State Category: Mississippi

New Report: Under-Investment in Public Health Leaves Nation Less Prepared for Current and Future Health Risks

COVID-19 Emergency Funding Helped Control the Pandemic, but Did Not Address Structural Weaknesses in the Nation’s Public Health System

(Washington, DC – June 14, 2023) – Decades of underfunding have left the nation’s public health system ill-equipped to protect the health of Americans, according to a new report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2023, being released today by Trust for America’s Health.

Insufficient funding for public health programs has been a long-standing problem. The COVID-19 crisis illuminated weaknesses in the nation’s public health infrastructure, including antiquated data systems, insufficient public health laboratory capacity, an under-resourced public health workforce, and the need for improved public health communications. These foundational public health capacities require increased, flexible, and sustained funding.

While pandemic response emergency funding was critical for addressing the crisis, it represented one-time funding and was often limited to COVID-19-specific spending, i.e., it could not be spent on underlying infrastructure needs. Furthermore, in most instances, this funding has now ended or was rescinded in the recent debt limit agreement. The nation is therefore at risk of returning to a boom-and-bust pattern of sporadic funding increases for public health during emergencies followed by insufficient funding in non-emergency periods.

The U.S. Centers for Disease Control and Prevention (CDC), the primary source of public health funding for state, local, tribal, and territorial health departments, is itself reliant on the annual federal appropriations process. Over the past two decades (FY 2014 – 2023), the CDC’s budget has increased by just 6 percent after adjusting for inflation, leading to insufficient funding in key program areas such as emergency preparedness and chronic disease prevention.

Two CDC programs focused on public health preparedness and response, the Public Health Emergency Preparedness Program (PHEP) and the Healthcare Readiness and Recovery Program, have both experienced major budget cuts over the past two decades. After adjusting for inflation, PHEP funding has been reduced by about half since 2003, and the budget for the Healthcare Readiness and Recovery Program has decreased by nearly two-thirds during the same period.

In addition to the risks associated with health emergencies, the country faces a growing number of people living with chronic diseases and the associated healthcare costs. Today, roughly 60 percent of the U.S. adult population has at least one chronic disease, such as obesity, diabetes, or heart disease. Treating these chronic diseases, along with mental health conditions, accounts for the vast majority of U.S. healthcare spending. While evidence-based public health programs that help prevent chronic disease are doing important work, insufficient funding has limited their accessibility and impact in many communities.

“We must address the serious mismatch between the nation’s public health needs and its public health investment,” said J. Nadine Gracia, M.D. MSCE, President and CEO of Trust for America’s Health. “Public health and prevention represent only a small fraction of the more than $4 trillion in annual health spending in our nation. Increased and sustained investment in public health would not only better prepare us for future public health emergencies, it would also help address the root causes of poor health and health disparities.”

TFAH is calling for annual funding for CDC of at least $11.581 billion in FY 2024, the level requested in the President’s FY 24 budget (FY 2023 CDC funding is $9.2 billion).

Other policy recommendations within the report include:

  • Increase and sustain disease-agnostic funding to strengthen public health infrastructure. Public health experts estimate an annual shortfall of $4.5 billion in necessary funding for state and local health departments to provide comprehensive public health services in their communities.
  • Strengthen public health emergency preparedness, including within the healthcare system. Investments should include the restoration of funding to the Public Health Emergency Preparedness Cooperative Agreement, the Healthcare Readiness and Recovery Program, and programs designed to support vaccine infrastructure as well as prevent, detect, and contain antimicrobial-resistant infections.
  • Modernize the public health data system to ensure comprehensive and real-time data sharing during public health emergencies. Public health experts estimate that at least $7.84 billion is needed over the next five years for CDC’s Data Modernization Initiative to strengthen public health data collection and reporting at the state and local levels. Congress should also provide sustained funding for CDC’s new Center for Forecasting and Outbreak Analytics.
  • Bolster the recruitment and retention of the public health workforce. In 2021, it was estimated that state and local public health departments needed to hire an additional 80,000 employees to be able to deliver a minimum set of public health services. The one-time nature of short-term emergency funding means that health departments will continue to experience understaffing.
  • Address health disparities and the root causes of disease by addressing the social determinants of health and investing in chronic disease prevention.
  • Invest in programs to prepare for and mitigate the impacts of climate change.

