California Archives - Page 10 of 17

New Datasets Show Opportunities Exist for States to Bolster Fair Hiring Protections and Workers Rights with Earned Sick Leave and Ban the Box Laws

(Washington DC – January 28, 2021) — Two new datasets published to LawAtlas.org today offer a comprehensive look at state laws that address earned sick leave laws and Ban the Box policies. These datasets provide a snapshot of how earned sick leave, also known as paid sick leave, and ban the box policies differ between states, how such policies help promote the well-being of state residents, and opportunities for states to adopt or expand such regulations.

“States have a critical role to play in promoting the health and well-being of their residents. These data provide a clear picture that opportunities exist nationwide for states to foster equitable economies in which job seekers are evaluated on their merits and workers have access to paid leave benefits to care for themselves and loved ones,” Adam Lustig, MS, Senior Policy Development Manager and Co-Principal Investigator of the PHACCS initiative.

Earned Sick Leave

As of January 1, 2021, 15 states and the District of Columbia have an earned sick leave law that requires employers of varying sizes to provide paid time away to address medical needs for themselves or their families as a benefit to their employees. Across states, eligibility requirements, employer size, how and when an employee may use their time, and rate of leave accrual of the laws vary:

All 16 jurisdictions allow for earned sick leave to be used to care for a family member.
Geographically, earned sick leave laws are almost exclusively in place in the northeast and on the west coast, with Colorado, Arizona, and Michigan being exceptions.
Of the 16 jurisdictions that have earned sick leave laws, just six require employers of all sizes to provide this benefit.
Only two states, New York and Colorado, allow employees to use earned leave immediately upon accrual.
Eight states provide the most generous accrual of earned sick leave, enabling workers to earn one hour of sick leave for every 30 hours worked.
Washington is the only state that does not specify a limit on the amount of earned sick leave that can be accrued within one year.

Ban the Box

As of January 1, 2021, 36 states and the District of Columbia have a Ban the Box policy that prevents an employer from asking about a potential employee’s criminal history until after fairly considering the applicant’s relevant qualifications. These laws vary greatly in who they apply to, and their enforcement mechanisms:

Thirty-six jurisdictions have Ban the Box policies that regulate public employers. However, significant gaps remain, as only three of these jurisdictions apply this protection to government contractors.
Only 15 of the 37 jurisdictions with Ban the Box policies regulate private employers, leaving a significant portion of the workforce lacking access to this important fair hiring practice.
The most common private positions exempt from Ban the Box policies include: working with children, working with vulnerable adults, law enforcement, and positions where a criminal history check is required by law.

“We have seen a growing body of evidence supporting that earned sick leave laws and Ban the Box policies are important legal approaches to ensuring equity in hiring in the United States,” said Lindsay K. Cloud, JD, Director of the Center’s Policy Surveillance Program. “These datasets are an invaluable resource as we continue to seek to better understand the impact of employer-provided protections and fair chance hiring practices on health, and particularly on the social determinants of health amidst the Covid-19 pandemic.”

The Promoting Health and Cost Control in States initiative’s legal data resources are a collaboration of the Temple University Center for Public Health Law Research with Trust for America’s Health, and support from the Robert Wood Johnson Foundation. The earned sick leave and Ban the Box datasets are the fifth and sixth in a series of datasets on laws and policies that can support cost-savings for states and promote health and well-being.

Access the datasets on LawAtlas.org.

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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. Learn more at www.tfah.org

The Center for Public Health Law Research at the Temple University Beasley School of Law supports the widespread adoption of scientific tools and methods for mapping and evaluating the impact of law on health. Learn more at http://phlr.org.

Increases in Drug Overdose Death Rates Were Up Before COVID-19 and Are Continuing to Rise During the Pandemic

Trust for America’s Health and Well Being Trust Call for Renewed Focus on Preventing Deaths of Despair

DISTRICT OF COLUMBIA & OAKLAND, CA – Dec. 23, 2020 – According to data released this week by the National Center for Health Statistics, in 2019 age-adjusted drug overdose deaths increased slightly over the prior year. Coupled with data released last week by the CDC showing increases in drug overdose deaths in early 2020, these reports demonstrate the continuing upward trajectory of drug deaths in the U.S, a trend that is being compounded by the COVID-19 pandemic.

