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Story article on health-related topics.

Trust for America’s Health is a Healthy People 2030 Champion!

As an organization that prioritizes optimal health for all people, Trust for America’s Health (TFAH) is pleased to be recognized as a Healthy People 2030 Champion by the U.S. Department of Health and Human Services (HHS). TFAH shares the Healthy People 2030 vision of a society in which all people can achieve optimal health and well-being across the lifespan. This commitment is reflected in TFAH’s overall vision and mission and within its Age-Friendly Public Health Systems (AFPHS) initiative.  TFAH prioritizes achieving equity in all of our work and promotes optimal well-being for all by focusing on the social determinants of health (SDOH).

TFAH has worked closely HHS leadership, particularly within the Office of Disease Prevention and Health Promotion, which administers Healthy People 2030, to promote stronger collaborations between state departments of health and state aging agencies.

The Age-Friendly Public Health Systems initiative and Healthy People 2030 are well aligned as they share a focus on optimal health in every community. AFPHS’s 6C’s strategy provides a roadmap for state and local health departments to engage in activities that support healthy aging in their communities including:

Connecting and convening multi-sector stakeholders

Coordinating existing supports and services

Collecting, analyzing, and translating relevant data

Communicating important public health information

Complementing existing health promoting programs

Creating and leading policy, systems, and environmental changes

In addition to the Healthy People 2030/AFPHS alignment, TFAH supports the Healthy People 2030 vision in the following ways:

Promoting and increasing access to disease prevention and health promotion activities.

TFAH’s federal advocacy priorities focus on strengthening the public health system so that every state, tribal, local, and territorial health department has the funding and capacity to improve and sustain optimal health for every person and community.

Addressing social determinants of health, eliminating disparities, achieving health equity, and/or promoting well-being.

TFAH is leading advocacy efforts to increase public health’s capacity to fully address the social determinants of health, with a focus on equity and eliminating disparities in health across the lifespan.

Providing training and other necessary resources to adapt or modify disease prevention and health promotion activities to meet the needs of diverse populations, address SDOH, eliminate disparities, achieve health equity, and/or promote well-being.

Many of TFAH’s reports and policy briefs document states where health promotion activities need improvement, as well as feature best practices. In addition, TFAH’s website includes detailed health data on every state and territory including on emergency preparedness, prevalence of chronic diseases and flu vaccination rates.

Developing partnerships across a variety of sectors, including public health, healthcare, government, philanthropy, civil rights, academia, education, community, faith-based, media, business, and technology

TFAH routinely hosts convenings of representatives across sectors including public health, healthcare, government, philanthropy, academia, community, and education. Such convenings have focused on the COVID-19 pandemic, adolescent health, healthy aging, state policies to promote health and control costs, and many other topics.

TFAH looks forward to continuing our strong partnership with the HHS Office of Disease Prevention and Health Promotion and other Healthy People 2030 Champions to create and sustain opportunities for all Americans to live healthfully and productively throughout their lives.

New CDC Data Shows 4 Percent Rise in Suicides in 2021

On September 30, the Centers for Disease Control and Prevention (CDC) released a new report on provisional data on suicide mortality in 2021. The new data shows a 4 percent increase in the national suicide rate—rising from 13.5 deaths per 100,000 population in 2020 to 14.0 deaths per 100,000 population in 2021. In contrast, the national suicide rate declined in both 2019 and 2020, though it had steadily increased over the previous two decades.

The report also includes additional information on suicide by sex, age group, and month. Key takeaways:

  • Suicide rates increased more among males (3 percent increase) than females (2 percent increase).
  • Suicide rates increased for people in nearly all age groups. The only exception was a 2 percent decline for people age 75 and over, though it was not a statistically significant change.
  • The largest statistically significant increase among all sex/age groups was for males aged 15–24, with an 8 percent increase in suicide rate from 2020 to 2021. Females aged 10–14 had the largest percentage increase in suicide rate (15 percent), though the change was not statistically significant due to a relatively small numbers of cases.
  • There were more suicides across all months of 2021 compared with 2020, except in January, February, and July. The largest increase across all the months was an 11 percent increase in suicide rate in October.

The report does not include racial/ethnic or geographic information, nor information on suicide method—all critical pieces to understanding the full picture. For example, data from 2020 showed higher rates of  suicide among American Indian, Black, and Latino people and of suicide by firearm—all in a year when the overall suicide rate declined. The National Center for Health Statistics will likely release final 2021 mortality data, including these additional data points, in December.

“The increase in suicide is devastating,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health (TFAH). “The new data underscores the need for more attention on this issue and action to prevent future suicides—by federal policymakers, the private and non-profit sectors, and every community across the nation. This study is a wakeup call that we continue to face a mental health and substance use crisis, but we can prevent these tragic deaths.”

