State Category: Virginia

TFAH Applauds Court’s Decision Preserving the Affordable Care Act

Decision strengthens the nation’s healthcare system, protects healthcare access for 31 million Americans and will help address health disparities

(Washington, DC — June 17, 2021) – Trust for America’s Health applauds today’s Supreme Court’s decision in California v. Texas for the ways in which it protects healthcare access for 31 million Americans and will help address the nation’s health disparities.

“Access to affordable healthcare is fundamental to individual health. It is also fundamental to achieving health equity. While as a nation we still have a lot of work to do to achieve good health for every individual, today’s court decision keeps us moving in the right direction – it will save lives,” says John Auerbach, President and CEO of Trust for America’s Health.

According to the U.S. Department of Health and Human Services, 31 million people have gained health insurance through the Affordable Care Act (ACA) including many who lost employment and health coverage during the COVID-19 pandemic.[i]  Since the ACA, rates of people without health insurance have decreased in every state, with states that expanded Medicaid experiencing the largest reductions.[ii]

The ACA is transformative legislation in at least three ways: the number of Americans who can now access medical care when they are ill or to deal with chronic conditions (78 percent of U.S. adults 55 and older have at least one chronic condition);[iii] the illness it prevented as millions of Americans gained access to preventive care and screenings and other life-saving services previously inaccessible to them;[iv] and the ways in which it resulted in improved access to healthcare for people of color, reducing – although not eliminating – longstanding healthcare access disparities.

Prior to the ACA, non-Hispanic Black Americans were 70 percent more likely to be uninsured than were whites and the uninsured rate for Hispanics was nearly three times the uninsured rate for whites.[v] Once the ACA was in place, Hispanics had the largest decrease in uninsurance rates, falling from 32.6 percent to 19.1 percent between 2010 and 2016. Uninsurance rates also fell for Asian and Black Americans by 8 percent during the same period.[vi]

Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates among the low-income population broadly and within specific vulnerable populations.[vii] According to the Center on Budget and Policy Priorities, expanding Medicaid coverage to low-income adults led to significant benefits to those individuals and families including improved access to care, improved health outcomes and increased financial stability – including a reduction in medical debt per person gaining coverage via the expansion.[viii] A study by the National Bureau of Economic Research found states that expanded Medicaid had an estimated 19,200 fewer adult deaths (ages 55 to 64) between 2014 and 2017 than did states that did not expand Medicaid.[ix]

The decision also has major implications for public health by protecting over $16 billion in funding over the next 10 years (FY 2022-FY 2031) for the Centers for Disease Control and Prevention (CDC) and other public health agencies. The Prevention and Public Health Fund, a dedicated funding stream created by the ACA and specifically designated for public health and prevention, funds approximately 11 percent of the CDC’s budget. These funds are put to work in every state to expand immunizations, prevent suicide, modernize laboratory and epidemiology services to detect and contain disease outbreaks, prevent childhood lead poisoning, and help smokers quit.

Also preserved are the requirement that insurers not refuse coverage due to preexisting conditions, the provision disallowing annual or lifetime limits on essential care, and the requirement that insurers cover recommended clinical preventive services without cost-sharing: all essential to Americans’ health.

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[i] HHS, HHS Press Office. New HHS Data Show More Americans Than Ever Have Health Coverage Through the Affordable Care Act. June 5, 2021. New HHS Data Show More Americans than Ever Have Health Coverage through the Affordable Care Act | HHS.gov

[ii] ibid

[iii] CDC, National Center for Health Statistics. Percentage of U.S. Adults over 55 with Chronic Conditions. https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm

[iv] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/ Google Scholar

[v] Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106(8):1416–21

[vi] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/ Google Scholar

[vii] Madeline Guth, et al. The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review. March 17, 2020.

[viii] Center on Budget and Policy Priorities. The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion. October 21, 2020. The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion | Center on Budget and Policy Priorities (cbpp.org)

[ix] Madeline Guth, et al. The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review. March 17, 2020.

