Issue Category: Substance Misuse and Mental Health

2024 Year in Review and Looking Ahead to 2025

During 2024, Trust for America’s Health (TFAH) continued its work to create a more resilient, trusted, and equitable public health system, and a healthier nation.

TFAH continued its work in a number of critical issue areas to improve the nation’s health, including emergency preparedness, public health funding, chronic disease prevention, the role of food and nutrition policy in stemming the nation’s obesity crisis, preventing substance misuse and suicide, supporting healthy aging, and addressing the health impacts of climate change and other environmental health risks.

Progress and Risks

The nation’s public health system is at an inflection point; progress has been made in many areas but there are also continuing and potential new risks to the nation’s health. The following are examples of areas of progress and areas of risk.

Areas of progress:

  • Drug overdose deaths, including from fentanyl, are down. The reduction can be credited in part to the increased availability of treatment options and the adoption of harm reduction strategies such as readily available naloxone, the overdose reversal drug, in many communities. However, disparities persist, with overdose rates increasing in many Black and Native American communities.
  • COVID-19 infection rates are currently low across the country, a testament to what can be achieved when the public health community rallies and has the funding and resources necessary to meet an immediate challenge.
  • Investments in public health data modernization, wastewater surveillance, and the Centers for Disease Control and Prevention’s (CDC) Center for Forecasting and Outbreak Analytics have improved the nation’s ability to identify and track emerging health threats. The Center has awarded more than $100 million to partners who are technologically advancing the use of outbreak data to control infectious disease spread.
  • Fifty-nine state and local health departments have earned Age-Friendly Public Health Systems Recognition Status through TFAH’s Age-Friendly Public Health Systems initiative by making healthy aging a core function of the department. In addition, four public health organizations and 154 individual public health practitioners have been recognized as public health champions.
  • Fifteen states and D.C. have adopted paid sick leave laws which require private employers to provide paid sick leave to employees attending to their own or a family member’s health. Alaska, Missouri, and Nebraska will require employers to provide paid sick leave beginning in 2025. Paid sick leave has been a long-standing TFAH policy recommendation.

Areas of risk:

  • Public health faces a serious funding cliff as monies infused into the public health system as part of the pandemic response are expiring or in some cases rescinded. The loss of such funding returns the public health system to the state of underfunding it experienced for decades prior to the global pandemic. TFAH’s annual report, The Impact of Chronic Underfunding on America’s Public Health System 2024: Trends, Risks, and Recommendations called attention to the critical need to increase investment in public health on a sustained basis.
  • The COVID-19 pandemic exposed serious gaps in the nation’s emergency infrastructure that have not been fully addressed. Furthermore, misinformation about the pandemic, particularly about lifesaving COVID-19 vaccines, contributed to an uptick in mistrust of public health officials that could lead to more vaccine hesitancy and challenges to important public health authorities, all of which could make containing future disease outbreaks more difficult.
  • New disease outbreaks such as the H5N1 Bird Flu could grow.
  • Rates of recommended childhood vaccinations are down.
  • Health disparities continue to impact the nation. Rates of chronic disease are on the rise in every community but are higher, for example, among many communities of color and in rural communities, due to structural barriers to health like access to healthy and affordable food, secure housing, and opportunities for physical activity in those communities.
  • Health risks are also increasing due to an increase in the number and severity of weather-related incidents including extended periods of extreme heat and extreme heat in regions of the country unaccustomed to such weather.

Working With Partners and Providing Leadership to Strengthen the Nation’s Public Health Ecosystem

TFAH released its Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress in October, after consultation with more than 45 experts, practitioners, organizations, and community members. The Blueprint provides the incoming Administration and Congress a policy roadmap for improving the nation’s health, economy, and national security within six priority areas: 1) invest in public health infrastructure and workforce, 2) strengthen prevention, readiness, and response to health security threats, 3) promote the health and well-being of individuals, families, and communities across the lifespan, 4) advance health equity by addressing structural discrimination, 5) address the non-medical drivers of health to improve the nation’s health outcomes, and 6) enhance and protect the scientific integrity, effectiveness, and accountability of agencies charged with protecting the health of all Americans.