The age-adjusted rate of drug overdose during 2019 was 21.6 per 100,000 deaths, up from the 2018 rate of 20.7 per 100,000. In 2019, 70,630 people died due to drug overdose in the United States.

Between 1999 and 2019 the rate of drug overdose deaths increased for all groups aged 15 and older, with people aged 35-44 experiencing the highest single year increase in 2019. While rates of drug overdose deaths involving heroin, natural and semisynthetic opioids, and methadone decreased between 2018 and 2019 the rate of overdose deaths involving synthetic opioids other than methadone continued to increase.

2018 data showing only minor progress after decades of worsening trends, provisional drug overdose data showing an 18% increase over the last 12 months, and the recent CDC Health Alert Network notice on early 2020 increases in fatal drug overdoses driven by synthetic opioids all underscore the continued impact of the deaths of despair crisis and how the COVID-19 pandemic has further diminished the mental health and well-being of many Americans.

“These 2019 overdose rates and the outlook for 2020 are extremely alarming and the result of insufficient prioritization and investment in the well-being and health of Americans for decades,” said John Auerbach, President and CEO of the Trust for America’s Health. “As we work to recover from the COVID-19 pandemic, we must take a comprehensive approach that includes policies and programs that help Americans currently struggling and target upstream root causes, like childhood trauma, poverty and discrimination in order to help change the trajectory of alcohol, drug, and suicide deaths in the upcoming decades.”

Over the last five years, Trust for America’s Health (TFAH) and Well Being Trust (WBT) have released a series of reports on “deaths of despair” called Pain in the Nation: The Drug, Alcohol and Suicides Epidemics and the Need for a National Resilience Strategy, which include data analysis and recommendations for evidence-based policies and programs that federal, state, and local officials.

“If leaders don’t act now to stymie America’s mental health and addiction crises, next year’s data will easily surpass the astounding numbers we’re seeing today,” said Dr. Benjamin F. Miller, PsyD, Chief Strategy Officer at Well Being Trust. “Overdose deaths can be prevented if individuals who are struggling are able to access the appropriate services and supports – and with greater demonstrated success if the care individuals receive is rooted in their immediate communities.”

Drug Overdose Deaths, 1999-2019 (Rates age-adjusted)

Year	Deaths	Deaths per 100,000
1999	16,849	6.1
2000	17,415	6.2
2001	19,394	6.8
2002	23,518	8.2
2003	25,785	8.9
2004	27,424	9.4
2005	29,813	10.1
2006	34,425	11.5
2007	36,010	11.9
2008	36,450	11.9
2009	37,004	11.9
2010	38,329	12.3
2011	41,340	13.2
2012	41,502	13.1
2013	43,982	13.8
2014	47,055	14.7
2015	52,404	16.3
2016	63,632	19.8
2017	70,237	21.7
2018	67,367	20.7
2019	70,630	21.6

Sources:
CDC – NCHS – National Center for Health Statistics
https://emergency.cdc.gov/han/2020/han00438.asp
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

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About Trust for America’s Health
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

About Well Being Trust
Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community well-being. www.wellbeingtrust.org Twitter: @WellBeingTrust

Building Trust in and Access to a COVID-19 Vaccine Within Communities of Color and Tribal Nations

Policymakers and Health Systems Must Earn Trust within Communities of Color and Tribal Nations to Ensure COVID-19 Vaccine Receptivity, Say Health and Public Health Leaders

Policy brief calls for building vaccine acceptance in communities of color and tribal communities through data transparency, tailored communications via trusted messengers, ensuring ease of vaccine access and no out-of-pocket costs

(Washington, DC – Dec. 21, 2020) – A woeful history of maltreatment of communities of color and tribal nations by government and the health sector, coupled with present day marginalization of these communities by the healthcare system, are the root of vaccine distrust among those groups, according to a policy brief, Building Trust in and Access to a COVID-19 Vaccine Among People of Color and Tribal Nations released today by Trust for America’s Health (TFAH) and co-authors the National Medical Association (NMA) and UnidosUS.

