Stories Archive - Page 7 of 18

Black History Month 2022: Policy Action to Support Black Health and Wellness

February 2022

A person’s health is impacted by a myriad of social and economic conditions in which they are born, live, work and age. The availability of safe and affordable housing, education and employment opportunities, food security, and access to quality healthcare all influence a person’s opportunity for good health. But these factors are not equally available to all Americans.

This Black History Month, TFAH calls for an end to the systemic and structural racism that continue to prevent Black Americans from achieving optimal health.

Structural racism is a predominant driver of health inequities – inequities that, on average, lead to more chronic disease, less access to healthcare, higher rates of infant and maternal mortality, and shorter life expectancy for Black people and other people of color as compared to whites. This increased risk for poorer health outcomes persists when controlling for socioeconomic status.

TFAH offers the following policy recommendations to advance health equity:

Make advancing health equity and eliminating health disparities a national priority. Such a priority requires ending systemic barriers and advancing policies and programs that create equitable opportunity for health and well-being.
Strengthen public health’s capacity to address health inequities, including modernizing public health data systems to better track health disparities, strengthening workforce training and recruitment from diverse communities, and investing in health equity expertise at health departments.
Target the elimination of poverty by increasing the minimum wage and expanding the Earned Income Tax Credit at the national and state levels.
Increase funding for programs that address health inequities, such as the Centers for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health (REACH) program.
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 and 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 policy actions to improve health outcomes in communities of color, see these TFAH reports and webinars:

Issue Backgrounder

Improving the Social Determinants of Health Act of 2021 Backgrounder

Reports

Webinars

Your Individual Donation to TFAH Will Help Advance Everyone’s Health

The last 22 months have demonstrated the urgent need to transform our public health system. As you know, we critically need to invest in modern data systems, grow the public health workforce and invest in disease prevention. But none of those investments will be effective until the nation addresses economic disparities, racism and the social determinants of health.

TFAH has worked tirelessly throughout the pandemic to help address the COVID-19 crisis. We’ve been a resource to policymakers, published policy briefs, gave congressional testimony, hosted webinars and provided news media with important data and context. We have and continue to advise Congress on the importance of devoting pandemic recovery funds to modernize the public health system.

We have spoken out firmly on issues of health equity. And we continue to publish our highly regarded reports on emergency preparedness, public health funding, deaths of despair, and obesity. In addition, our new initiatives in the areas of climate change and health and an age-friendly public health system continue to grow in footprint and impact.

As the challenges before the public health system continue to grow the need to expand our work does too. We are not a membership organization, and we don’t seek government or corporate funding – all to preserve our independent voice. Your support as an individual donor will allow us to continue to drive positive change and give everyone the opportunity to lead a healthy life.

New Data Underscores Impact of COVID-19 Pandemic on Americans’ Mental Health, Substance Use, and Suicide

December 2021

The impact of the COVID-19 pandemic on Americans’ physical health and economic security is evident. New data shows other significant impacts, like disruption of mental and behavioral healthcare, continued alarming increases in drug overdoses, more suicide attempts among adolescents, and divergent trends in suicide rates.

In May of 2021 TFAH and Well Being Trust’s Pain in the Nation report described emerging data on many of COVID-19’s direct and indirect effects related to mental health and substance use, including more calls to crisis lines, worse reported mental health, more substance use, and higher rates of drug overdoses. Additional data and studies released in 2021 show a more complete picture of the effects of the pandemic on mental and behavioral healthcare, drug overdoses, and suicidal behaviors. Here’s what we’ve learned from four new studies:

Reduced utilization of mental and behavioral healthcare in 2020
A February 2021 report from Milliman examined utilization patterns for mental health and substance use healthcare for 12.5 million Americans with health coverage from private health plans, Medicaid, and Medicare between January 2019 and August 2020. The authors found that in-person mental and substance use services declined substantially in early 2020 at the beginning of the pandemic. This includes decreases in inpatient admissions, emergency services, primary care visits, and specialty care visits for mental and behavioral healthcare. The largest declines were in-person primary care and specialty care visits in April, May, and June 2020—these visits declined 75 percent for individuals with private health coverage. In June 2020, utilization began to increase until it reached or surpassed 2019 levels by the end of the summer.