Read the full report

 

 

 

U.S. Death Rate Due to Alcohol, Drugs, and Suicide Increased by 11 Percent in 2021

Increases occurred among all ages, races, and geographic groups, but were particularly high for youth suicides and overdoses among certain populations of color

(Washington, DC – May 24, 2023) – The rate of U.S. deaths due to alcohol, drugs, and suicide climbed 11 percent in 2021, according to Pain in the Nation 2023: The Epidemics of Alcohol, Drug, and Suicide Deaths, a new report released today by Trust for America’s Health (TFAH).

While an all-time record, 209,225 Americans lost their lives due to alcohol, drugs or suicide last year these deaths are part of a two-decade trend of sharply increasing fatalities due to substance misuse and suicide in the U.S. The 2021 data showed such deaths were up across the U.S. population, with the largest increases occurring among certain populations of color as well as people living in the South, West, and rural regions of the country.

  • Drug overdose deaths increased by 14 percent between 2020 and 2021, with larger increases among Native Hawaiians and Pacific Islanders, American Indian/Alaska Native people, and among youth and older adults. For the year, drug overdose rates were highest among adults ages 35 to 54, males, Black people, and young adults ages 18 to 34.
  • Alcohol-induced deaths increased by 10 percent between 2020 and 2021, with the highest increases among Native Hawaiians and Pacific Islanders, Latino people, and American Indian/Alaska Native people.
  • Suicide mortality increased by 4 percent between 2020 and 2021, with the highest increases among American Indian/Alaska Native people and Black people.

While the 2021 trends were not good news, they were an improvement over the 2020 data. For 2020, the number of alcohol, drug, and suicide deaths was up 20 percent as compared with 2019.

“The data continue to show alarming increases in deaths due to substance misuse and suicide,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “What is needed is urgent and sustained investment in policies and programs that prevent the root causes of substance misuse and suicidality. We need to prevent adverse childhood experiences and trauma and support mental health services in schools, within healthcare settings, and in community settings for all populations.”

Two Decades Overview
Deaths due to alcohol, drugs, and suicide have been on the rise for over two decades, doubling over the period from 104,379 deaths in 2011 to 209,225 in 2021.  Between 2016 and 2021, the escalation in the rate of drug overdose deaths was more than 60 percent. These increases disproportionately impacted Black and Latino populations.

Most of the upturn in deaths due to drug overdose involved opioid overdose, with additional deaths due to cocaine and psychostimulants. In addition, a new and growing threat is xylazine, a tranquilizer approved for veterinary use but mixed with fentanyl to create a highly toxic illicit drug combination.

During the last two decades alcohol and suicide deaths have also increased, but not as sharply as drug deaths.

Youth Suicide Risk
Over the last decade, alcohol, drug, and suicide deaths among youth ages 10 to 17 increased by 65 percent. While youth have a much lower suicide rate than the general population, the upward trend of youth suicide, beginning well before the COVID-19 pandemic—a 71 percent increase tween 2010 and 2021—is tragic and warrants immediate attention. Unlike for other age groups, an increase in suicide deaths among young people was the primary driver for the age group’s increased overall mortality.

American Indian/Alaska Native and LGBTQ youth are most at risk for poor mental health and suicidal behaviors.

Veteran Suicide Risk
Veteran suicide risk also needs immediate attention.  The suicide mortality rate for veterans was 32 deaths per 100,000 veterans in 2020, a much higher rate than the general population.