Working with partners across multiple sectors is central to TFAH’s work. TFAH staff led or participated in a number of coalitions during 2024, including the Coalition for Health Funding, the CDC Coalition, the Common Health Coalition, the Well-Being Working Group, the Injury and Violence Prevention Network, National Alliance for Nutrition and Activity, the Coalition to Stop Flu, the Adult Vaccine Access Coalition, the Age-Friendly Ecosystem Collaborative, the National Alliance to Impact the Social Determinants of Health, the National Commission on Climate and Workforce Health, and the National Council on Environmental Health & Equity.

Advocating for Evidence-Based Solutions

A healthy community supports the health of individuals and families by creating access to non-medical drivers of health such as secure housing, transportation, quality healthcare, high-quality childcare and educational opportunities, and jobs that pay a living wage. Such health security supports individuals, families, communities, and the nation’s economy.

Throughout the year, TFAH convened partners to strategize ways to effectively advance health promoting policies and programs at the federal and state levels. In addition, TFAH staff worked with numerous federal agencies and offices, like CDC, FDA, and SAMHSA, as well as public health organizations such as the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), Big Cities Health Coalition, and the National Governors Association to advance policies and garner support for programs that will improve Americans’ health. Among TFAH’s legislative goals for 2024 and moving into 2025 are increased and sustained investment in public health agencies, infrastructure, and programs; passage of a new Farm bill that provides access to nutrition support programs; reauthorization of the Pandemic and All Hazards Preparedness Act and the Older Americans Act; and passage of the Public Health Infrastructure Saves Lives Act and the Social Determinants of Health Act.

These advocacy efforts earned numerous policy wins, including the U.S. Department of Agriculture’s (USDA) updates to school meals formulas and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefit food packages that aligns with TFAH recommendations.

TFAH’s core annual reports, which track data and recommend policy solutions in the areas of emergency preparedness, public health funding, preventing substance misuse and suicide, and addressing the nation’s obesity crisis, continue to be a critical source for data trends and evidence-based policy and program solutions for health officials, policymakers, other decision-makers, and advocates across the country.

Making Healthy Aging a Core Function of Local Health Departments

Through its Age-Friendly Public Health Systems Initiative (AFPHS), TFAH continues to provide guidance and resources to state and local health departments to help them promote healthy aging in their communities. During 2024, AFPHS co-hosted the 2024 National Healthy Aging Symposium with the U.S. Department of Health and Human Services’ (HHS) Office of Disease Prevention and Health Promotion. The symposium brought together speakers from sectors across all levels of government, philanthropy, academia, nonprofits, community-based organizations, tribal representatives, and others who shared their perspectives on important topics related to healthy aging including caregiving, brain health, the caregiving workforce, transportation, housing, and social engagement. TFAH also launched the Age-Friendly Ecosystem Collaborative to continuously engage organizations and sectors central to healthy aging.

Supporting Public Health Communicators

TFAH continues to be a managing partner of the Public Health Communications Collaborative (PHCC). PHCC provides no-cost messaging resources and communications training to state and local health departments to help the field effectively address the public’s information needs on public health issues. The Collaborative was first established during the COVID-19 pandemic and now works across the public health sector on such issues as H5N1 Bird Flu, Mpox, protecting health during periods of extreme heat, and vaccine confidence. Its training materials include resources on strengthening public health through community engagement, responding to misinformation, and using social media in health communications. The PHCC newsletter is shared with over 38,000 opted-in subscribers, and its website has earned over 1.2 million page views since its launch in 2020.

Looking Ahead

The 2025 calendar year promises to be pivotal for the nation’s health. TFAH looks forward to bringing evidence-based policy recommendations to the new Administration and Congress, particularly on issues such as emergency preparedness, chronic disease prevention, mental health, veterans’ and rural health, and investing in prevention to reverse the pattern of increasing healthcare spending without better health outcomes. We are committed to making the case for policies and programs that address the non-medical drivers of health in order to promote the nation’s health and economic security.