The most recent Pain in the Nation report from TFAH includes 2020 data and an analysis of longer-term trends, as well as policy recommendations for reducing alcohol, drug, and suicide deaths. The new CDC report reaffirms the importance of many of these recommendations, including to:

  • Strengthen the continuum of crisis intervention programs with a focus on the newly established “988” lifeline.
  • Expand CDC’s comprehensive suicide-prevention efforts, including measures to strengthen economic supports, promote connectedness, and create protective environments.
  • Address the social determinants of health and promote resilience in children, families, and communities, including through economic supports, access to quality childcare, and prevention and early intervention efforts in schools.
  • Build grassroots community capacity for early identification and intervention for individuals with mental health and substance use disorders, including through community-based or non-traditional settings.
  • Limit access to lethal means of suicide, including drugs and firearms, among individuals at higher risk of suicide through state and federal laws, more funding of foundational research, and the adoption of counseling programs in healthcare systems.

 

 

U.S. Experienced Steepest Two-year Decline in Life Expectancy in a Century

Social Factors and Health Inequities Are Strongly Associated with Life Expectancy Disparities

September 22, 2022

A young Black male born last year in the United States has a shorter life expectancy than a boy born in Rwanda, a country in which the typical person lives on less than $2 a day. Native Americans born last year could, absent any progress in mortality rates, expect to live roughly as long as people in low-income Sub-Saharan African countries that are some of the poorest in the world.

These and other disturbing findings are drawn from new provisional data on life expectancy in the United States, released in August 2022 by the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention (CDC). CDC estimates that in 2021, life expectancy at birth—a measure of the average number of years a newborn can expect to live—was 76.1 years, down from 77 years in 2020 and 78.8 years in 2019—the steepest two-year fall in a century. This was the second time in a decade that there has been a sustained downturn in U.S. life expectancy, something that hadn’t happened since World War II.

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Interpreting life-expectancy data. Estimates of life expectancy are sometimes misunderstood as a fixed prediction for how many additional years the average person will live. Rather, it is a profile of how much longer the average person would live at each age, based on mortality rates from that year. The life expectancies of children born in 2021, for example, can increase in the years ahead if broad-based improvements in health and well-being bring about reduced mortality rates.
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Pandemic drives life expectancy losses

COVID-19 was the primary driver of the decline in life expectancy since 2019, accounting for about half of the drop in 2021, followed by unintentional injuries (e.g., drug overdoses, motor vehicle accidents, falls, etc.), heart disease, chronic liver disease and cirrhosis, and suicide. The effects from these were offset partially by decreases in mortality due to influenza and pneumonia—perhaps connected to masking, social distancing, and other COVID-19-related mitigation actions—as well as chronic lower respiratory diseases, and Alzheimer’s disease, among other causes. Overall, the leading causes of death in the U.S. since the pandemic began have been heart disease, cancer, and COVID-19.

Disparities in life expectancy

Behind these topline numbers is a great deal of variation by sex, race/ethnicity, and income. For example, the difference in life expectancy at birth between the sexes widened in 2020 and again in 2021, reaching 5.9 years in 2021 (Females: 79.1; Males: 73.2), the broadest gap since 1996. Deaths owed to homicide are one reason for this; by age 50, the gap in life expectancy shrinks to 3.9 years.

Looking across races and ethnicities, the American Indian or Alaska Native population experienced a devastating loss in life expectancy between 2019 and 2021, from 71.8 years in 2019 to 65.2 years in 2021, a 9 percent decline. Newborns in this population can now be expected to live, on average, as long as the typical U.S. resident in 1944, about the time that penicillin was beginning to be mass produced and two decades before the U.S. Surgeon General’s landmark smoking report. The next greatest declines over the two-year period occurred among Black and Hispanic residents (each 5 percent). Asian men were the only group to experience an increase in life expectancy in 2021; notably, across all races and ethnicities in the U.S. for which data are available, Asian people have the highest COVID-19 vaccination rate.

Entering the pandemic, Native American and Black people experienced higher rates of obesity, diabetes, coronary heart disease, stroke, and chronic liver disease than White people, and they developed these chronic conditions earlier in life, putting them at higher risk of mortality from COVID-19 and other leading causes of death. These disparities reflect centuries of marginalization and environmental, economic, medical, and political factors—commonly described as social determinants of health—that contribute to people’s health outcomes.

Source: Centers for Disease Control and Prevention

Life expectancy has also been found to very dramatically by income. For instance, a 2016 study by economist Raj Chetty and others found that the difference for 40-year-olds in the top 1 percent of U.S. income distribution and in the bottom 1 percent was 15 years for men and 10 years for women, and this chasm had widened over time. Interestingly, there was even significant regional variation among people with low incomes, reflecting individual differences (e.g., obesity, smoking, exercise) as well as local levels of education and government expenditures.