Evidence-based Programs Can Help Reverse Deaths of Despair Trends

In response to the growing deaths of despair crisis, a multifaceted approach to improving mental health and well-being in every community is needed. The report includes recommendations for steps federal, state, and local government and other stakeholders should take to address substance misuse and suicide deaths. The recommendations include:

  • Invest in prevention programs and conditions that promote health including programs that prevent or reduce adverse childhood experiences and provide trauma-informed services, student mental health services in schools, and strengthened crisis intervention programs, including the 988 crisis lifeline.
  • Prevent substance misuse and overdose by supporting syringe service programs, increasing naloxone and fentanyl test strips availability, and expanding funding for the Drug-Free Communities Support Program to bolster prevention programs for youth specifically.
  • Transform the mental health and substance use prevention system by increasing access to mental health and substance use healthcare through full enforcement of the Mental Health Parity and Addiction Equity Act, integrating mental health and substance use treatment with other healthcare services, and expanding culturally and linguistically appropriate care for populations of color and other underserved populations.

Read the full report

 

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. 

 

 

 

 

 

 

 

 

 

 

 

 

Improving Minority Health Requires Addressing Social and Economic Disparities

The data tell the story. Members of certain racial and ethnic groups in the U.S. have, on average, worse health outcomes, including higher rates of chronic and infectious disease, than do their white counterparts. According to the National Institutes of Health, American Indian and Alaska Native people have a greater chance of having diabetes than any other racial group and are twice as likely as whites to have diabetes. Black adults in the U.S. are nearly twice as likely to develop diabetes compared to white adults. Asian Americans are 40 percent more likely to have diabetes than are whites, and Hispanic and Latino adults are also more likely to have diabetes than are whites.

Cancer is another disease for which people of color experience higher disease and death rates than do white people, according to the National Cancer Institute, typically due to social, environmental, and economic disadvantages. People of color also often have less access to healthcare screening and services, experience a lower quality of care, and face discrimination and bias when they do seek care. Black men have the highest prostate cancer mortality rate among all U.S. population groups, Black women have a lower incidence of breast cancer than white women but a higher mortality rate, and American Indian and Alaska Native people have higher death rates from kidney cancer than other racial and ethnic groups.

Health disparities are preventable differences in the burden of disease or in opportunities to achieve optimal health as experienced by racial and ethnic groups. Health disparities are among the many ways in which both the legacy of and present-day structural racism impact the disease burden and life expectancy of people of color. At the root of these disproportional health burdens are historic patterns of systematic inequities which have led to communities disadvantaged by poverty, exposure to pollution and environmental risks, unstable housing, limited employment opportunities and lack of access to healthy food, quality education, transportation, and healthcare. These differential disease burdens are rooted in differences that go beyond personal choices. They occur at the systems level, are rooted in centuries of structural racism, and were exacerbated by the COVID-19 pandemic.

Solutions can be found in policy action to create conditions in every community that allow all residents to achieve optimal health. Conditions such as access to safe and affordable housing; access to healthy foods, transportation, education, employment, and healthcare; jobs that pay a living wage and a built environment that supports physical activity. Building such communities will require a multi-sector and intentional focus on health equity and should start by targeting resources to communities most in need.

Trust for America’s Health’s (TFAH) recommendations for policy action that will advance health equity include:

  • The Federal government should be a leader in advancing health equity by making it a priority and by ensuring accountability to health equity goals in all federal agencies, policies, and programs.
    • Update: The Biden-Harris Administration’s American Rescue Plan and other COVID-19 response measures were designed to mitigate the impacts of the pandemic, with households of color being at particular risk for negative health and economic impacts during the emergency. Numerous programs including cash relief to low-and-middle income people, expansion of food and nutrition security programs, rent payment programs, and lower health insurance marketplace premiums helped Americans weather the pandemic. Of concern, is that many of these programs and program flexibilities will expire with the end of the public health emergency in May 2023.
    • Update: On his first day in office, President Biden signed Executive Order 13985 Further Advancing Racial Equity and Support for Underserved Communities Through the Federal Government which instructed Federal agencies “to redress inequities in their policies and programs that serve as barriers to equal opportunity”.
  • Congress should further develop and expand funding for programs that serve communities that are under-resourced and marginalized, including enacting and funding the Health Equity and Accountability Act and expanding investment for the Centers for Disease Control and Prevention’s (CDC) Racial and Ethnic Approaches to Community Health (REACH) program and its Healthy Tribes program so that all approved applicants are funded.
  • Government at all levels and the healthcare sector should work together to ensure that health data is complete, shareable, and disaggregated (while still protecting individual privacy) so that the impact of health conditions, disease threats, health policies and interventions on specific population groups are known. All health data should be collected and disaggregated by race and ethnicity and other demographic factors. Investments in modernizing the nation’s public health data infrastructure are needed to meet these goals.
  • The Biden Administration should create, and Congress should fund, a strategy and programs to address the root causes of health inequities including providing at least $100 million in FY 2024 for the expansion of the social determinants of health program at CDC.
  • The federal government should prioritize the elimination of poverty by raising the national minimum wage, expanding programs to make higher education more accessible to lower-income people, growing federal supports for affordable housing and childcare and by expanding nutrition support programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).
  • Federal and state governments should ensure that all Americans have access to health insurance and have job-protected paid leave for illness or to care for a family member who is ill.
  • Federal and state governments should expand programs that support families including child tax credits, earned income tax credits, and programs that support childcare, early childhood education programs, school meal programs, and school-based Medicaid health services programs.