The report also looked at telehealth visits, which increased dramatically in March and April, particularly for individuals with private plans and Medicare. In prior years, 1 percent or less of mental or behavioral healthcare visits were via telehealth, while it exceeded 75 percent for private plan enrollees and 50 percent for Medicare enrollees at the peak. For Medicaid enrollees, the uptake was much lower—peaking at 28 percent for Medicaid enrollees—pointing to limitations of telehealth to reach all patients.

Continued increase in drug overdoses in 2020–2021
Provisional data from the CDC shows a rapid escalation in drug overdose deaths since the beginning of 2020 after several years of relatively flat death rates. The most recent data released—for the 12-month period May 2020–April 2021—shows 97,990 provisional drug overdose deaths. In comparison, a year prior (May 2019–April 2020), had 77,007 provisional drug overdose deaths and two years prior (May 2018–April 2019), had 67,736 provisional drug overdose deaths. The increases were nearly universal across states with just three states (New Hampshire, New Jersey, and South Dakota) seeing decreases, and several states (Kentucky, Louisiana, Tennessee, Vermont, West Virginia) having staggering increases of more than 50 percent.

More suicide attempts among adolescents during the pandemic
A CDC study from June 2021 compared the number of emergency department visits for suspected suicide attempts for 12–17-year-olds before and during the pandemic. The study found that in May 2020, suspected suicide attempts among adolescents began to increase, particularly among girls, and remained higher through 2021. During the weeks of February 21–March 20, 2021, suspected suicide attempts were 51 percent higher among girls aged 12–17 years than during the same period in 2019; among boys aged 12–17 years, suspected suicide attempts increased 4 percent.

Suicide trends diverge by population groups in 2020
The National Center for Health Statistics released a report using provisional mortality data to examine suicide trends in 2020 in November 2021. The topline trend shows a drop in the overall suicide rate from 13.9 deaths per 100,000 in 2019 to 13.5 deaths per 100,000 in 2020. This includes a notable drop in suicides in April 2020, at the beginning of the pandemic. For the year 2020, suicide rates declined across many groups including for females of all race/ethnicities, middle age adults (aged 35-64), whites, and Asians. There are several major exceptions to this trend: younger Americans (aged 10-34) saw increases in suicide rates between 2019 and 2020— including a statically significant increase among young adults aged 25–34 years old— and likewise American Indian/Alaska Native, Black, and Hispanic males saw increases in suicide rates between 2019 and 2020—including a statistically significant increase for Hispanic males. These divergent trends by age, sex, and race/ethnicity highlight the importance of collecting demographic information and analyzing trends among populations in order understand the different outcomes and experiences, and how best to focus resources and policy responses towards those in need.

Policy action is needed
These new studies underscore the need for urgent action, or risk an increase in deaths from alcohol, drugs, and suicide — already on a grim trajectory—in the coming years.

“The pandemic has created new stressors, and worsened the substance use and mental health crises in our country. We need to focus on how we can better support individuals with emergent crises, mental health conditions, and substance use disorders now, as well as look ahead and invest in policies that promote good health, well-being, equity, and resilience for everyone,” said J. Nadine Gracia, President and CEO Trust for America’s Health.

Specifically, we need to make progress in three priority areas:

Invest in Prevention and Conditions that Promote Health

Reduce traumatic experiences, and promote resilience in children, families, and communities. Programs that promote economic security, such as a living wage, and create affordable housing help strengthen families and reduce traumatic experiences in childhood.
Expand substance use prevention, mental health, and resiliency programs and staff in schools.
Bolster crisis-intervention programs and supports.
Reduce availability of illicit opioids and inappropriate prescriptions.
Lower excessive alcohol use through evidence-based policies such as increasing pricing, reducing sales hours and enforcing underage drinking laws.
Limit access to lethal means of suicide, including drugs and firearms.

Address the Worsening Drug Use and Overdose Crisis

Implement policies targeting psychostimulant use.
Promote harm-reduction policies to reduce overdose and blood-borne infections.
Continue pandemic-related enhanced flexibilities in access to and rules for substance-use treatment.
Address the secondary impact of the substance use and overdoses on children.

