio, solo el 5 por ciento de los residentes del estado utilizó un sistema de agua comunitario en 2019 que no cumplía con todos los estándares de salud aplicables.

El informe incluye recomendaciones de acciones por parte de los legisladores federales y estatales para mejorar la preparación para emergencias de salud pública de la nación en siete áreas prioritarias:

  • Proporcionar financiación suficiente y estable para la seguridad de la salud pública nacional y mundial.
  • Fortalecer las políticas y los sistemas para prevenir y responder a brotes y pandemias.
  • Construir comunidades resilientes y promover la equidad en salud en general y en la preparación.
  • Asegurar liderazgo, coordinación y fuerza laboral efectivos en salud pública.
  • Acelerar el desarrollo y la distribución, incluida la distribución de última milla, de contramedidas médicas.
  • Fortalecer la capacidad del sistema de salud para responder y recuperarse durante y de emergencias de salud.
  • Prepárese para las amenazas ambientales y el clima extremo.

El informe de la serie Ready or Not está financiado por la Fundación Robert Wood Johnson con el apoyo adicional de The California Endowment, W.K. Fundación Kellogg y Fundación Kresge.

###

Trust for America’s Health es una organización no partidista sin fines de lucro que promueve la salud óptima para cada persona y comunidad y hace de la prevención de enfermedades y lesiones una prioridad nacional. Twitter: @HealthyAmerica1

New Report Finds Gaps in States’ Preparedness for Public Health Emergencies

COVID-19 Illuminated critical harm of underinvestment in public health infrastructure

(Washington, DC – March 10, 2021) The COVID-19 pandemic has starkly demonstrated that underinvestment in preparedness to respond to public health emergencies can cost hundreds of thousands of lives and wreak havoc on the economy.  A new report released today by Trust for America’s Health (TFAH) measured states’ performance on 10 key emergency preparedness indicators and found room for improvement in every jurisdiction.

The report, Ready or Not 2021: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism measured states’ readiness for health emergencies of any kind (not just the COVID-19 crisis). It placed 20 states and the District of Columbia in a high level of preparedness category, 15 states in a middle preparation tier and 15 states in a low degree of preparation tier.

State performance, by scoring tier, 2020

 Performance Tier States Number of States
High Tier CO, CT, DC, DE, GA, ID, KS, MA, MD, ME, MS, NC, NE, NM, OK, RI, UT, VA, VT, WA, WI 20 states and DC
Middle Tier AL, CA, FL, IA, IL, KY, LA, MI, MN, MT, ND, NJ, OR, TN, TX 15 states
Low Tier AK, AR, AZ, HI, IN, MO, NH, NV, NY, OH, PA, SC, SD, WV, WY 15 states

For nearly two decades, TFAH has examined the nation’s public health emergency preparedness in this annual report. During that time, all states have made improvements in their emergency preparedness, but all continue to have room for additional strengthening of their public health preparedness and response.

“The importance of this report is that it gives states actionable data to adopt policies that save lives. The COVID-19 crisis shows that we have much more work to do to protect Americans from health threats, particularly in the ways in which structural racism create and exacerbate health risks within communities of color,” said John Auerbach, President and CEO of Trust for America’s Health. “States need to take aggressive steps to shore up their preparedness for all types of public health emergencies.”

While the report’s findings are not a measure of any state’s COVID-19 response, they demonstrate that while states’ readiness is important, national health emergencies on the scale of a pandemic require strong federal leadership and coordination, and long-term investment in public health infrastructure and workforce.  States alone, even those that rank high in this report, are not sufficiently equipped to respond to a pandemic without federal help, say the report’s authors.

The report found:

A majority of states have made preparations to expand healthcare and public health capabilities in an emergency, often through collaboration. Thirty-four states participated in the Nurse Licensure Compact, up from 26 in 2017. The compact allows registered nurses and licensed practical or vocational nurses to practice in multiple jurisdictions with a single license. In an emergency, this enables health officials to quickly increase their staffing levels. In addition, hospitals in most states have a high degree of participation in healthcare coalitions. On average, 89 percent of hospitals were in a coalition and 17 states and the District of Columbia had universal participation, meaning every hospital in the jurisdiction was part of a coalition. Such coalitions bring hospitals and other healthcare facilities together with emergency management and public health officials to plan for and respond to incidents. Every state and the District of Columbia had public health laboratories that had plans for a large influx of testing needs. This ability to surge laboratory testing capacity during the COVID-19 crisis was extremely critical.

Most states are accredited in the areas of public health, emergency management, or both. As of December 2020, the Public Health Accreditation Board (PHAB) or the Emergency Management Accreditation Program (EMAP) accredited 42 states and the District of Columbia; 29 states and the District of Columbia were accredited by both groups, a net increase of one since November 2019. Both programs help ensure that necessary emergency preparation and response systems are in place and staffed by qualified personnel.

Seasonal flu vaccination rates, while still too low, have risen significantly. The seasonal flu vaccination rate among Americans ages 6 months or older rose from 42 percent during the 2017–2018 season to 52 percent during the 2019–2020 season but is still below the 70 percent target vaccination rate set by Healthy People 2030.

In 2019, only 55 percent of employed state residents, on average, used paid time off, the same percentage as in 2018. Those without paid leave are more likely to work when they are sick and risk spreading infection. This became particularly relevant during the COVID-19 pandemic, as isolation and quarantine are important tools for controlling the outbreak.

Most residents who got their household water through a community water system had access to safe water. On average, just 5 percent of state residents used a community water system in 2019 that did not meet all applicable health-based standards.

The report includes recommendations for actions by federal and state policymakers to improve the nation’s public health emergency preparedness in seven priority areas:

  • Provide stable, sufficient funding for domestic and global public health security.
  • Strengthen policies and systems to prevent and respond to outbreaks and pandemics.
  • Build resilient communities and promote health equity generally and in preparedness.
  • Ensure effective public health leadership, coordination, and workforce.
  • Accelerate development and distribution, including last mile distribution, of medical countermeasures.
  • Strengthen the healthcare system’s ability to respond and recover during and from health emergencies.
  • Prepare for environmental threats and extreme weather.

The Ready or Not report series is funded by the Robert Wood Johnson Foundation with additional support from The California Endowment, W.K. Kellogg Foundation and The Kresge Foundation.

###

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.  Twitter: @HealthyAmerica1

Over 300 Health and Public Health Groups Call on Congress to Fund Public Health Infrastructure and Workforce as Part of Next COVID-19 Recovery Package

(Washington, DC – February 12, 2021) – The nation’s leading health and public health organizations today wrote to Congressional leaders recommending $4.5 billion in long term, additional annual funding for CDC and states, localities, tribes and territories to support public health infrastructure and workforce.

The letter, endorsed by 316 organizations, calls on Congress to include such funding in the next COVID-19 legislation to not only strengthen the response to the current pandemic but to better prepare the country for the next public health emergency.  A significant, sustained investment is needed to support essential public health activities including disease surveillance, epidemiology, laboratory capacity, all-hazards preparedness and response, and policies to advance health equity, the letter said.

“The COVID-19 pandemic is illustrating in the direst terms the consequences of underfunding public health,” the letter said.  “For too long, the nation has neglected basic public health capacity, and the nation’s response to the pandemic reflects this chronic underfunding.”

The letter applauded Congress for taking quick action to provide funding for the initial pandemic response but also noted that short-term, supplemental funding does not allow public health to recruit and retain the workforce needed to protect the public’s health against a number of growing threats including surging levels of chronic disease, substance misuse and suicide, infectious disease and weather-related events.