One way to see this impact in the data is to compare the life expectancies of various states. For example, in 2020, life expectancies at birth of residents in Maryland (76.8 years), New Hampshire (79 years), and Massachusetts (79 years), the states with the highest median household incomes (excluding the District of Columbia), were much higher than in Mississippi (71.9 years), Arkansas (73.8 years), and New Mexico (74.5 years), the states with the lowest median household incomes.

Divergences can be starker at the local level. For example, even before the pandemic, a team of researchers at New York University found that, among the 500 largest cities in the U.S., 56 had life expectancy gaps between neighborhoods separated by just a few miles of up to 20 to 30 years. The largest gaps tended to be in cities with higher levels of racial and ethnic segregation. In New York City, for example, people living in East Harlem lived, on average, 19 years less than residents of the Upper East Side, which is just a few blocks away.
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“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman.” Martin Luther King, Jr.
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The national trend in the U.S. over the past few decades are especially disturbing when compared to peer countries. Indeed, researchers at the Peterson Center on Healthcare and the Kaiser Family Foundation have demonstrated how, since the 1980s, growth in life expectancy at birth in the U.S. has separated from that of comparable countries. And whereas life expectancy fell in 2021 for the second consecutive year, it rebounded in most peer countries, resulting in an estimated 1.1 million “missing Americans” (i.e., people who would still be alive if U.S. mortality rates had matched the average of the comparison group) from that year alone, equating to 25 million lost years of life. Setting deaths from COVID-19 aside, the leading contributors to the U.S.’s outlier status are its high rates of deaths tied to obesity, overdoses, gun deaths (including homicides and suicides), and traffic fatalities.

Source: Peterson-KFF Health System Tracker

 

It might be tempting for some to review all of these statistics and come away thinking that the solutions can be arrived at through greater levels of healthcare spending, but the available evidence suggests that’s not the case. Indeed, the United States spends far more on healthcare on a per capita basis but, tragically, achieves much poorer results. That suggests that the most effective solutions are to be found in preventing disease and injury and promoting health—the central aims of public health.

Source: Our World in Data

Trust for America’s Health (TFAH) serves this mission by working to promote optimal health for every person and community and making the prevention of illness and injury a national priority. We report on and recommend evidence-based programs and policies that make prevention and health equity foundational to health and community systems at all levels of society. Our goal is a modernized, public health system that meets the challenge of health equity for all and is prepared to respond to a wide variety of health threats in an inclusive, community appropriate, and rigorous manner. These efforts, and indeed TFAH’s strategic focus on some of the country’s greatest challenges, are reflected in our work on obesity; deaths from alcohol, drugs, and suicide; public health emergency preparedness; and health equity, among other areas.

With deaths from COVID-19 on track to be lower in 2022 than in 2021, there is reason to hope for a reversal in life expectancy trends from the past two years. But there’s much work to be done to protect U.S. residents from COVID-19 and address persistent long-term issues that preceded the pandemic. TFAH looks forward to working with fellow researchers and advocates, communities, and their policymakers to bring about much-needed, broad-based progress.

Trust for America’s Health (TFAH) Statement in Recognition of Juneteenth, 2022

Chair of the TFAH Board of Directors Gail Christopher, D.N. and President and CEO J. Nadine Gracia, M.D., MSCE released the following statement in recognition of Juneteenth, 2022

(Washington, DC – June 17, 2022) — “Juneteenth is a celebration of freedom. It’s also a day on which we should recognize that as a nation we have more work to do before all Americans are free from the burdens of social, economic, and health inequities.

Well over a century after the first Juneteenth, structural racism continues to have far-reaching impacts on health, well-being, and opportunity.

Our goal is to recommend policies that will advance the social, economic, and environmental conditions that promote health by ensuring equitable access to high-quality childcare, education, employment, safe and affordable housing, transportation, and healthcare for all Americans.”

Trust for America’s Health calls for the following policy actions to reverse the impact of structural racism in America:

  • Make advancing health equity and eliminating health disparities a national priority. This includes increasing funding for programs that advance healthy equity, such as the Centers for Disease Control and Prevention’s (CDC) Racial and Ethnic Approaches to Community Health and Healthy Tribes Programs.
  • Invest in multisector efforts to address upstream drivers of poor health through CDC’s Social Determinants of Health program.
  • Target the elimination of poverty by increasing the minimum wage and expanding the Earned Income Tax Credit at the national and state levels.
  • Increase access to high-quality healthcare for all by strengthening incentives to expand Medicaid in all states and by making marketplace coverage more affordable for low-and moderate-income people.
  • Create a national standard mandating job-protected paid family and medical leave for all employees.
  • Increase funding for programs that promote long-term security and good health for children and families, including programs designed to expand access to affordable housing, Head Start, Early Head Start, and nutrition support programs such as Healthy School Meals for All, the Supplemental Nutrition Assistance Program (SNAP), and the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC).