Annual Deaths Due to Alcohol, Drugs or Suicide Exceeded 156,000 According to the Most Recent Data

Preliminary data shows COVID-19 crisis created higher rates of mental distress, substance use, and drug overdose; 2019 alcohol deaths were higher for every adult age group

(Washington, DC and Oakland, Ca) – May 18, 2021 – Newly released data show that 156,242 Americans died due to alcohol, drugs or suicide in 2019, a record number of such deaths in a single year.  Furthermore, the COVID-19 pandemic increased stress and related substance use for many Americans.

During 2019, alcohol and drug-induced deaths increased, while suicide rates were slightly lower. Over the last decade, 2009 – 2019, the number of alcohol and drug related and suicide deaths increased by 52 percent.  These data are part of a report releasing today, Pain in the Nation: Alcohol, Drug and Suicide Deaths, the latest in a series of reports tracking the nation’s deaths of despair crisis produced by Trust for America’s Health and Well Being Trust.

Americans dying due to drug-induced causes was five percent higher in 2019 than the previous year, for a total of 74,511 deaths. The data are also beginning to show changes in the most affected population groups.  For many years, the death rate for drug overdoses among whites was substantially higher than other racial groups, data are now showing dramatic increases in drug related deaths for certain populations of color. For the year, drug-induced deaths were up by 15 percent among Latinos and Blacks, 11 percent for American Indians and 10 percent for people of Asian descent. Among whites’ drug-induced deaths rose by 2 percent for the year.

For the first time since 2005, 2019 deaths rates from drugs for Black people was higher than that of whites.

Synthetic opioids, such as fentanyl, (up 16%), cocaine (up 8%) and other psychostimulants (e.g., methamphetamine and ecstasy) (up 28%) continue to drive drug-induced deaths higher. Natural/semisynthetic opioids (e.g., Prescription opioids) and heroin overdoses declined for the year.

In 2019, 39,043 Americans died from alcohol-related causes, up 4 percent over 2018.  It was the tenth year in a row that the alcohol death rate increased.  Alcohol deaths were highest among American Indians (31.9 deaths per 100,000 people), adults over 55 (28.3 deaths per 100,000 people) and males (15.2 deaths per 100,000 people). All groups, except children, had a higher rate of alcohol deaths in 2019 compared with 2018 and early 2020 data show that rates of consumption are continuing to increase.

One bright spot in the data is that for the year (2019), the age-adjusted suicide rate declined from 14.2 to 13.9 deaths per 100,000 deaths, a 2 percent decrease. Americans who died by suicide in 2019 totaled 47,511. This decline in suicide deaths was the first since 2005 and is statistically significant. Preliminary 2020 data show a further small decrease in suicides despite the COVID crisis.

States with the highest age-adjusted death rates from alcohol, drugs and suicide combined in 2019 were New Mexico (88 deaths per 100,000 people) and West Virginia (85.1 deaths per 100,000 people).

“These data underscore, yet again, the massive problem we have had on our hands in this country,” said Benjamin Miller, PsyD, Chief Strategy Officer, Well Being Trust. “The trends are clear we are going in the wrong direction. If we are serious about addressing mental health and addiction, we must invest in strategies that are comprehensive and integrated. Incremental tinkering will not change the course or direction sufficiently enough – it’s time for bold leadership to demand more.”

The Impact of the COVID-19 Pandemic

The COVID-19 pandemic impacted Americans in almost inconceivable ways including illness, the loss of loved ones, job loss, financial stress, food insecurity, social isolation, and learning loss and the interruption of school-based services for millions of children. These stressors are impacting rates of alcohol and drug use and drug overdose deaths as more people turn to substances to help them cope.

From March 2019 to March 2020, the number of calls to the Substance Abuse and Mental Health Services Administration Disaster Distress Helpline increased by 891 percent.  The U.S. Household Pulse Survey found that the number of adults reporting symptoms of anxiety or depression from April 2020 through March 2021 was triple the number who reported such symptoms in 2019. A June 2020 CDC study found that 13 percent of adults “started or increased substance use to cope with pandemic-related stress or emotions.”

“The drug, alcohol and suicide crisis has been growing for a decade and growing in uneven ways. The COVID crisis has increased stress on all Americans and has worsened the differential impact of health inequities on communities of color. While all Americans need support coping with the pandemic, people who are currently struggling with addiction or a mental health issue need urgent attention,” said John Auerbach, President and CEO Trust for America’s Health.