Over 50 Public Health Advocacy Organizations Support Robust Investment in CDC Suicide Prevention

(November 1, 2024 – Washington, DC)  – According to data from the Centers for Disease Control and Prevention (CDC), the number of suicides increased in 2022 to historic peak levels—over 49,000 deaths—after slight declines in 2019 and 2020. Suicide is the second leading cause of death among Americans between the ages of 10-14 and 25-34, and suicide rates increased by 36 percent between 2000 and 2021. The complex nature of suicide requires a comprehensive approach to prevention that focuses on disproportionately affected populations, uses data to understand risk factors associated with suicide in these groups, and applies the best available evidence to decrease risk and increase protective factors.

In a recent letter to key Congressional leaders, TFAH and the American Foundation for Suicide Prevention (AFSP) led more than 50 public health advocacy organizations in urging increased investment in these approaches through the CDC Comprehensive Suicide Prevention Program (CSP). Established in 2020, the CSP currently funds 24 initiatives nationwide through cooperative agreements designed to implement and evaluate a comprehensive public health approach to suicide prevention, with a special focus on populations that are disproportionately affected by suicide. These CSP initiatives have led to significant benefits, including decreases in suicide rates and increased training, awareness, and data collection. For example, the veteran and servicemember population that CSP initiatives served saw a 6.5% reduction in suicide rates from 2019-2021.

As the letter explains, “[b]y promoting mental health awareness, encouraging early intervention, and supporting individuals in crisis, the CSP plays a pivotal role in addressing one of the most serious public health challenges of our time.” TFAH and AFSP urge Congressional leaders to provide robust funding for the CSP to save lives and foster hope for Americans in crisis.

Pain in the Nation 2024: The Epidemics of Alcohol, Drug, and Suicide Deaths

Trust for America’s Health (TFAH) hosted a national webinar on our report, Pain in the Nation 2024: The Epidemics of Alcohol, Drug, and Suicide Deaths.

TFAH’s report found that a decrease in the alcohol-induced mortality rate led to a slightly lower combined rate of all U.S. deaths due to alcohol, drugs, and suicide in 2022, but the long-term trend of such deaths is still alarmingly high. Between 2002 and 2022, combined deaths due to alcohol, drugs, and suicide have increased by 142 percent from 74,003 deaths in 2002 to 207,827 deaths in 2022. For 2022, the alcohol-induced mortality rate decreased by six percent to 13.5 deaths per 100,000 people, the first decrease in the rate after more than a decade of increases, but death rates for drug overdose and suicide remained unchanged. The report also includes a special feature on polysubstance misuse and overdose.

The webinar discussed steps policymakers should take to begin to reverse these crises.

 

U.S. Deaths Due to Alcohol, Drugs, and Suicide Down Slightly After Years of Growth

Data Show First Improvement in Combined Substance Misuse and Suicide Mortality Rate in Five Years but Multidecade Trends Remain Alarmingly High

(Washington, DC – July 31, 2024) – A decrease in the alcohol-induced mortality rate led to a slightly lower combined rate of all U.S. deaths due to alcohol, drugs, and suicide in 2022, but the long-term trend of such deaths is still alarmingly high, according to a report released today by Trust for America’s Health.

The report, Pain in the Nation 2024: the Epidemics of Alcohol, Drug, and Suicide Deaths, includes data showing that between 2002 and 2022, combined rate of deaths due to alcohol, drugs, and suicide have increased by 142 percent from 74,003 deaths in 2002 to 207,827 deaths in 2022.

For 2022, the alcohol-induced mortality rate decreased by six percent to 13.5 deaths per 100,000 people, the first decrease in the rate after more than a decade of increases, but death rates for drug overdose and suicide remained unchanged.

Rates and trends for deaths due to substance misuse and suicide vary across population groups and states and regions of the country. While all population groups have experienced increases in substance misuse and suicide deaths over the last two decades, American Indian and Alaska Native people, Black people, and white people have higher than average combined rates for alcohol, drug, and suicide deaths.