For more information about these and other policy recommendations see these TFAH reports:

A Blueprint for the 2021 Administration and Congress – The Promise of Good Health for All: Transforming Public Health in America.

Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity

Additional statement from the National Collaborative for Health Equity

The National Collaborative for Health Equity (NCHE) applauds the work of TFAH and supports these vital social policy actions. NCHE recognizes that we have to generate the public will for enacting and sustaining the needed policies. One vehicle for doing this is the Truth, Racial Healing, and Transformation (TRHT) work of communities across America. This work involves changing false narratives, building trusted relationships, as well as addressing the systemic and institutional legacies of the false ideology of the hierarchy of human value.

While the federal holiday, Juneteenth, enables us to celebrate the end of slavery, we must all remember that the beliefs that animated it for centuries lived on and continue to exist today. Racism must end.

Dr. Christopher is the Executive Director of the National Collaborative for Health Equity, in addition to her role as the TFAH Chair of the Board of Directors.

 

Public Transit Access to Full-Service Grocery Stores Will Help Address Country’s Obesity Crisis

Trust for America’s Health’s (TFAH) report, The State of Obesity 2021: Better Policies for a Healthier America provides an annual analysis of national obesity and overweight trends. In 2020, 16 states had adult obesity rates at or above 35 percent, up from 12 states the previous year. These and other emerging data show that while obesity rates in the U.S. have been at epidemic proportion for years, the COVID-19 pandemic changed eating habits, put families at risk for food insecurity, and heightened stress, all worsening the countries’ decades long pattern of obesity.

Food Access

A major part of a person’s ability to maintain a healthy diet is being able to access and afford quality, nutritious food. This access requires that all communities have local grocery providers, like supermarkets, farmer’s markets, and/or community gardens. In addition to physical proximity, stores need to be accessible via driving, walking, biking, and public transportation.  Access to farmer’s markets or full-service grocery stores means that community members have the option to purchase fruits and vegetables, and less processed foods. Without such access, “food deserts” can develop – neighborhoods where grocery stores are largely inaccessible due to their distance or the lack of public transportation. Food desert communities often have fast food outlets or stores that sell processed, packaged foods with low nutritional value. A food environment with limited healthy options can contribute to the likelihood that a person or community struggles with chronic health issues related to diet like obesity, diabetes, hypertension, stroke, and cardiovascular disease.

Transportation and Food Access

The 2017-2018 National Health and Nutrition Examination Survey (NHANES) estimates the 42.4 percent of U.S. adults have obesity. According to the United States Department of Agriculture (USDA) 40 million Americans have poor access to food retailers. This lack of access is heavily concentrated in rural, low-income, and minority neighborhoods. Also contributing to the food deserts problem is that 2.1 million U.S. households do not own an automobile and live 20 miles from a supermarket, burdening mostly low-income and minority communities. According to the U.S. Centers for Disease Control and Prevention, providing public transit is a simple strategy that can improve people’s ability to receive medical care, purchase healthy food, and access opportunities for physical activity, but 45 percent of U.S. households do not have access to public transit and approximately 20 percent have transportation barriers that limit their ability to buy healthy foods. Poor transportation infrastructure is considered the largest and most pressing healthy foods access barrier in rural areas.

A study published in Preventing Chronic Disease evaluated a nationally representative sample of approximately 2,000 U.S. municipalities for their public transit infrastructure: availability of public transit, planning for food access in public transit, and availability of more individualized demand-responsive transit (DRT) as a public transit alternative. DRT offers smaller buses or vans for transportation without a fixed time schedule or route. The study used National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (CBS HEAL) data that evaluated municipal government policies and practices that encourage healthy eating and physical activity. It found that approximately one-third of municipalities did not have public transit, most commonly in municipalities that were rural, Southern, had a population of fewer than 2,500 people, had a median educational attainment of high school graduation or less, or had a population that was greater than 50 percent non-Hispanic white. Statistical significance was found for smaller population size, rural status, being in the Southern census region, and greater poverty prevalence relative to the availability of public transit. Approximately one-third of municipalities with public transit reported planning for food accessibility. It was reported more commonly among larger municipalities, urban municipalities, Western municipalities, municipalities with less than 50 percent non-Hispanic white people, and in municipalities that contained food deserts.