The report includes policy solutions and recommendations including:

  • Expand programs that support families and communities and reduce traumatic experiences, particularly in childhood.
  • Expand access to substance use prevention programs and mental health and resiliency programs in schools.
  • Tailor prevention and intervention programs for communities of color.
  • Strengthen crisis intervention programs and supports.
  • Increase access to mental health and substance use healthcare through full enforcement of the Mental Health Parity and Addiction Equity Act.
  • Reduce availability of illicit opioids and psychostimulants.
  • Limit access to lethal means of suicide.
  • Expand efforts to combat stigma about mental health issues.
  • Improve mental health data accuracy, completeness and timeliness.
  • Expand the mental health and substance use treatment workforce; promote diversity and culturally informed practices within the workforce.
  • Build community capacity for early identification and intervention with individuals who need mental health care.

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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.

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

 

 

 

 

 

 

 

 

John Auerbach Stepping Down from TFAH President & CEO Position to Return to CDC; TFAH Executive Vice President & COO Dr. J. Nadine Gracia Named New President & CEO

Statement by Dr. Gail Christopher, Chair

TFAH Board of Directors

May 12, 2021

 It is with mixed feelings that I announce that as of June 18th John Auerbach will be leaving Trust for America’s Health (TFAH) to return to the Centers for Disease Control and Prevention (CDC).  I am also delighted to announce that the Board of Directors has selected J. Nadine Gracia, MD, MSCE, as the new President and CEO of TFAH.

During Mr. Auerbach’s four and a half years as TFAH’s President and CEO he has led the transformation of the organization, doubling the number of philanthropic funders, increasing the budget by 50 percent, and growing its staff by 33 percent.  During this time, we have elevated our work on equity and on the social determinants of health and made them central to who we are as an organization.  TFAH has continued many of its signature activities while also taking on new projects from Promoting Health and Cost Control in States to the Public Health Communications Collaborative, from Pain in the Nation to Age-Friendly Public Health and much more. There is so much that John can be proud of during his tenure at TFAH.

In his new position, John will serve as the Director of Intergovernmental and Strategic Affairs, in which he will oversee external affairs and help guide the development of agency-wide priority initiatives.

Dr. Gracia is a national health equity leader with significant experience in federal government, the nonprofit sector, and professional associations. She is recognized for her work at TFAH and previously in federal government service in the Obama Administration as the Deputy Assistant Secretary for Minority Health and Director of the Office of Minority Health at the U.S. Department of Health and Human Services (HHS).  In that capacity, she directed departmental policies and programs to end health disparities and advance health equity and provided executive leadership on administration priorities including the Affordable Care Act and My Brother’s Keeper.

Previously, she served as Chief Medical Officer in the Office of the Assistant Secretary for Health at HHS, where her portfolio included adolescent health, emergency preparedness, environmental health and climate change, global health, and the White House Council on Women and Girls.  Prior to that role, she was appointed as a White House Fellow at the U.S. Department of Health and Human Services and worked in the Office of the First Lady on the development of the Let’s Move! initiative to solve childhood obesity.

Dr. Gracia earned her undergraduate degree from Stanford University, a medical degree from the University of Pittsburgh School of Medicine, and a Master of Science in Clinical Epidemiology from the University of Pennsylvania.  She is active in many civic and professional organizations.

Nadine and John worked as a team in every aspect of TFAH’s mission for the past three and a half years.   During that time, Nadine successfully managed many roles as she handled TFAH’s operational responsibilities, provided policy leadership and strengthened and broadened partnership relations while also often serving as the face of TFAH at national conferences and convenings.  Her expertise in and commitment to the promotion of equity ensured that TFAH walks the walk as well as talks the talk.  The Board of Directors unanimously agreed that had we done a national search, we would not have found a more ideal person to lead the organization.  We enthusiastically anticipate the achievements that will result from her being at the helm.

During this transition, let me offer my thanks to the wonderful and talented staff at TFAH who day in and day out display skill, and dedication in the service of our mission.  And let me thank my fellow Board members as well, for their commitment and wisdom in supporting TFAH during the last several years under John’s leadership and in choosing Nadine as the new President and CEO.  Your selfless commitment to promoting optimal health and well-being for all is inspiring.

