Issue Category: Public Health Preparedness

Nuevo Reporte: Pocos estados han clasificaron en el nivel de rendimiento superior de la preparación de salud pública en el 2021

La pandemia de COVID-19 continúa ilustrando la necesidad crítica de invertir en la infraestructura de la salud pública y los factores sociales determinantes de la salud

 

(Washington, DC – 10 de marzo del 2022) – A medida que la nación atraviesa su tercer año de pandemia del COVID-19, un nuevo informe demuestra la necesidad de una inversión urgente para crear una infraestructura de salud pública capaz de proteger la salud de todos los estadounidenses durante emergencias. El informe, publicado hoy por Trust for America’s Health, mide el desempeño de los estados basado en 10 indicadores claves de preparación para emergencias e identifica diferencias considerables en la preparación de los estados para responder durante emergencias. El informe incluye recomendaciones de políticas públicas para fortalecer la seguridad sanitaria de la nación.

El informe Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism (Protegiendo la Salud Pública de Enfermedades, Desastres y Bioterrorismo), mide el grado de preparación de los estados para responder a un amplio número de emergencias de salud, ofreciendo continuos servicios de salud pública, incluyendo vigilancia sanitaria,  vacunación contra la influenza estacional, agua potable entre otros servicios de salud ampliados durante emergencias. El reporte clasifica los estados y el Distrito de Columbia en tres niveles de rendimiento: alto, medio y bajo, colocando 17 estados y DC en el nivel de alto rendimiento, 20 estados en el nivel de rendimiento medio y 13 estados en el nivel de bajo rendimiento. Durante el 2020, 20 estados y el Distrito de Columbia se ubicaron en el nivel de alto rendimiento.

Gráfico de niveles de rendimiento de los estados (2021) AQUÍ (manuscrito tabla 2 – página 10)

 

Este año el reporte indicó que 12 estados mejoraron su clasificación de desempeño, mientras que 16 estados descendieron en su clasificación. Las clasificaciones de todos los estados son relativas a las de otros estados.

Tres estados, Ohio, Pensilvania y Carolina del Sur mejoraron su desempeño en dos niveles.

Nueve estados mejoraron en un nivel: Alabama, Arizona, Florida, Illinois, Iowa, Missouri, New Hampshire, New Jersey y New York.

Dieciséis estados bajaron un nivel: Delaware, Georgia, Idaho, Kentucky, Luisiana, Maine, Minnesota, Mississippi, Montana, Nebraska, Nuevo México, Carolina del Norte, Oklahoma, Oregón, Rhode Island y Wisconsin.

Además, el informe demostró:

  • La mayoría de los estados tenían planes para expandir la asistencia médica y la salud publica mejorando sus capacidades de laboratorios en las emergencias.
  • La mayoría de los estados están acreditados en las áreas de salud pública, manejo de emergencias o ambas.
  • Una gran mayoría de estadounidenses que reciben agua para su hogar a través de un sistema de agua comunitario tenían acceso a agua segura.
  • Solo alrededor de la mitad de la población de los EE. UU. cuenta con un sistema integral de salud pública local.
  • Las tasas de vacunación contra la gripe estacional han aumentado significativamente en los últimos años, pero siguen siendo inferiores a la meta establecida por Healthy People 2030.
  • Poco más de la mitad de los trabajadores utilizaron algún tipo de tiempo libre remunerado. La necesidad de tiempo libre remunerado se ha vuelto particularmente necesario durante la pandemia, ya que muchos trabajadores se enfermaron o tuvieron que cuidar a un familiar enfermo.
  • En promedio, sólo el 28 por ciento de los hospitales obtuvo una calificación de máxima calidad de seguridad por parte del paciente durante el año, comparado a un 31 por ciento registrado el año anterior.

“La conclusión principal de este informe es que la inversión es insuficiente en el sistema de salud pública de la nación y los ataques a su autoridad han tenido consecuencias mortales durante la pandemia del COVID-19. Se necesitan acciones e inversiones con urgencia. Los hallazgos de este reporte pueden ayudar a funcionarios federales y estatales a identificar las deficiencias en la preparación de la salud pública y los pasos necesarios para proteger vidas de una manera más eficiente y lograr una mejor economía durante una próxima emergencia de salud”, dijo J. Nadine Gracia, MSCE, presidenta y directora ejecutiva de Trust for America’s Health.