Community Examples to Improve Food Access

Although the study results did not find a strong, health-focused public transit infrastructure in many communities, often communities most in need of such services, there are some hopeful examples of community efforts to improve food access. They include the public Grocery Bus line in Austin, Texas that connects a low-income, Latino community that lacks adequate transportation options with supermarkets. It is a city-community-business collaborative that has now been integrated into the regular transit system. Similarly, the Dallas Area Rapid Transit (DART) GoLink program in Dallas, Texas provides transportation for essential needs, including food, that is an on-demand service and has been expanded in partnership with Uber. Community leaders have been able to distribute rider cards to residents and social workers, hoping to partner with community-based organizations, and anecdotally observed users benefit, like being able to purchase their full grocery list with the help of readily available and accessible transportation. As of February 2019, thirty-eight states, Puerto Rico, and the District of Columbia also authorize by statute, public-private transportation partnerships.

Policy Actions and Recommendations

In addition to the encouraged collaborations targeting food access and availability through public transit, TFAH makes additional policy recommendations to encourage healthy behaviors and mitigate obesity risk. These can be especially impactful in affected areas struggling with food insecurity.

  • Ensure free, healthy school meals for all students to increase childhood access to healthy foods.
  • Expand Supplemental Nutrition Assistance Program (SNAP) benefits and enhance access to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).
  • Increase funding to allow for the expansion of the Centers for Disease Control and Prevention’s (CDC) National Center for Chronic Disease Prevention and Health Promotion obesity prevention programs in all 50 states. This funding should include allocations for the CDC divisions of Nutrition, Physical Activity and Obesity and Racial and Ethnic Approaches to Community Health.
  • Ensure safe and convenient access to walking and biking trails, for leisure as well as school transportation. Furthermore, education agencies should prioritize integrating physical activity and movement regularly throughout the school day.
  • Disincentivize unhealthy food choices by closing tax loopholes and eliminating business-cost deductions related to the advertising of unhealthy food and beverages to children and by enacting sugary drink excise taxes where tax revenue is allocated to local efforts to reduce health and socioeconomic disparities.

Read TFAH’s State of Obesity: Policy Recommendations for a Healthier America 2021 report and recommendations.

TFAH’s Portal of COVID-19 Resources

The following is a list of TFAH resources and documents related to the novel coronavirus read of COVID-19 and better equip the nation’s public health system to deal with this and future health emergencies.

Press Releases and Statements

20 Public Health Organizations Condemn Herd Immunity Scheme for Controlling Spread of 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… read more (October 14, 2020)

Newly Announced Order for Hospitals to Bypass CDC and Send Coronavirus Patient Information Directly to Washington Database Likely to Worsen Pandemic Response Rather than Improve It  The U.S. Centers for Disease Control and Prevention (CDC), as the nation’s lead public health agency, is uniquely qualified to collect, analyze and disseminate information regarding infectious diseases… read more (July 16, 2020)

Nearly 350 Public Health Organizations Implore HHS Secretary Azar to Support CDC’s Critical Role in the COVID-19 Pandemic Response  The expertise of the U.S. Centers for Disease Control and Prevention (CDC) and all public health agencies is critical to protecting Americans’ health during the COVID-19 crisis, said a letter to Health and Human Services Secretary Alex Azar from 347 health and public health organizations released today… read more (July 7, 2020)

Public Health Needs Our Support “As our nation’s struggles to manage the continued surge of COVID-19 cases, we need to strengthen the public health response… read more (June 23, 2020)

Summary of CDC Morbidity and Mortality Weekly Report on COVID-19 Impact Patterns This is the first data reported on U.S. patients and is consistent with findings from other countries. Key takeaways… read more (March 31, 2020)

Trust for America’s Health Statement in Response to Congressional Passage of the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”)
“Congress took an important step today to begin giving public health the resources it needs now to respond to the COVID-19 pandemic. We are seeing in real-time the impact of the chipping away at public health budgets over the past 15 years… read more (March 27, 2020)

Cross-Sector Group of Eighty-eight Organizations Calls on Congress to Address Americans’ Mental Health and Substance Misuse Treatment Needs as Part of COVID-19 Response
A cross-sector group of 88 organizations from the mental health and substance misuse, public health and patient-advocacy sectors are jointly calling on the Trump Administration and Congress to address the immediate and long term mental health and substance misuse treatment needs of all Americans as part of their COVID-19 response… read more (March 20, 2020)

55 Organizations Call for Passage and Fast Implementation of Paid Sick Leave for all Workers as a Critical Part of COVID-19 Response
A cross-sector group of 55 public health, health, labor, business, and social policy organizations are jointly calling on the Trump Administration and Congress to pass and quickly implement a federal paid sick leave law that provides 14 days of such leave to all workers, available immediately… read more (March 13, 2020)

TFAH Applauds Passage of Supplemental Funding for COVID-19 Response: Now Funding Must Move Quickly to States and Other Entities
TFAH applauds Congress’ fast action in approving the Coronavirus Preparedness and Response Supplemental Appropriations Act (H.R 6074). We now call on the tasked federal agencies to move quickly to send the appropriated monies to the agencies and localities working at the frontlines of the COVID-19 crisis… read more (March 5, 2020)