Transform the Mental Health and Substance Use Prevention System

Expand efforts to combat stigma and improve social attitudes toward mental health.
Improve data accuracy, completeness, and timeliness through innovation and additional funding.
Increase access to mental health and substance use healthcare through full enforcement of the Mental Health Parity and Addiction Equity Act.
Expand the mental health and substance use treatment workforce.
Build community capacity for early identification and intervention for individuals with mental health needs.
Promote diversity and culturally appropriate care in the healthcare system and adopt trauma-informed and culturally competent practices in youth-services programs.

For more details on these policies, see the solutions and recommendations section in the latest Pain in the Nation report.

Bipartisan Infrastructure Law Will Help Protect Communities from the Health Effects of Climate Change

On November 15, 2021, President Biden signed the Infrastructure Investment and Jobs Act into law. The legislation, in addition to addressing other vital priorities, represents one of the most significant—if not the most significant—federal actions to protect U.S. residents from health threats posed by climate change and weather-related emergencies. We increasingly experience longstanding threats that are being turbocharged by a warming planet, including heat waves that are becoming hotter and longer; severe storms that break records year after year; wildfires that outmatch traditional methods of control; pollution and contaminants increasingly endangering the quality of our air and water; pests bringing disease and threatening staple foods; and the trauma of it all on our mental health.

As with all health hazards, these effects are not felt equally, as a mix of environmental, social, and demographic factors influence people’s exposure and vulnerability. Some people are more vulnerable because of age (e.g., children, older adults) or preexisting medical conditions (e.g., diabetes, asthma). People who work outdoors or as first responders may face greater exposure. Large portions of other groups, such as immigrants, people of color, people living in poverty, or people experiencing homelessness may have less access to resources that would allow them to avoid exposures, seek care or treatment, or navigate long-term recovery. In many cases, vulnerability to the health impacts of climate change reflect existing health risk factors and disparities. In the United States, the legacy of colonization, slavery, and ongoing structural and systemic racism contribute to such inequities.

“Climate change and its impacts on health are a reality we must acknowledge and respond to,” said J. Nadine Gracia, President and CEO of Trust for America’s Health. “The new Infrastructure Investment and Jobs Act provides critical direction and funding to do so. Also important to protecting the health of all U.S. residents is designing adaptation programs that are rooted in the recognition that some communities are at greater risk and that strive to promote health equity.”

Below is an analysis of the law that highlights key adaptation-related measures. These range from programs to mitigate coastal and inland flooding to preparations for severe drought to proactive wildfire mitigation initiatives to innovative strategies for reducing urban heat islands and more.

For more information on the health impacts of climate change and the extent of states’ preparedness, see “Climate Change & Health: Assessing State Preparedness,” which Trust for America’s Health (TFAH) produced in partnership with the Johns Hopkins Bloomberg School of Public Health. And for examinations of concrete steps states and localities are taking to equitably protect their communities, see TFAH’s case studies series.

Coastal Storm and Flood Risk Management

$17.1 billion for the U.S. Army Corps of Engineers, to remain available until expended, for a range of priorities, including $2.55 billion for coastal storm risk management, hurricane and storm damage reduction projects, and related activities; and $2.5 billion for inland flood risk management projects, with a directive to prioritize projects in communities that are economically disadvantaged, or where the percentage of people that live in poverty or identify as belonging to a minority group is greater than the average such percentage in the United States.
$3.5 billion ($700 million annually over five years FY 2022-26) for the Flood Mitigation Assistance program, which is administered by the U.S. Federal Emergency Management Agency (FEMA). The program provides competitive grants to states, local governments, Tribal governments, and territories to support projects that reduce or eliminate the risk of repetitive flood damage to buildings insured by the National Flood Insurance Program.
$2.611 billion for operational, research, and facility costs of the U.S. National Oceanic and Atmospheric Administration (NOAA), including $492 million for the National Oceans and Coastal Security Fund, established by NOAA and the National Fish and Wildlife Foundation to restore, increase, and strengthen coastal ecosystems (e.g., wetlands, dunes, coral reefs) that offer flood protection for coastal communities; $492 million for coastal and inland flood and inundation mapping and forecasting, and for next-generation water modeling activities; and $491 million for, among other purposes, protecting ecological features that help mitigate coastal flooding or coastal storms.

Wildfire Risk Reduction

$3.37 billion for the U.S. Department of the Interior and the U.S. Department of Agriculture to support a range of wildfire risk reduction activities, including $600 million for the salaries and expenses of federal wildland firefighters; $500 million for conducting mechanical thinning and timber harvesting; $500 million to award community wildfire defense grants to at-risk communities; and $500 million for planning and conducting prescribed fires and related activities.