This historic maltreatment, coupled with current day structural racism, has played out in COVID-19’s disproportionate impact on communities of color and tribal communities. These factors also make ensuring vaccine receptivity and access within those communities challenging and of critical importance to protecting lives and ending the pandemic.

In October 2020, TFAH, NMA and UnidosUS hosted a policy convening with 40 leading health equity, healthcare, civil rights, and public health organizations. The purpose of the convening was to advise policymakers on the barriers to vaccine receptivity within communities of color and tribal communities and how to overcome those barriers.

“Earning trust within communities of color and tribal communities will be critical to the successful administration of the COVID-19 vaccine. Doing so will require prioritizing equity, ensuring that leaders from those communities have authentic opportunities to impact vaccine distribution and administration planning, and, the resources to fully participate in supporting vaccine outreach, education and delivery in their communities,” said Dr. J. Nadine Gracia, Executive Vice President and COO of Trust for America’s Health.

The convening created recommendations for policy actions that should be taken immediately within six key areas:

Ensure the scientific fidelity of the vaccine development process.

HHS and vaccine developers should release all available vaccine data at frequent and regular intervals to improve transparency and increase confidence in the vaccine evaluation process. Leadership at FDA and HHS must commit to advancing any vaccine only after it has been validated based on established federal and scientific protocols. Programs to monitor for adverse events must also be in place and transparent. Any perception of bypassing safety measures or withholding information could derail a successful vaccination effort.
FDA should engage health and public health professional societies, particularly those representing healthcare providers of color, local public health officials, as well as other stakeholders with a role in vaccination, and allow these groups to validate all available data, review the vaccine development and approval process, and issue regular updates on data to their patients, members, and the public.

Equip trusted community organizations and networks within communities of color and tribal nations to participate in vaccination planning, education, delivery and administration. Ensure their meaningful engagement and participation by providing funding.

Congress should fund CDC and its state, local, tribal, and territorial partners to provide training, support, and financial resources for community-based organizations to join in vaccination planning and implementation, including community outreach, training of providers, and participation in vaccination clinics. State, local, tribal, and territorial authorities should authentically engage and immediately begin vaccination planning with community-based organizations, community health workers/promotores de salud, faith leaders, educators, civic and tribal leaders, and other trusted organizations outside the clinical healthcare setting as key, funded partners.

Provide communities the information they need to understand the vaccine, make informed decisions, and deliver messages through trusted messengers and pathways.

Congress should provide at least $500 million to CDC for outreach, communication, and educational efforts to reach priority populations in order to increase vaccine confidence and combat misinformation. All communications must be culturally and linguistically appropriate and tailored as much as possible to reach diverse populations as well as generations within groups.
FDA and CDC should initiate early engagement with diverse national organizations and provide funding and guidance for state, local, tribal, and territorial planners to help shape messaging and engage locally with healthcare providers in communities of color and tribal communities, such as nurses, pharmacists, promotores de salud, community health workers, and others to ensure they have the information they need to feel comfortable recommending the vaccine to their patients. Congress and HHS should provide funding for training and engagement of trusted non-healthcare communicators to help shape messaging and to train informal networks, civic and lay leaders, and other trusted community leaders and community-based organizations to answer questions and encourage vaccination.
All messaging about the vaccine must be appropriate for all levels of health literacy. Communication should be realistic and clear about timelines and priority groups (and the rationale for these decisions), vaccine effectiveness, types of vaccines, the number of doses, costs, and the need for ongoing public health protections. Planners must provide information that meets people where they are (e.g., barber shops, bodegas, grocery stores, places of worship, etc.) and ensure that trusted messengers in those places have the information they need to be credible and authentic spokespeople.

Ensure that it is as easy as possible for people to be vaccinated. Vaccines must be delivered in community settings that are trusted, safe and accessible.