TFAH Statement on COVID-19 Preparations
Now that the U.S. has transitioned from the planning phase to the response phase of the COVID-19 outbreak, the Federal Executive Branch and Congress as well as state and local governments and other stakeholders should prioritize… read more (March 3, 2020)

Congressional Testimony and Sign-on Letters

Commentaries and Op-Eds

Additional News Coverage We Recommend

Coronavirus in the U.S.: Latest Map and Case Count

as compiled by the New York Times

 

 

CDC COVID-19 Information Resources

COVID-19 and Response: Webinars and Briefings

Related Reports

The Role of Community Development in Improving Population Health and How Pediatricians Can Help

A research article authored by Build Healthy Places Network and published by Academic Pediatrics, discusses the relationship between the zip code in which a child lives and that communities’ health implications that permeate well into adulthood. This includes the physical environment measured by things like access to healthy food, places to engage in physical activity, sanitation, and the mental and emotional environments including healthy relationships, communication with adults, and connectedness at school.

The effects of the environment in which a child is raised can be exacerbated by adverse childhood experiences (ACEs) like exposure to violence or family instability and can have negative impacts on a child’s health and into adulthood. Thee article reviews the role of pediatricians can play in advocating for community development initiatives that foster healthy neighborhood conditions where children can grow and thrive.

What Is Community Development?

Community development is a multifaceted term that has its origins in the antipoverty and racial justice movements of the 1960s. It partly began as a corrective response to racial segregation and redlining practices in the housing and finance markets that created and perpetuated low-resource neighborhoods. Organizations involved in community development work often focused on building generational wealth and quality of neighborhoods are increased through investments in affordable housing, grocery stores, health clinics schools and childcare centers, and small businesses to provide local jobs. These are direct resources in the community that are also known to have a positive effect on reducing crime, substance misuse, and other risk factors.
The Conway Center in Washington, DC  is an example. The Conway Center provides affordable family housing and housing for individuals experiencing homelessness, green space and a playground, office space, a job raining center, and a community health clinic in a property that is accessible by public transportation. The center has yet to be formally evaluated but the article’s authors advise that when such programs are evaluated the evaluators should measure its impact in ways beyond the traditional measurements of controlled or clinical experiments. For example, measures that capture the real world impact on people’s lives should be employed.

Other examples are the neighborhoods of the Villages at East Lake in Atlanta, GA and Columbia Parc in New Orleans, LA. Both communities were originally public housing projects, that now focus on children’s education and family economic success by prioritizing mixed-income housing, cradle-to=college education, healthy food access, recreation, public safety, and neighborhood services like shopping and banking. Columbia Parc has not been quantitatively evaluated, but the Villages at East Lake, Atlanta, has seen a significant decrease in violent crime, a 5-fold increase in household income, standardized test scores among the top five for K-12 schools in the Atlanta metro area, and a 97% high school graduation rate that was previously under 30% in the 1990s.

How Can Pediatricians Support Community Development?

What a child experiences and its impact on their developing minds and bodies can put them at risk well into adolescence and even adulthood. Interventions are therefore most effective when they target the early stages of a child’s life.

The opportunity to be healthy during childhood is a bridge to other opportunities – for education, emotional well-being and employment, the article states. Promoting health should therefore be a priority consideration for community development, and health experts should be included in the community development process. As experts in child health, pediatricians are uniquely qualified to integrate health as a protective factor in community development efforts. According to the National Academy of Medicine, only 10-20 percent of health status is related to medical care; the rest is accounted for by social determinants of health – opportunities for healthy behaviors like access to healthy food choices and safe and accessible places for physical activity, socioeconomic factors like education and employment,  and physical environment like housing and pollution. It is not just beneficial, but necessary for a physician to consider this holistic and interactive context in which health operates, knowing that health can be modified by any one of these non-clinical factors.

According to the article, a pediatrician therefore has a professional interest in understanding their patients’ family and community characteristics that influence health. Pediatricians’ input can help design community development initiatives that support families and children’s healthy development. Jutte, Badruzzaman, and Thomas-Squance share some tangible ways pediatrician can use their professional voice to drive neighborhood investments through a community development framework.

Next, researchers in the field of pediatrics can investigate the effects of neighborhood investments on child and adolescent health, in one potential way by studying health variables in neighborhoods where investments have already been made but impact has yet to be measured, like the Conway Center.