El informe midió el desempeño de los estados durante un año que presentó altas demandas en el sistema de salud pública de la nación. Además de considerarnos en medio de la pandemia del COVID-19,  se debe tomar en cuenta que en el 2021 se registraron altas temperaturas récord de calor en muchos lugares, y como consecuencia hubo inundaciones extensas, incendios forestales en todo el oeste de los EE. UU., una temporada de huracanes muy activa y tornados inusuales y mortales en diciembre en ocho estados. Al mismo tiempo, cientos de funcionarios de salud pública experimentaron agotamiento, amenazas a su seguridad e intentos de limitar sus autoridades de salud pública, los cuales renunciaron, se jubilaron o fueron despedidos.

Es cierto que se logró un progreso crítico en la lucha contra el COVID-19 durante 2021, particularmente a través de la disponibilidad generalizada de vacunas y una respuesta federal más coordinada, pero es un hecho que la pandemia resaltó las formas en que las desigualdades en salud ponen a las comunidades de color y de bajos ingresos en mayor riesgo y peores resultados de salud durante una emergencia.

“Las desigualdades sociales, económicas y de salud debilitan la capacidad de una comunidad para prepararse, responder y recuperarse de una emergencia de salud pública. Si entramos en la próxima crisis de salud pública con la misma magnitud de inequidades en temas de salud pública en nuestras comunidades como ha sido evidenciado durante esta pandemia, el impacto será similar:  evitar la pérdida de vidas, el impacto desproporcionado en comunidades de color y comunidades de bajos ingresos, y las perturbaciones sociales y económicas generalizadas. Es imposible separar una sólida preparación para emergencias de salud pública y la equidad en salud”, dijo la Dra. Gracia.

Entre las recomendaciones del informe, se detacan:

  • El Congreso y los estados deben proporcionar fondos estables, flexibles y suficientes para la salud pública, incluida la infraestructura, los sistemas de datos y la fuerza laboral de salud pública.
  • El Congreso debe crear una Comisión COVID-19 para revisar y abordar las brechas en la respuesta a la pandemia, y los líderes en todos los niveles del gobierno deben rechazar los intentos de debilitar a las autoridades de salud pública.
  • Los legisladores deben tomar medidas para prevenir brotes de enfermedades invirtiendo en infraestructura de vacunación, programas de resistencia a los antibióticos y otorgando licencias pagadas a todos los trabajadores.
  • El Congreso debe crear programas para ayudar a construir comunidades resilientes invirtiendo en la equidad en la salud y los determinantes sociales de la salud, incluidos los programas antipobreza y los programas que generan seguridad financiera para las familias.
  • El Congreso debe invertir en el desarrollo y trabajar en medidas medicas de protección para permitir el desarrollo rápido y el despliegue efectivo de productos que salvan vidas durante emergencias, y los legisladores federales y estatales y los líderes de los sistemas de atención médica deben trabajar juntos para priorizar la coordinación y la comunicación efectivas durante las emergencias.
  • La Casa Blanca, el Congreso y los estados deben desarrollar planes y proporcionar fondos para minimizar los impactos del cambio climático en la salud y hacerlo de manera que aborde la equidad en el sistema de salud publica.

Trust for America’s Health es una organización no partidista y 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

Next Iteration of the Build Back Better Act Should Include Critical Investments in Public Health, Emergency Preparedness, and the Social Determinants of Health

(January 10, 2022) — As the 117th Congress begins its work in 2022, it is critical that it seeks to bolster the nation’s public health system and address longstanding inequities that have been exacerbated by the COVID-19 pandemic. As the country continues to grapple with the health and economic impacts of COVID-19, Congress has the opportunity to make urgent investments in core public health infrastructure, to modernize national, state and local public health laboratory systems, and to direct much needed resources to address current and longstanding public health challenges. As Congress considers the next steps for the Build Back Better Act, TFAH recommends that the following policies be prioritized as negotiations move forward:

  • Investing in chronically underfunded public health infrastructure to address the COVID-19 pandemic and ensure that public health is better equipped to effectively respond to future health threats. The pandemic exposed the impact of outdated, understaffed health departments. The Build Back Better Act includes $8.4 billion in funding to enable health departments to address longstanding infrastructure and workforce gaps and modernize public health data systems and laboratories across the country. TFAH recommends an additional $4.5 billion annual investment to support and sustain federal, state, local, territorial, and Tribal foundational public health capabilities.
  • Expanding availability of nutritious foods to ensure children, regardless of their socioeconomic status, can access high-quality, nutritious meals when school is in session and during school closures. The Build Back Better Act includes provisions to expand the Community Eligibility Program (CEP), invest in a Summer Electronic Benefits Transfer (EBT) program, and establish a Healthy Food Incentives Demonstration to support schools in developing healthy food offerings. TFAH also recommends extending Healthy School Meals for All, which provides students access to school meals at no charge regardless of their family income as a step to ending child hunger and ensuring access to healthy foods.
  • Increasing access to life-saving behavioral health programs. The Build Back Better Act includes $2.5 billion in funding to support public health approaches to reduce community violence and trauma, $75 million to support the infrastructure of the National Suicide Prevention Lifeline, and $15 million to support the Substance Abuse and Mental Health Services Administration’s Project Aware program, which helps schools promote the mental health of their students. TFAH recommends focusing on primary prevention of behavioral health concerns, including through suicide and Adverse Childhood Experiences prevention and increasing investments in social-emotional learning and wellness in schools.
  • Investing in early childhood education and services to ensure families have access to high-quality childcare and early education. The Build Back Better Act includes $400 billion to establish a birth-through-five childcare and early learning entitlement program, bolster Head Start, create a universal preschool program, and significantly strengthen the early childhood education workforce through training and increased pay.
  • Establishing a comprehensive paid family and medical leave policy to ensure workers can take time off to address health or caregiving needs. The Build Back Better Act includes provisions that grew out of the FAMILY Act and would provide up to 12 weeks of partial income while employees take family or medical leave. Access to paid family and medical leave can help control disease outbreaks, improve parental and child health, and contribute to a healthier, more productive workforce.
  • Increasing access to safe and affordable housing to address housing insecurity amongst low-income families. Stable and healthy housing is a significant social determinant of health. The Build Back Better Act includes $24 billion for new Housing Choice Vouchers and supportive services, $5 billion to address lead paint and other health hazards, $15 billion to support the preservation and creation of rental homes for low-income households, and $500 million to expand the supply of affordable housing with supportive services for older adults.

Staffing Up: Public Health Workforce Must Grow to Provide Basic Public Health for All Americans

Public health budget and staffing cuts have weakened America’s health security and increased Americans’ vulnerability to emerging infectious and chronic diseases.

State and local governmental public health departments are essential to maintaining the security, safety, and prosperity of local communities, yet they are consistently underfunded. A recent analysis conducted by the de Beaumont Foundation and the Public Health National Center for Innovations (PHNCI) found state and local governmental public health departments have lost 15 percent of their essential staff over the last decade. These staffing cuts have been especially detrimental in the midst of the global pandemic as understaffed health departments had a limited ability to plan for and respond to emergencies like COVID-19 and struggle to meet the daily health security needs of their communities.

The issue brief, Staffing Up: Workforce Levels Needed to Provide Basic Public Health Services for All Americans, found that nationally state and local governmental public health departments need an 80 percent increase in their workforce (80,000 additional full-time employees) to provide an adequate infrastructure and a minimum set of public health services to the nation (See Figure 1). Specifically, due to existing staffing shortages local health departments need to add approximately 54,00 full-time employees, and state departments need to add 26,000 full-time employees across differing levels of categories and areas of expertise. (See Figure 4).

Source: Staffing Up: Workforce Levels Needed to Provide Basic Public Health Services for All Americans

Source: Staffing Up: Workforce Levels Needed to Provide Basic Public Health Services for All Americans

This chronic underfunding of the public health system was a key contributing factor in the nation’s unprepared response to the COVID-19 pandemic, according to TFAH’s report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021. The report highlights how the underfunding of core public health programs – resulting in under-resourced, understaffed, and overburdened health agencies – impeded the pandemic response and exacerbated its impacts. Years of underfunding core public health programs created the situation in which local health departments were fighting a 21st century pandemic with 20th century tools and has made the nation less resilient, the report said.

To combat the growing public health crisis, and emerge better prepared for future public health emergencies, the U.S. needs to adequately fund public health and disease prevention all the time, not just in response to a crisis, and it needs to address the social determinants of health. At present, the country spends about $3.8 trillion on healthcare with just 2.6 percent of that spending directed toward public health and prevention.

Investment to ensure foundational capabilities is key. (See Figure 5).

Source: Staffing Up: Workforce Levels Needed to Provide Basic Public Health Services for All Americans

TFAH’s public health funding report calls for a $4.5 billion annual investment in the nation’s core public health capabilities, and includes four priorities for policy action:

  1. 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.
  2. Strengthen public health emergency preparedness, including within the healthcare system.
  3. Safeguard and improve Americans’ health by investing in chronic disease prevention and the prevention of substance misuse and suicide.
  4. Take steps to advance health equity by combating the impacts of racism and addressing the social determinants that lead to poor health.

 

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.