We urge the administration and Congress to appropriate the resources necessary to expand and strengthen federal, state, local, territorial, and tribal capacity for a timely, comprehensive, and equitable COVID-19 vaccination planning, communications, distribution, and administration campaign, including funding to support vaccine distribution at the local level and by community-based organizations.
Congress and HHS should allocate funding to increase access to vaccination services to ensure that people seeking to be vaccinated do not experience undue increased exposure to the virus as they travel to, move through, and return home from vaccination sites. Flexibility in funding is needed to enable transport of people to vaccination sites, increase accessibility to people without cars, and promote safety and minimize exposure at vaccination locations. Funding should also be provided to health and community-based agencies to assist those for whom transportation or childcare costs are an obstacle to receipt of the vaccine.
Planners should ensure that vaccination sites are located in areas that have borne a disproportionate burden of COVID-19, especially leveraging community-based organizations such as Federally Qualified Health Centers, community health centers, rural health centers, schools and places of worship. Mobile services will be particularly important in rural areas. Planners should prioritize congregate living facilities, such as long-term care, prisons, and homeless shelters. In addition, some families, displaced by the COVID economic fallout, may be living with relatives. Planners should ensure vaccination sites have services that meet the Americans with Disabilities Act (ADA) and HHS Office for Civil Rights (OCR) standards for disability and language access.
Federal state, local, tribal, and territorial officials must guarantee and communicate with the public that immigration status is not a factor in people’s ability to receive the vaccine and that immigration status is not collected or reported by vaccination sites/providers. Similarly, the presence of law enforcement officers or military personnel could be a deterrent for vaccination at locations, so planners should consider other means of securing sites.
In the initial phase, as communities vaccinate healthcare workers, planners must be sure to prioritize home health, long-term care, and other non-hospital-based healthcare workers, who are more likely to be people of color. Other essential workers that comprise large numbers of workers who are people of color and should be treated as within the vaccination priority groups are the food service industry, farmworkers and public transportation employees.

Ensure complete coverage of the costs associated with the vaccine incurred by individuals, providers of the vaccine, and state/local/tribal/territorial governments responsible for administering the vaccine and communicating with their communities about it.

Congress, the Centers for Medicare and Medicaid Services, and private payers must guarantee that people receiving the vaccine have zero out-of-pocket costs for the vaccine, related health care visits, or any adverse events related to the vaccine, regardless of their health insurance status.
HHS, with emergency funding from Congress, should provide funding so that state, local, tribal, and territorial governments do not bear any cost of vaccine communication efforts, working with their communities, organizing sites, training their staff, and providing personal protective equipment (PPE).

Congress must provide additional funding and require disaggregated data collection and reporting by age, race, ethnicity, gender identity, primary language, disability status, and other demographic factors on vaccine trust and acceptance, access, vaccination rates, adverse experiences, and ongoing health outcomes.

CDC, and state, local, tribal, and territorial authorities should include leaders from communities of color and tribal communities and to plan on-going data collection on vaccination efforts, interpret data, add cultural context, share data with communities, and determine implications and next steps.
CDC, and state, local, tribal, and territorial authorities should use these data to inform ongoing prioritization of vaccine distribution and rapidly address gaps in vaccination that may arise among subpopulations by race, ethnicity, neighborhood, or housing setting.

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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

Climate Change & Health: Assessing State Preparedness

States at Greatest Risk for Health Impacts of Climate Change are Often Least Prepared to Protect Residents During Climate Related Events, New Report Finds

(Washington, DC and Baltimore, MD – December 9, 2020) – Many of the states most at risk from climate change are also the least ready to deal with it, according to a new report from researchers at Trust for America’s Health and the Johns Hopkins Bloomberg School of Public Health. This group of states faces increased hazards including hurricanes, floods, heat waves, and vector-borne diseases, but have done the least to prepare, according to the report Climate Change & Health: Assessing State Preparedness.

The report assessed all 50 states and the District of Columbia on their level of preparedness for the health effects of climate change. The researchers found a great deal of variation: Some states have made significant preparations, while others have barely begun this process. Eight states in particular are both most vulnerable to the health impacts of climate change and least prepared.