Policy Action is Needed

The Build Healthy Places Network’s article underscores the need for policy action Community development should be a central value and initiative in improving the health of and preventive services in neighborhoods. Neighborhood infrastructure has lasting effects on children that persist into adulthood, for both risk and protective factors. Pediatric professionals can use their expertise in the field to practice, educate, and advocate for the principles of community development that consider holistic wellness. Trust for America’s Health’s (TFAH) Promoting Health and Cost Control in States (PHACCS) report includes several policy actions that pediatricians can support in order to advance pediatric health:

  • School-based health centers that meet comprehensive pediatric needs in primary care including healthcare, oral care, behavioral healthcare, and health education in fixed, mobile, or telehealth location settings.
  • Early education and universal pre-kindergarten programs that benefit childhood development and reduce the likelihood of risk factors throughout the life course.
  • Housing rehabilitation programs that make physical improvements in neglected properties like lead abatement, re-housing programs that offer support services for individuals experiencing homelessness to transition to permanent housing, and policies that protect the affordability of housing like tax credits and incentives.
  • Developmental infrastructure like “Complete Streets” policies that promote physical activity, safer streets, and mixed-use land spaces that create inclusive, integrative, and healthier neighborhoods for living and growing.
  • Affordable, sustainable quality housing that provides stability, economic and social opportunity for families, and long-term health benefits that are protective factors for life-long wellness.

For more details on these solutions and policies, see TFAH’s PHACCS initiative and accompanying reports.

TFAH Recognizes National Minority Health Month

Trust for America’s Health (TFAH) is proud to support National Minority Health Month (NMHM) 2022 and its critical focus on addressing health inequities. This year’s NMHM theme Give Your Community a Boost! notes the importance of ensuring that everyone eligible to receive the COVID-19 vaccine is vaccinated, including all eligible booster doses. Being vaccinated is the best way to protect yourself and your loved ones against severe illness from COVID-19.

“Ensuring that communities of color have equitable access to and reliable sources of information about the COVID-19 vaccine is vital to promoting and protecting the health and well-being of the community,” said TFAH President and CEO, Dr. J. Nadine Gracia. “People of color have been disproportionately impacted by the pandemic, due to longstanding social, economic, and health inequities that led to higher rates of job loss, less access to essential resources for remote learning, and higher rates of infections, hospitalizations, and deaths. We need to focus on two priorities: protecting everyone from COVID-19 now and ensuring that no community is at heightened risk during the next public health emergency. ”

Additional Readings:

TFAH’s 2020 policy brief Building Trust in and Access to a COVID-19 Vaccine Within Communities of Color and Tribal Nations reports on challenges to building vaccine trust and access in communities of color and tribal communities and recommends solutions.

TFAH’s 2022 Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism reports on state-level public health emergency readiness and the connection between health equity and emergency preparedness.

TFAH’s Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity recommends policy action that if adopted will address the social determinants of health that currently drive poor health in many communities.

Read more about TFAH’s policy recommendations to rebuild the nation’s public health system and invest in the social determinants of health and health equity in our Blueprint report: The Promise of Good Health for All: Transforming Public Health in America. A Blueprint for the 2021 Administration and Congress.

TFAH Recognizes National Public Health Week, April 4 – 10, 2022

Trust for America’s Health is proud to participate in National Public Health Week and its 2022 theme “Public Health is Where You Are.”

Public health’s mission is to promote health and protect people from health risks, including diseases and natural or man-made disasters. Prevention and disease surveillance are central to that mission, as are population-level health interventions including addressing the social determinants of health. Public health practitioners work at the community level to ensure that everyone has an opportunity for optimal health. A critical premise of that work is engaging with and empowering communities, including identifying and addressing root causes of health inequities and barriers to good health.

The COVID-19 pandemic has illustrated the urgent need to grow the public health workforce and ensure that it has the tools it needs to fulfill its mission. TFAH and other public health leaders have called for an annual investment of $4.5 billion to support public health infrastructure and workforce. Much of what we spend as a nation on healthcare today is spent on preventable illness and injury. Rebuilding the public health system would help address health inequities,  would make the country better prepared for future health emergencies, and would improve health outcomes.

Additional Readings:

TFAH’s 2022 Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism report for more information on public health emergency readiness and the connection between health equity and emergency preparedness.

TFAH’s annual report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021 tracks the dearth of funding for public health and the impact that scarcity has had on the public health infrastructure, readiness, and workforce.

 

The Challenge of Vaccine Hesitancy Didn’t Start with COVID-19, and it Won’t End There

Will COVID-19 Vaccine Misinformation Lead to More Measles, Flu and Shingles?