For more information about the data and policy solutions summarized in this news feature see TFAH’s Blueprint report for the 2021 Administration and Congress, The Promise of Good Health for All: Transforming Public Health in America.

 

Unseen Guardians: Measles Outbreak Highlights Public Health’s Crucial Role and Evolving Challenges

Local health officials and CDC work together to stamp out Ohio measles outbreak

In 1912, the United States formally recognized measles—a highly contagious viral infection causing fever, cough, runny nose, red eyes, and a characteristic rash in milder cases, while leading to pneumonia, encephalitis, and death in more severe instances—as a nationally notifiable disease. For centuries, this ubiquitous childhood ailment afflicted millions. In the first decade of reporting, an annual average of 6,000 measles-related fatalities were recorded in the U.S.

The introduction of the first measles vaccine in 1963, with its near-perfect efficacy, marked a turning point. The vaccine was later combined with those for mumps and rubella (MMR) in 1971, and varicella (MMRV) in 2005, providing children protection against several diseases in a single shot. Bolstered by this potent new preventive tool, the Centers for Disease Control and Prevention (CDC) set a goal in 1978 to eliminate measles from the country. This objective was realized in 2000, thanks to robust vaccination campaigns, the introduction of a second dose in 1989 to increase efficacy, and rigorous disease surveillance systems.

In the new millennium, measles appeared a relic of the past, but the specter of outbreaks returned—first in the 2014-15 Disneyland episode, and then in the largest outbreak in decades in 2019. Declining vaccination rates, fueled by skepticism and misinformation, left vulnerable communities exposed. The 2019 outbreak primarily affected unvaccinated children in communities with low vaccination rates across 31 states, such as ultra-Orthodox Jewish communities in New York and vaccine hesitant regions in Washington. Travelers imported the virus, sparking infections among the unvaccinated.

One such measles outbreak erupted in Ohio in 2022. Between November 2022 and February 2023, when the outbreak was declared over, 85 cases were reported, primarily affecting children under five, with 36 hospitalizations. Among the 85 cases, 80 were unvaccinated, including 25 infants too young to receive their first dose.

To quell the outbreak, a team of epidemiologists from the CDC worked in concert with Columbus Public Health to track cases, identify and notify exposed residents, and understand the spread of the virus. Dr. Mysheika Roberts, Columbus’s health commissioner, led the outbreak response, raising awareness of the disease through public information and education, and promoting and easing access to vaccination.

In addition to the on-the-ground work of state and local health departments, the CDC plays a vital, often behind-the-scenes role in supporting those departments and safeguarding public health. It provides robust disease surveillance systems, expert guidance, technical assistance, and financial support, enabling locally targeted interventions and infrastructure improvements.

Though the latest outbreak was successfully contained, the Ohio measles episode may portend further challenges. Vaccine hesitancy, a complex and deeply ingrained phenomenon, threatens to erode hard-won public health gains and could precipitate resurgent outbreaks. The issue has multifaceted roots including mistrust in science and institutions, and misinformation amplified on digital platforms. In communities of color, vaccine hesitancy is compounded by longstanding health disparities and medical mistreatment.