States in the most-vulnerable/least-prepared group were: Georgia, Kentucky, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia. Overall, the more vulnerable a state was, the less prepared it tended to be. Many of these high vulnerability/low preparedness states are in the Southeast or Southern Great Plains.

“We wanted to better understand the risks posed to individual states and their level of readiness to protect residents,” said the report’s lead author, Matt McKillop, Senior Researcher at Trust for America’s Health. “Our hope is that the report will give officials at all levels actionable information to better prepare.”

Another group of states: Colorado, Maine, Maryland, New Hampshire, Utah, Vermont, Wisconsin, and the District of Columbia – have done much more to prepare (See addendum for state-by-state preparedness summary.)

The researchers emphasized that every state, including those rated as most prepared, can do much more to protect residents from the harmful health impacts of climate change.

“The impacts of climate change on our health demand that policymakers respond,” said Megan Latshaw, a scientist at the Johns Hopkins Bloomberg School of Public Health. “Our goal is that every single state will take this as a clarion call and think of this report as a starting point to do more to help make residents’ lives safer.”

Some climate-related events, such as hurricanes and wildfires, have immediate health impacts. Others are more insidious, including more frequent heat waves; deteriorating air quality; chronic flooding; and increases in vector, water, and food-related disease. These threats already exist. But climate change exacerbates them, and also shifts or expands the regions and populations at risk. In addition, all of these effects can take a severe toll on mental health and well-being.

Some populations and communities are especially vulnerable. High-risk residents include those who are very young or very old, people with a disability, and those living in poverty. Often, the legacy and continued presence of systemic racism, including patterns of deprivation and discrimination, makes communities of color especially vulnerable.

The researchers calculated each state’s vulnerability by looking at a range of factors. Environment and geography are crucial, but in addition, social and demographic factors also play a key role. State assessments were based on three indicators: vulnerability, public health preparedness, and climate-related adaptation. All of the report’s findings are relative, i.e., based on comparisons between states.

The report, released today at the 3^rd annual Bloomberg American Health Summit, makes recommendations for federal and state action including:

Federal

Congress should enact legislation creating a national climate-readiness plan.
The administration and Congress should fully fund the Centers for Disease Control and Prevention’s (CDC) Climate and Health program and the National Environmental Public Health Tracking Network.
Strengthen the national public health system and workforce, including by modernizing data and surveillance capacities.

State

Complete all steps of the CDC’s Building Resilience Against Climate Effects (BRACE) framework.
Bolster core public health preparedness capacity, and establish and sustain dedicated funding and staffing for climate-related preparations.
Plan with communities, not for them.

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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. On Twitter at: @healthyamerica1

The Johns Hopkins Bloomberg School of Public Health is dedicated to the improvement of health for all people through the discovery, dissemination, and translation of knowledge, and the education of a diverse global community of research scientists, public health professionals, and others in positions to advance the public’s health.

The Bloomberg American Health Initiative was created in 2016 with a $300 million gift from Bloomberg Philanthropies to the Johns Hopkins Bloomberg School of Public Health. The Initiative is tackling key public health challenges in the U.S., focusing primarily on addiction and overdose, adolescent health, the environment, obesity and the food system, and violence. It is also working to train a new generation of professionals committed to improving health in America.

20 Public Health Organizations Condemn Herd Immunity Scheme for Controlling Spread of SARS-CoV-2

Great Barrington Declaration is not grounded in science and is dangerous

(Washington, DC – October 14, 2020) – SARS-CoV-2, the virus that causes COVID-19 has infected at least 7.8 million people in the United States and 38 million worldwide. It has led to over 215,000 deaths domestically, and more than 1 million globally – with deaths continuing to climb.

If followed, the recommendations in the Great Barrington Declaration would haphazardly and unnecessarily sacrifice lives. The declaration is not a strategy, it is a political statement. It ignores sound public health expertise. It preys on a frustrated populace. Instead of selling false hope that will predictably backfire, we must focus on how to manage this pandemic in a safe, responsible, and equitable way.