Cecelia Thomas, JD

Just over one year has passed since the first availability of the COVID-19 vaccine. At this one-year mark 63 percent of U.S. adults are fully vaccinated. This ranks the United States as 60th in the world based on the percentage of fully vaccinated individuals. To say that these rates are troubling is an understatement. Even before the COVID-19 pandemic, the World Health Organization named vaccine hesitancy, the reluctance or refusal to vaccinate despite the availability of vaccines, as one of the top ten threats to global health. The consequences of this threat are tragically apparent with the deaths of mostly unvaccinated Americans. High levels of vaccine hesitancy have slowed the world’s ability to move past the pandemic and may be what’s allowed new variants of the virus to emerge.  Without addressing the root causes of vaccine hesitancy, more preventable infectious disease outbreaks will occur, and they will cost thousands of more lives in addition to further social and economic disruption.

Reasons for Vaccine Hesitancy
The problem of vaccine hesitancy did not start with COVID-19 and it likely won’t end there. In communities of color, vaccine hesitancy stems from long-standing health disparities and medical mistreatment . These deep and painful roots in this country’s history are exacerbated by the persistence of racial discrimination and bias in healthcare today and by practical barriers to vaccination such as health coverage limitations, inadequate transportation, and insufficient paid time off. While communities of color and low-income communities have had the most pervasive vaccine hesitancy historically, these groups are far from the only groups driving current vaccine hesitancy.

Efforts to rectify these past and present injustices should focus on cultural competence training for medical providers and community leaders on issues related to COVID-19 and routine vaccinations for children and adults. In addition, we need to improve vaccine accessibility and transparency. Other groups, other than populations that are systematically marginalized, such as white Evangelical Christians, have also expressed high rates of vaccine hesitancy before and throughout the pandemic. The politicization of public health that occurred during the last election intensified anti-vaccine sentiments, while social media and other platforms have allowed for the increased spread of misinformation.

Addressing Vaccine Hesitancy through Policy
Congress has recently passed legislation to fund fortified public health infrastructure to conduct and support widespread outreach, engagement, and vaccinations to communities across the nation. In addition, the COVID-19 Health Equity Task Force served as a forum for experts in the field to comprehensively address disparities in pandemic-related inequalities and develop solutions to issues such as vaccine accessibility and hesitancy. These are crucial steps at the federal level. States should follow suit with steps to bolster vaccination access and education.  Vaccine mandate bans are a step in the wrong direction and bad public policy.

Long-term Impacts of Vaccine Hesitancy
The U.S. also remains vulnerable to vaccine-preventable diseases such as flu, hepatitis B, pneumococcal, and shingles, due to under-vaccination. The threat of increased hesitance could further endanger people at higher risk for severe outcomes including older adults and people with underlying health conditions.  A year before the pandemic, the U.S. was in the midst of its worst measles outbreak in two decades and just narrowly preserved its measles elimination status.  The seasonal flu vaccine has also remained significantly underutilized in recent years. The lowest flu vaccination rate in recent years,  42% during the 2017-2018 flu season, contributed to 2017-2018 being the deadliest flu season in 40 years with 80,000 deaths. Despite this tragic reality check, the flu vaccination rate has yet to increase past 49% . If vaccination rates for diseases such as the seasonal flu do not improve, the combined burden of these infectious diseases will further strain the healthcare system and cause needless death and illness. There has also been a significant drop in routine vaccination rates across all ages due to the pandemic.  Adult vaccination rates are already far below Healthy People 2030 goals pre-pandemic and an estimated 26 million doses for adults and adolescents were missed in 2020.

Looking Forward
Congress, the Biden Administration and public health advocates must continue to work on immunization catch-up and support efforts to maintain high immunization coverage rates. These efforts are especially critical for the communities most impacted by COVID-19, such as communities of color and children. In October 2020, Trust for America’s Health co-hosted a national convening on building vaccine confidence and ensuring equitable access to the COVID-19 vaccine in communities of color, in partnership with the National Medical Association and UnidosUS. The policy recommendations of this report apply to other groups with growing rates of vaccine hesitancy, such as people who identify as politically conservative. Recommendations from the resulting policy brief also extend beyond the COVID-19 vaccine:

  • Expanding federal funding to support and strengthen national, state, local, Tribal and territorial work on equitable and effective vaccination planning, communications, distribution and administration, including funding to support vaccine distribution at the local level and by community-based organizations;
  • Collaborating with trusted community messengers/leaders for vaccine administration and education;
  • Creating culturally and linguistically appropriate vaccine education;
  • Ensuring zero out-of-pocket costs for individuals receiving recommended vaccines; and
  • Collecting complete disaggregated racial and ethnic data on adverse experiences in healthcare as well as health outcomes.

While these recommendations are most immediately applicable to the COVID-19 pandemic, they will also be important to increasing vaccine trust in the future.  These methods have already begun to work, vaccine hesitancy and racial gaps in vaccinations are beginning to slowly decrease. We must build on this momentum and prioritize increasing vaccine confidence across the U.S. to ensure that the nation is better prepared for future public health crises.

Cecelia Thomas, JD, is a Senior Government Relations Manager at Trust for America’s Health