The COVID-19 pandemic exacerbated the problem, with routine vaccination rates falling due to school closures and disrupted well-child doctor visits. A recent Kaiser Family Foundation poll revealed that, amid the politicization of COVID-19 vaccines and school mandates, over a third of parents with children under 18 believe they should have the choice to not vaccinate their children against measles, mumps, and rubella, even at the risk of others’ health. This represents a 52% increase compared to 2019. During the 2021-22 school year, kindergarten vaccination coverage fell to roughly 93%, leaving about 250,000 kindergartners potentially unprotected against measles.

Tackling vaccine hesitancy and strengthening our public health systems requires a multifaceted national approach. Federal, state, and local governments should invest in accessible, science-based education campaigns that dispel myths and foster trust. Working with local partners, public health agencies are developing tailored, culturally sensitive vaccine education and access programs that bridge gaps in understanding and acceptance.

The Ohio measles outbreak serves as a stark reminder that the fight against vaccine-preventable diseases remains ongoing, the indispensable role of the public health workforce, and the critical need for a robust public health system. Increased, sustained, and flexible public health funding is key to having such a system. As is growing a diverse workforce to ensure that those shaping policy and delivering services reflect the communities they serve. By taking these steps, among others, we can reduce vaccine hesitancy, create a more robust public health system, and foster an environment of trust in science. Doing so can protect the hard-won progress made against measles and other diseases, safeguard the health and well-being of generations to come, and pave the way for a more equitable future.

New Report Measures States’ Emergency Preparedness and Makes Recommendations About How to Strengthen the Nation’s Public Health System

Sustained Investment in Public Health Infrastructure and Preparedness is Needed to Protect Lives During Disease Outbreaks and Natural Disasters

(Washington, DC – March 23, 2023) – As infectious disease outbreaks and extreme weather events threaten the health of more Americans, a new report shows the need for strengthened national and state public health emergency preparedness.

Ready or Not 2023: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, released today by Trust for America’s Health, measures states’ readiness to respond to a spectrum of health emergencies and to provide ongoing public health services. The report gives federal and state health officials and policymakers actionable data and recommends policies to improve the nation’s emergency preparedness at a time when health emergencies are increasing. During 2022, the U.S. surpassed 1 million deaths due to COVID-19 and saw decreasing rates of routine vaccinations and increasing prevalence of health misinformation.  In addition, the past year was the eighth consecutive year the U.S. experienced 10 or more billion-dollar weather-related disasters.

The report tiers states and the District of Columbia into three performance levels for health emergency preparedness: high, middle, and low. This year’s report placed 19 states and DC in the high-performance tier, 16 states in the middle performance tier, and 15 states in the low performance tier.

High Tier – 19 states & DC

CO, CT, DC, DE, FL, GA, KS, ME, MD, MA, MS, NJ, NC, OH, PA, UT, VT, VA, WA, WI

Middle Tier – 16 states

AK, AL, AR, CA, IA, ID, IL, IN, MO, ND, NE, NH, NY, RI, SC, TX

Low Tier – 15 states

AZ, HI, KY, LA, MI, MN, MT, NM, NV, OK, OR, SD, TN, WV, WY

“Increased and sustained investment in public health infrastructure, emergency preparedness, and health equity will save lives,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “Federal, state, and local officials as well as leaders in the healthcare and business sectors should use our findings to identify and address gaps in public health preparedness. Neglecting to do so will mean that the country will not be as prepared as it needs to be for the next public health emergency.”

The report’s findings showed both areas of strength within the nation’s public health system and areas that need attention.

Areas of strong performance include:

  • A majority of states have made preparations to expand healthcare and public health laboratory capacity in an emergency.
  • Most states are accredited in the areas of public health or emergency management. Some states are accredited in both.
  • Most U.S. residents who received their household water through a community water system had access to safe water. However recent water system failures in Jackson, Mississippi and Newark, New Jersey demonstrate the importance of continued attention to the integrity of municipal water systems.