The suggestions put forth by the Great Barrington Declaration are NOT based in science.

There is no evidence that we are even remotely close to herd immunity. To the contrary, experts believe that 85 to 90 percent of the U.S. population is still at risk of contracting SARS-CoV-2. Herd immunity is achieved when the virus stops circulating because a large segment of the population has already been infected. Letting Americans get sick, rather than focusing on proven methods to prevent infections, could lead to hundreds of thousands of preventable illnesses and deaths.[i] It would also add greater risk in communities of color which have already experienced disproportionate impacts of the pandemic.
The declaration ignores what are our best tools to fight the virus, i.e. wearing masks, physical distancing, hand-washing, avoiding large crowds, strategic testing, rapid isolation of infected people and supportive quarantine for people who need to isolate.
We have seen the failure of the herd immunity experiment in nations such as Sweden, which has the highest mortality rate among Nordic countries.[ii] COVID-19 carries a much higher risk of severe disease and death than other infections where herd immunity was attempted before a vaccine was available.[iii] It is illogical to ignore public health and scientific evidence when so many lives are at stake.

Combatting the pandemic with lockdowns or full reopening is not a binary, either/or choice. We need to embrace common sense public health practices that allow for a safe reopening of the economy and a return to in-person work and learning while also using proven strategies to reduce the spread of the virus.

The declaration suggests a so-called focused protection approach. It suggests allowing the virus to spread unchecked among young people to create herd immunity in the entire population. This notion is dangerous because it puts the entire population, particularly the most vulnerable, at risk. Young people are not all healthy and they don’t live in vacuums.[iv] They interact with family members, co-workers and neighbors. Inviting increased rates of COVID-19 in young people will lead to increased infections rates among all Americans.

Public health guidance and requirements related to masking and physical distancing are not an impediment to normalcy – they are the path to a new normal. The goal is both public health safety and economic security; the two are not in conflict with one another, they are dependent on each other. We need to focus our efforts on the development and implementation of a national, science-based and ethical pandemic disease-control strategy.

The pandemic has created serious hardships on families’ economic security and on American’s mental health and well-being. What we need is a coordinated and robust national response including mask use, hand hygiene and physical distancing, while also ensuring social supports for those most vulnerable, including physical and mental health, and social factors. What we do not need is wrong-headed proposals masquerading as science.

This statement was authored by:

American Public Health Association

Big Cities Health Coalition

Trust for America’s Health

American Academy of Social Work and Social Welfare

Association for Professionals in Infection Control and Epidemiology

Association of Public Health Laboratories

Association of Schools and Programs of Public Health

de Beaumont Foundation

Johns Hopkins Center for Health Security at the Bloomberg School of Public Health

Los Angeles County Department of Public Health

National Association of County Behavioral Health and Developmental Disabilities Directors

National Association of County and City Health Officials

National Association for Rural Mental Health

National Network of Public Health Institutes

New York City Department of Health and Mental Hygiene

Nurses Who Vaccinate

Prevention Institute

Public Health Institute

Resolve to Save Lives, an initiative of Vital Strategies

Well Being Trust

[i] https://www.medpagetoday.com/infectiousdisease/covid19/88401

[ii] https://www.medpagetoday.com/infectiousdisease/covid19/88401

[iii] https://coronavirus.jhu.edu/from-our-experts/early-herd-immunity-against-covid-19-a-dangerous-misconception

[iv] https://www.cdc.gov/mmwr/volumes/69/wr/mm6941e1.htm?s_cid=mm6941e1_w

New Report Recommends Policies to Protect and Improve Americans’ Health by Transforming the Public Health System

Nation’s Public Health System Needs Sustained Attention and Investment; The Report Provides Action Plan for the Administration and Congress Taking Office in 2021

(Washington, DC – October 6, 2020) — The COVID-19 pandemic sharply illuminated weaknesses in the nation’s public health system and ways in which structural racism put communities of color at disproportionate risk of negative health outcomes, according to a new report, The Promise of Good Health for All: Transforming Public Health in America. The report was released today by Trust for America’s Health. Among its findings is that the nation’s public health system is dangerously inadequate. The report offers a blueprint for policymakers taking office next year on how to strengthen the system, protect against health security threats, address the social determinants of health, and combat racism and other forms of discrimination that negatively affect community and individual health and resilience.