$50 million for NOAA to improve its capabilities related to wildfire prediction, detection, observation, modeling, and forecasting.

Amends the Robert T. Stafford Disaster Relief and Emergency Assistance Act to include wildfire within the hazard mitigation program so that recipients of FEMA grants may engage in such fire-prevention activities as replacing or installing electrical transmission or distribution utility pole structures and installing fire-resistant wires, infrastructure, and underground wires.

Water Infrastructure

$8.3 billion for the Bureau of Reclamation, an agency within the U.S. Department of the Interior, to fund western water infrastructure projects, including $3.2 billion for projects that rehabilitate or replace aging infrastructure; $1.15 billion for water storage, groundwater storage, and conveyance projects; $1 billion for water recycling and reuse projects, and $250 million for water desalination projects and studies.
$1.4 billion ($280 million annually over five years: FY 2022-26) to the existing Sewer Overflow and Stormwater Reuse Municipal Grants program, which is administered by the U.S. Environmental Protection Agency (EPA). Grants may be used to plan, construct, and design certain treatment works; to take measures to better manage, reduce, or recapture stormwater or subsurface drainage; and to implement notification systems to inform the public of overflows that result in sewage being released into rivers and other waters. At least 25 percent of the funds a state receives are to be used in rural and/or financially distressed communities.

$300 million for implementing the Colorado River Basin Drought Contingency Plan, a joint effort by the Department of the Interior and seven states (Arizona, California, Colorado, Nevada, New Mexico, Utah, and Wyoming) to reduce risks from ongoing drought and protect this shared water resource.

$250 million ($50 million annually over five years: FY 2022-26) to the new Midsize and Large Drinking Water System Infrastructure Resilience and Sustainability program, to be administered by the EPA. Grants will be available to public water systems that serve communities with a population of 10,000 or more for the purposes of increasing resilience to natural hazards and extreme weather events, and for reducing cybersecurity vulnerabilities. Funds may be used to conserve water or enhance water-use efficiency, create desalination facilities, relocate or modify existing water systems that are vulnerable to natural hazards or extreme weather events (e.g., risks to drinking water from flooding), enhance water supply, and develop and implement measures to increase resiliency to natural hazards, among other permitted uses.

$125 million ($25 million annually over five years: FY 2022-26) to the new Clean Water Infrastructure Resiliency and Sustainability program, to be administered by the EPA. Grants will be available to municipalities and other owners of publicly owned treatment works to plan, design, or construct projects that increase their resilience to natural hazards (e.g., extreme weather events, sea-level rise, extreme drought conditions) or cybersecurity vulnerabilities. Funds may be used to conserve water; enhance water-use efficiency; improve wastewater and stormwater management; and modify or relocate existing publicly owned treatment works, conveyance, or discharge systems that are vulnerable, among other permitted uses.

$125 million ($25 million annually over five years: FY 2022-26) to the existing Pilot Program for Alternative Water Source Projects initiative, which is administered by the EPA. The grants may be used to engineer, design, construct, and test alternative water source projects that conserve, manage, reclaim, or reuse water for groundwater recharge and potable reuse.

Energy Infrastructure

$5 billion over five years (FY 2022-26) for the U.S. Department of Energy (DOE) to administer grants to states, Tribal governments, electric grid operators, electricity storage operators, and other eligible entities for the purposes of preventing power outages and enhancing the resilience of the electric grid. Recipients may use grants to reduce the risk of power lines causing a wildfire or to reduce the likelihood and consequences of disruptive events—an event in which operations of the electric grid are disrupted, preventively shut off, or cannot operate safely due to extreme weather, wildfire, or a natural disaster.

$5 billion over five years (FY 2022-26) for the new Program Upgrading Our Electric Grid and Ensuring Reliability and Resiliency initiative, to be administered by the DOE. Grants will be available to states, Tribal governments, local governments, and other eligible entities to coordinate and collaborate with electric sector owners and operators for the purposes of demonstrating innovative approaches to enhancing the resilience of transmission, storage, and distribution infrastructure, and to demonstrate new approaches to enhancing regional grid resilience. In addition, the DOE is directed to assess the resilience, reliability, safety, and security of energy infrastructure in the United States, in collaboration with the U.S. Department of Homeland Security, the Federal Energy Regulatory Commission, and the North American Electric Reliability Corporation.