Areas that need attention include:

  • Too few people were vaccinated against seasonal flu last year despite significant improvement in flu vaccination rates in recent years. During the 2021-2022 flu season, 51 percent of Americans ages 6 months or older received a flu vaccine, well short of the 70 percent goal established by Healthy People 2030.
  • Only half the U.S. population is served by a comprehensive public health system. Comprehensive public health systems ensure that necessary health services are available to all residents.
  • Only 26 percent of hospitals in states, on average, earned a top-quality patient safety grade in 2022. Hospital safety scores measure performance on such issues as healthcare-associated infection rates, intensive-care capacity, and an overall culture of error prevention.

The report contains recommendations for policy actions that would create a stronger public health system at all levels, including:

  • The Administration, Congress, and state lawmakers should modernize public health infrastructure, including by investing $4.5 billion annually to support foundational public health capabilities. In addition, Congress should continue to increase funding for the Public Health Emergency Preparedness cooperative agreement and public health data modernization to allow for earlier and more accurate detection of emerging health threats.
  • Policymakers at all levels should act to protect and strengthen public health authorities and should prioritize rebuilding trust in public health agencies and leaders.
  • Congress and state legislatures should invest in effective public health communications, including countering misinformation.
  • Congress and states should ensure first-dollar coverage for all recommended vaccines under commercial insurance and for uninsured people. States should minimize vaccine exemptions for school children, and healthcare facilities should increase rates of vaccination for healthcare workers.
  • Congress and states should provide job-protected paid leave for employees due to illness or family caregiving demands.
  • Congress and states should invest in policies and capacity to address the social determinants of health such as secure housing, access to transportation, and access to healthy food.
  • Congress should fund the entire medical countermeasures (MCM) enterprise, including the distribution and dispensing of MCMs. Congress should also create incentives for new products to prevent and fight antibiotic-resistant infections.
  • Congress and states should strengthen readiness for climate change, extreme weather, and environmental health threats.

Read the full report

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. 

 

 

 

 

 

Improving Americans’ Nutrition Security Requires Legislative Action

Q&A with Dr. Hilary Seligman:

Hilary Seligman, M.D., MAS, is a professor at the University of California, San Francisco, with appointments in the Departments of Medicine, Epidemiology, and Biostatistics. Her research and advocacy work focuses on food insecurity, its health implications, and the needed policy responses.

 

TFAH: Food insecurity is obviously a serious problem in the United States. Can you also talk about the issue of nutrition insecurity and the relationship between the two?

Dr. Seligman: First, it’s important to recognize that the food-security construct always considered access to nutrition, not just calories. But, the sector’s new focus on nutrition security has helped emphasize the importance of providing not just food but food that meets people’s health and nutrition needs. The construct of nutrition security is also strongly related to issues of equity and the massive burden of early mortality in our country that is related to poor diets.


TFAH: Can food banks and charitable food networks address hunger and improve nutrition?

Dr. Seligman: Yes, of course they can, and they must. The charitable food system as a whole has made massive investment and progress in this area over the last decade. What I do want to call attention to though is that the same forces that make it difficult for individuals to afford and prepare healthy food make it difficult for the charitable food system to distribute healthy food. Healthy alternatives almost always cost more, they are often perishable, and they often require more preparation time which can be costly to provide. So, although there has been strong investment and tremendous progress at the system level, there is still a lot to be done. It will always be cheaper to distribute a box of mac and cheese than it will be to distribute a peach.


TFAH: You’ve been a leader in grassroots anti-hunger programs in the San Francisco area, programs like EatSF, a healthy food voucher program. Are these programs making a difference in food insecurity for San Francisco families and children?

Dr. Seligman: EatSF is one of a rapidly growing ecosystem of state and local food voucher programs and produce prescription programs in the U.S. These programs have functioned as a way for local leaders and health systems to say: We see we have this critical problem of nutrition insecurity in our community, this is not acceptable in the richest county in the U.S., and we are going to do something about it. I think that is amazing, and I am privileged to be a part of that movement. But, let’s be honest, the nutrition security problem in the U.S. is not going to be solved by small local programs. We need a systems-based approach. We need better policies to address nutrition security, and we need to rectify the way in which our current policies work better for white people than they do for people who are not white.