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

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

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

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

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

Response funding critical but not a long-term solution

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

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

CDC funding down for the year and decade

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

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

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

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

Public health workforce is smaller than it was a decade ago

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

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

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

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

New Report: U.S. Must Prioritize COVID-19 Vaccines for People Who Are Homebound

Experts provide strategies to ensure equitable vaccine distribution for homebound people

(Washington, DC – May 3, 2021) – At least 2 million older adults are homebound a number that increases when including younger people who are homebound due to illness or disability.  Ensuring that this population group receives the COVID-19 vaccination requires focused attention, collaboration and resources according to a policy brief released today by Trust for America’s Health (TFAH).

The brief, Ensuring Access to COVID-19 Vaccines for Older Adults and People with Disabilities Who are Homebound, recommends actions that federal, state, and local government, state and local health agencies, the healthcare sector and community partners should take to ensure that people who are homebound are vaccinated.

According to the report, all parties involved in the COVID-19 vaccination effort have a responsibility to ensure people who are homebound are vaccinated, which means redirecting or creating the infrastructure, workforce, and funding support to bring the vaccination process to them.  Adding to the importance of equity in vaccine access is the fact that people who are homebound often have underlying health conditions that put them at heighten risk if they were infected by the COVID-19 virus.  In addition, the processes created or improved to meet the challenge of this pandemic will strengthen the nation’s public health infrastructure for the growing segment of the population who are homebound and help better safeguard their health during future public health emergencies.

“Ensuring that every person is vaccinated against the COVID-19 virus is not only a matter of health equity, its critical to ending the pandemic, said John Auerbach, President and CEO of TFAH. “But millions of people in the U.S. cannot travel to a vaccination site. Government and community partners must work together to protect the health of the homebound population by bringing the vaccine to them.”

Among the report’s recommendations are:

  • Prioritize the administration of COVID-19 vaccination for people who are homebound and their caregivers (both paid and unpaid) by providing sufficient vaccines and the resources needed to administer them in the shortest time possible.
  • Develop a standardized operational definition of “people who are homebound” in order to identify this population and prioritize their vaccination.
  • Ensure that the COVID-19 vaccine is equitably available across the homebound population and that no subset of the population is less served due to race, ethnicity, SES status or where they live. Use data to identify pockets of under-vaccination.
  • Develop and actively promote multiple communications channels for vaccine appointments scheduling, including use of channels that minimize reliance on computers and internet access.
  • Leverage partnerships and establish new ones with public and private sector organizations that already serve the homebound population to ensure equitable and efficient vaccine administration.
  • Ensure, to the degree possible, that in-home vaccination teams include people who are trusted by those being vaccinated and who represent the diversity of the population they serve.
  • Government agencies and private payors should ensure that all costs associated with in-home vaccinations are covered including administrative expenses, travel time and transportation costs, and observation time.

The report is an outgrowth of two national expert convenings hosted by Trust for America’s Health.  Funding for the report and convenings was provided by The John A. Hartford Foundation and the Cambia Health Foundation.

“Older adults and those with disabilities who are homebound have been the forgotten faces of this pandemic,” said Terry Fulmer, PhD, RN, FAAN, President of The John A. Hartford Foundation. “We now know about cutting-edge solutions, as well as failed strategies we can learn from, to ensure that everyone has equitable access to vaccinations going forward.”

“We are committed to ensuring equitable vaccine access for all, including homebound older adults and people with disabilities who may face obstacles scheduling online appointments or getting to vaccination sites,” said Peggy Maguire, President, Cambia Health Foundation. “We funded the Trust for America’s Health national grant with thought leaders from other parts of the country so that we could share learnings and best practices that will help homebound people and their caregivers in our four states access the COVID-19 vaccine and achieve health equity.

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

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

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

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

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

 

Rendimiento estatal, por nivel de puntuación, 2020

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

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

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

El informe encontró:

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

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

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

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

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

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

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

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

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

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

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

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

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

State performance, by scoring tier, 2020

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

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

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

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

The report found:

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

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

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

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

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

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

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

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

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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