$3 billion for FY 2022, to remain available through FY 2026, for the new Smart Grid Investment Matching Grant program, to be administered by the DOE. The program would facilitate the deployment of technologies to enhance electric grid flexibility and mitigate impacts of extreme weather or natural disasters on grid resiliency, among other purposes.

Transportation Infrastructure

$8.7 billion over five years (FY 2022-26) to the new Promoting Resilient Operations for Transformative, Efficient, and Cost-saving Transportation (PROTECT) program, to be administered by the U.S. Department of Transportation (DOT). The law makes $7.3 billion available for formula grants to states and $1.4 billion ($250 million annually from FY 2022-23; $300 million annually from FY 2024-26) available for competitive grants to states, local governments, public authorities, Tribal governments, and other eligible entities for the purposes of making transportation infrastructure assets more resilient against weather events, natural disasters, and changing conditions, including sea level rise.
$550 million ($55 million annually over 10 years: FY 2022-31) for the DOT to designate 10 regional Centers of Excellence for Resilience and Adaptation and one national Center of Excellence for Resilience and Adaptation to advance research and development that improves the resilience of regions of the United States to natural disasters and extreme weather by promoting the resilience of surface transportation infrastructure and infrastructure dependent on surface transportation.
$500 million ($100 million annually over five years: FY 2022-26) to the new Healthy Streets program, to be administered by the DOT. Competitive grants will be available to states, local governments, Tribal governments, and other eligible entities to utilize cool pavements and porous pavements, and to expand tree cover, for the purposes of mitigating urban heat islands, improving air quality, and reducing the extent of impervious surfaces, storm water runoff and flood risks, and heat impacts to infrastructure and road users. (For more information on urban heat islands and how some places are working to protect their residents, see TFAH’s case study on Philadelphia’s Beat the Heat program.)
Directs the DOT to conduct a study on permeable pavements to gather existing information on their effect on flood control in different contexts and to develop models for their performance in flood control and best practices for designing them.
Directs the DOT and EPA to offer to partner with the Transportation Research Board of the National Academies of Sciences, Engineering, and Medicine on a study on stormwater management practices to estimate pollutant loads from stormwater runoff from highways and pedestrian facilities, provide recommendations of stormwater management and total maximum daily load compliance strategies within a watershed, and examine the potential for the DOT to assist state departments of transportation in carrying out and communicating stormwater management practices for highways and pedestrian facilities.
Directs the Federal Highway Administration, a division of the DOT, to update within one year and at least every five years thereafter two previously issued reports on stormwater management practices: ‘‘Determining the State of the Practice in Data Collection and Performance Measurement of Stormwater Best Management Practices” and “‘Stormwater Best Management Practices in an Ultra-Urban Setting: Selection and Monitoring.”

Cross-cutting

$1 billion ($200 million annually over five years FY 2022-26) for the Building Resilient Infrastructure and Communities (BRIC) program, which is administered by FEMA. The program provides competitive grants to states, local governments, Tribal governments, and territories to support pre-disaster hazard mitigation projects.
$500 million ($100 million annually over five years FY 2022-26) for the Safeguarding Tomorrow through Ongoing Risk Mitigation Act (STORM) Act, which authorizes FEMA to enter into agreements with states or Tribal governments to make capitalization grants for the establishment of hazard mitigation revolving loan funds. Such funds are meant to support local government projects to reduce disaster risks for homeowners, businesses, nonprofit organizations, and others.
$216 million ($43.2 million annually over five years FY 2022-26) for the S. Bureau of Indian Affairs to distribute to tribes and tribal organizations for climate resilience, adaptation, and community relocation planning, design, and implementation of projects which address the varying climate challenges facing tribal communities across the country. Of the total, $130 million is set aside for community relocation and the remaining $86 million is for climate resilience and adaptation projects.

Staffing Up: Public Health Workforce Must Grow to Provide Basic Public Health for All Americans

Public health budget and staffing cuts have weakened America’s health security and increased Americans’ vulnerability to emerging infectious and chronic diseases.