In 2022, states with the highest rates of deaths due to alcohol, drugs, and suicide were New Mexico (124.3 deaths per 100,000 people), West Virginia (115.7 deaths per 100,000 people), and Alaska (104.1 deaths per 100,000 people).

Substance use and drug overdose

The overall age-adjusted drug overdose mortality rate was virtually unchanged from 2021 to 2022 (32.4 deaths per 100,000 people and 32.6 deaths per 100,000 respectively), but despite the flat trend, 107,941 people died in the U.S. due to a drug overdose in 2022.

According to data collected by the U.S. Substance Abuse and Mental Health Services Administration, in 2022 approximately 70 million people in the U.S. aged 12 and older – about one-quarter of the adolescent and adult population – reported using one or more illegal drugs and just under 10 percent of people aged 12 and over in the U.S. had a drug use disorder.

Drug overdose rates were highest among American Indian/Alaska Native people at 65.2 deaths per 100,000 people, adults ages 35 to 54 (59.4 deaths per 100,000), Black people (47.5 deaths per 100,000), and males (45.6 deaths per 100,000).

Alcohol Misuse

Despite the decrease in alcohol-induced deaths in 2022, 51,191 people in the U.S. died from alcohol-induced causes during the year. Alcohol-induced deaths were highest among American Indian and Alaska Native people (78.4 deaths per 100,000 people) and adults ages 55 to 74 (34.9 deaths per 100,000 people).

Suicide Deaths

In 2022, 49,476 people in the U.S. died from suicide. Overall mortality due to suicide was virtually unchanged between 2021 and 2022: 14.1 deaths per 100,000 people and 14.2 deaths per 100,000, respectively.

The highest rate of suicide was among American Indian/Alaska Native people (27.1 deaths per 100,000 people), males (23 deaths per 100,000), older adults (21 deaths per 100,000), and people living in rural areas (20.5 deaths per 100,000). Suicide mortality between age groups moved in different directions with suicide deaths among young people (ages 0-17 and 18 – 34) decreasing while increasing for all older age groups.

“While the stabilization in the combined rate of alcohol, drug, and suicide deaths in 2022 is promising news, it is overshadowed by decades of tragically increasing numbers of such deaths and spotlights the need to continue to apply evidence-based solutions in order to save lives,” said J. Nadine Gracia, M.D., MSCE, President and CEO, Trust for America’s Health. “We have strategies that we know work, including early prevention and harm reduction strategies, creating safe and supportive schools, ensuring access to mental and behavioral healthcare, and creating community conditions that support children and families. We need to invest in these policies and programs.”

Report Recommendations

The report includes recommendations for steps that federal, state, local government and other stakeholders should take to address the substance misuse and suicide crisis, including:

Invest in prevention and community conditions that promote health, including programs to reduce adverse childhood experiences and those that support families and offer trauma-informed and culturally appropriate services for youth.

Reduce overdose risk and access to lethal means of suicide through harm reduction programs including syringe services programs, access to overdose prevention medications like naloxone, and promoting safe storage of all firearms.

Strengthen the mental health and substance use prevention system by continuing to build a continuum of crisis intervention programs, ensuring access to mental health and substance use services, and growing the mental health workforce while increasing its diversity and offering more culturally and linguistically responsive services.

Read the full report

Trust for America’s Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.

 

Ensuring Culturally and Linguistically Appropriate Mental Health Services Will Reduce Health Disparities and Promote Well-being

In 1966, Dr. Martin Luther King, Jr. famously condemned injustice in health as the most shocking of all forms of inequality.  As TFAH recognizes Mental Health Awareness Month almost 60 years later, populations of color and other underserved groups in the United States continue to experience disparities in behavioral health outcomes and the availability and quality of care.  By supporting and promoting culturally and linguistically appropriate services (or CLAS), however, policymakers can reduce these disparities and promote well-being for all Americans.