Americans are facing increasing environmental and weather-related threats from wildfires to hurricanes. Infectious disease outbreaks are a constant and complex risk as world travel allows small outbreaks to become worldwide threats in a matter of hours. Additionally, Americans have higher levels of chronic disease and mental health and substance misuse issues than ever before. As a nation, we spend over $3 trillion annually on healthcare but lag behind other developed countries in practically every health metric. A key to addressing these threats to the nation’s health is a significant investment in the public health system, including programs rooted in prevention and working at the population health level. The report calls for an annual $4.5 billion investment in the nation’s public health infrastructure including in 21^st century data systems and a robust public health workforce.

“Even before COVID-19, numerous health emergencies, including infectious disease outbreaks like measles, Zika and Ebola, the opioid epidemic, weather-related events and lung injuries due to vaping demonstrated the urgency of a strong public health system,” says John Auerbach, President and CEO of Trust for America’s Health.

“Each of these emergencies brought short-term attention to the importance of the public health system, but short-term attention is not enough. Without sustained investment the nation’s public health system we will not be ready to protect Americans’ lives and livelihoods during the next health emergency,” Auerbach said.

The conditions in which people live and work are key drivers of their health. Therefore, solutions to health risks and inequities largely exist outside the healthcare sector and reinforce the importance of investing in population health and the social determinants of health. Increasing the nation’s investment in health promotion and disease prevention will not only improve the quality of life for millions of Americans, it will help decrease the nation’s exploding healthcare spending.

The report focuses on five key priority areas:

PRIORITY 1: Make substantial and sustained investments in a more effective public health system including a highly-skilled public health workforce.

PRIORITY 2: Mobilize an all-out effort to combat racism and other forms of discrimination and to advance health equity by providing the conditions that optimize health.

PRIORITY 3: Address the social determinants of health including economic, social, and environmental factors that result in preventable illness, injuries and death.

PRIORITY 4: Proactively address threats to the nation’s health security.

PRIORITY 5: Improve health, safety, and well-being for all people by providing pathways to optimal health across the life span.

Among the report’s recommendations for federal policymakers are:

Strengthen and modernize the public health system by creating a $4.5 billion per year Public Health Infrastructure Fund to support foundational public health capabilities at the state, local, territorial and tribal levels.
Build 21^st century public health surveillance systems at the federal, state and local levels to enable rapid detection and response to disease threats.
Create a Health Defense Operations budget designation to build sustainable funding for public health programs that prevent, detect and respond to outbreaks.
Make advancing health equity and eliminating health disparities a national priority with a senior-level, federal interdepartmental task force charged with adopting policies and programs in housing, employment, health, environmental justice and education that reduce health inequities and address the social determinants of health.
Expand grants to address health inequities and ensure funding is reaching under-resourced, marginalized, and disproportionately affected communities.
Prioritize increased funding for state, local, tribal and territorial public health emergency preparedness and response programs, such as CDC’s Public Health Emergency Preparedness program and HHS’s Hospital Preparedness Program.
Build surge capacity across the healthcare system and develop standards for healthcare facility readiness. Policymakers should provide payment incentives and reward facilities that maintain specialized disaster care capabilities.
Grow the CDC’s Climate and Health Program so it can support every state, large cities, territories and tribes to be climate-ready. Clean air and water regulations should be restored and strengthened, including the Clean Air Act and Clean Water Act.
Increase research and effective messaging to build vaccine confidence and ensure that no person faces barriers to receiving all necessary vaccinations.
Promote optimal health across the lifespan through access to health insurance, job-protected paid leave for workers, and significant investments in programs proven to support families and improve health – from babies to older adults.

The report is endorsed by the American Public Health Association, the Asian & Pacific Islander American Health Forum, the Big Cities Health Coalition, the Public Health Institute, and the National Network of Public Health Institutes.

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