TFAH: Can you say more about that? How does current policy work better for white people than for people of color?

Dr. Seligman: SNAP program policies are a good example. In order for able bodied adults to receive SNAP benefits they have to be working. For a myriad of reasons, Black people are less likely to be able to secure employment. They are therefore less likely to be able to meet the work requirements that would allow them to enroll in SNAP, even if they are food insecure.


TFAH: You direct the National Clinician Scholars Program at the UCSF School of Medicine. The goal of the program is to train clinicians to be change-agents in order to improve their patients’ health. Are clinicians and the healthcare system doing enough to address the social determinants of health? Are they well-prepared to treat their patients who have obesity?

Dr. Seligman: Traditionally, healthcare in the U.S. has focused on treating, not preventing, disease in individuals. The evidence is very clear that this is the worst way to approach obesity: first to do it at the treatment stage (when obesity has already developed, rather than to prevent the onset of obesity) and second to do it by attempting to change people’s behaviors, rather than changing the environments that resulted in the onset of obesity to begin with. So, although I hate that we need to be having this discussion at all, we do. We do because the U.S. has completely failed at prevention efforts and at policy and environmental approaches to obesity prevention for decades. So now, what needs to be done? Obesity and poor diets are the biggest drivers of healthcare costs in the country— so the healthcare system has to get involved (whether it is traditionally in their wheelhouse or not), and the best way to do this is by addressing social determinants of health and food environments. It is not a comfortable fit for the healthcare system, but there really is no other choice. And because it is not a comfortable fit and requires a new way of thinking about healthcare and new kinds of engagement and policy change, we have to nurture the next generation of healthcare leaders to be able to tackle these really complicated problems.


TFAH: What are the links between public policy and obesity? What policy actions or changes would you like to see enacted?

Dr. Seligman: Oh, there are so many of them—dozens if not more are being discussed as potential approaches for the next Farm Bill. At the federal level alone, there are policy levers that Congress, USDA, and the FDA have authority over that could help reverse obesity trends. Let’s start with an enormous one: SNAP. Early in my career I worked on health literacy, and I was always challenged by the lack of existing infrastructure to reach people with effective health literacy interventions. Food insecurity is not like that. SNAP works. It reaches almost 50 million people in the U.S. annually. It is available in every county nationwide. It helps families to afford more nutritious food. So, we have the tools, we have the evidence, and we have the infrastructure to solve food insecurity in the U.S. What we lack is the political will. We need to expand SNAP eligibility to all the people who aren’t receiving the food they need but who are not currently eligible for benefits, and we need to raise benefit rates to allow for the purchase of healthy food. If these changes are made, it is very clear to me that they will have a substantial impact on obesity rates and on public health.


TFAH: There  were a number of waivers in federal food programs like SNAP, WIC, and school meals, during the COVID-19 pandemic to better reach individuals and families during the public health emergency. Are there any lessons we can learn from these policy changes?

Dr. Seligman: Yes! The predominant lesson is: these programs work. Food insecurity rates did not increase nearly as much as anticipated during the pandemic, although there were certainly vast disparities in how the pandemic impacted different communities. Why didn’t rates of food insecurity rise as much as anticipated? Because we had the will to do the things we knew—based on a tremendous amount of evidence— would make a difference. When we make it easier for people to enroll in SNAP, more people have access to benefits and food insecurity falls. When we provide money on debit cards to replace the meals not being served in schools, food insecurity falls. When stimulus checks were sent to people across the U.S. in response to the pandemic, low-income households reported that food was the first or second most covered item from the stimulus money.

The really optimistic lesson is that we know how to address hunger, nutrition security, and obesity prevention through good public policy. Now we just have to keep these programs in place as interest in the pandemic wanes.

Additional Resources:

Brief: Legislative Priorities for the 118th Congress

Report:  State of Obesity 2022

Priority Issue: Obesity /Chronic Disease

This interview was originally published as a part of TFAH’s 2022 State Of Obesity: Better Policies for a Healthier America report.