The Office of Minority Health at the U.S. Department of Health and Human Services (HHS) defines CLAS as services that are respectful of and responsive to cultural and communication needs, including through consideration of cultural health beliefs, health literacy levels, and preferred languages.  By incorporating CLAS, providers can ensure individuals and families receive respectful, understandable, effective, and equitable care.  Among other features, CLAS can involve recruiting and supporting a culturally and linguistically diverse workforce, offering language assistance to individuals with limited English proficiency, and collecting and maintaining accurate data to evaluate impacts on health equity and outcomes.

The U.S. mental health care system, specifically, has struggled to address the needs of culturally and linguistically diverse populations; as a result, racial and ethnic minority populations have historically been less likely to receive necessary mental health care and more likely to receive low-quality care.  In addition, these groups are more likely to use hospitals and inpatient facilities to address mental health needs instead of community-based services.  Across the healthcare system, non-white patients report lower quality patient-physician interactions, less participation in medical decision making, and lower overall satisfaction with care. Other social and economic factors like lack of health insurance, limited income, transportation barriers, and experiences of racism and bias also contribute to these outcomes. In addition, a recent report found that 50 percent of LGBTQ+ young people who wanted mental healthcare could not get it due, in part, to a lack of affordable options and fears of negative reactions or other consequences.

Racial and ethnic health disparities impose a high burden in the United States—one study found $451 billion in costs, including medical expenses, lost productivity, and premature death, for 2018 alone—but CLAS can significantly improve quality of care and advance equity.  One study found that the single most important factor for increasing use of mental health services for individuals with limited English language proficiency was access to providers speaking their native languages.  In addition, the use of peer support specialists and other lay health workers with community-specific experience can promote access to care and help to reduce dropout rates and boost attendance rates for patients during mental health treatment.  In Native communities, for example, these workers can help overcome practical barriers to mental healthcare like lack of transportation and reduce symptoms of depression and suicide-related outcomes.  An integrated care approach that coordinates a variety of services can also improve mental health outcomes for patients from racially and ethnically diverse populations.

The Biden-Harris Administration has undertaken significant efforts to support and enhance CLAS across the spectrum of behavioral healthcare.  The 988 Suicide and Crisis Lifeline, which launched in July 2022, for example, has implemented specialized services for the LGBTQ+ population, and the Substance Abuse and Mental Health Services Administration announced the addition of Spanish language text and chat services in July 2023.  In November 2023, the White House also released the U.S. Playbook to Address Social Determinants of Health.  This document outlines strategies to “support equitable health outcomes by improving the social circumstances of individuals and communities,” including the structural inequities that “often disproportionately impact historically underserved individuals.” The 2023 HHS Equity Action Plan similarly outlined measures to improve access to behavioral healthcare coverage for underserved populations, including by developing an inclusive workforce, promoting behavioral health integration, and enhancing language services.  Relatedly, in January 2024, the Centers for Medicare & Medicaid Services (CMS) announced the Innovation in Behavioral Health (IBH) Model, which will comprehensively address health-related social needs of Medicaid and Medicare populations with moderate to severe mental health conditions and substance use disorder.  Importantly, this model requires participating Medicaid agencies to develop a health equity plan to address disparities in the populations they serve.

Several recent Congressional initiatives have also focused on promoting CLAS in the behavioral health system.  The PEER Support Act, for example, would strengthen the peer support specialist workforce by ensuring accurate data reporting on the profession, supporting best practices on training and supervision, and addressing barriers to certification and practice.  In addition, the Pursuing Equity in Mental Health Act would help establish behavioral healthcare teams in areas with underserved populations, improve training and best practices for addressing mental health disparities, and enhance outreach to populations of color to promote mental health and reduce stigma.  Finally, the Health Equity and Accountability Act would help reduce health disparities by improving data reporting, supporting workforce diversity, and increasing access to CLAS.

TFAH encourages Administration officials and Congressional leaders to continue to bolster CLAS to improve behavioral health outcomes for populations of color and other underserved groups. These improvements will not only help address the high cost of health disparities in the United States but will also support foundational changes to improve access and outcomes in the future.