State and local governmental public health departments are essential to maintaining the security, safety, and prosperity of local communities, yet they are consistently underfunded. A recent analysis conducted by the de Beaumont Foundation and the Public Health National Center for Innovations (PHNCI) found state and local governmental public health departments have lost 15 percent of their essential staff over the last decade. These staffing cuts have been especially detrimental in the midst of the global pandemic as understaffed health departments had a limited ability to plan for and respond to emergencies like COVID-19 and struggle to meet the daily health security needs of their communities.

The issue brief, Staffing Up: Workforce Levels Needed to Provide Basic Public Health Services for All Americans, found that nationally state and local governmental public health departments need an 80 percent increase in their workforce (80,000 additional full-time employees) to provide an adequate infrastructure and a minimum set of public health services to the nation (See Figure 1). Specifically, due to existing staffing shortages local health departments need to add approximately 54,00 full-time employees, and state departments need to add 26,000 full-time employees across differing levels of categories and areas of expertise. (See Figure 4).

Source: Staffing Up: Workforce Levels Needed to Provide Basic Public Health Services for All Americans

This chronic underfunding of the public health system was a key contributing factor in the nation’s unprepared response to the COVID-19 pandemic, according to TFAH’s report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021. The report highlights how the underfunding of core public health programs – resulting in under-resourced, understaffed, and overburdened health agencies – impeded the pandemic response and exacerbated its impacts. Years of underfunding core public health programs created the situation in which local health departments were fighting a 21st century pandemic with 20th century tools and has made the nation less resilient, the report said.

To combat the growing public health crisis, and emerge better prepared for future public health emergencies, the U.S. needs to adequately fund public health and disease prevention all the time, not just in response to a crisis, and it needs to address the social determinants of health. At present, the country spends about $3.8 trillion on healthcare with just 2.6 percent of that spending directed toward public health and prevention.

Investment to ensure foundational capabilities is key. (See Figure 5).

Source: Staffing Up: Workforce Levels Needed to Provide Basic Public Health Services for All Americans

TFAH’s public health funding report calls for a $4.5 billion annual investment in the nation’s core public health capabilities, and includes four priorities for policy action:

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.

Understanding Our Society Will Help Us Understand Obesity: An Interview with Angela Odoms-Young, PhD

Dr. Angela Odoms-Young, an associate professor in Nutritional Sciences at Cornell University, studies the ways in which cultural and environmental factors influence diet and related health conditions, particularly in communities of color. Dr. Odoms-Young’s research illuminates the roots of the obesity crisis within the Black community including poor food environments, stress, trauma, a lack of economic opportunity and the lack of active transportation and safe places for physical activity.

“We need to think of obesity as an outcome,” Dr. Odoms-Young said. “If you look at the conditions under which Black people live, those conditions over years have created what we see today. The fact that people of color are disproportionately impacted makes perfect sense because generally society has restricted their access to resources.”

According to TFAH’s State of Obesity 2021: Better Policies for a Healthier America report, while obesity is a problem across all racial and ethnic groups – 42 percent of all U.S. adults have obesity – Blacks have the highest rate of obesity in the country. Nearly half of all Black adults in the U.S. (49.6 percent) have obesity. The rate is even higher for Black women at 56.9 percent. Read the full interview with Angela Odom-Young, PhD

Program Helps Move Homeless People Receiving Care in Emergency Room into Stable Housing

Stable housing is a key social determinant of health. Yet, many Americans struggle to maintain a safe and healthy place to live. As defined by the U.S. Department of Housing and Urban Development (HUD), chronic homelessness is the state of being without housing for more than a year, or experiencing a disabling condition, including physical disability, serious mental illness, or substance use disorder making it difficult to maintain and secure housing. Nationally, in 2019, a reported 567,715 individuals experienced homelessness at some point during the year, and according to experts, the 2020-2021 COVID-19 crisis is likely to have increased homelessness.

Chronic homelessness may be caused by a number of factors including long-term existing economic and health disparities that disproportionally affect some population groups including low-income people, people of color, individuals recently released from incarceration or formerly incarcerated, and those struggling with mental health and substance use disorders among others.

A program in Illinois, Better Health through Housing (BHTH) supports the transition of currently homeless people receiving healthcare services in an emergency room to stable housing within the community. In addition, the city of Chicago, is working on an initiative to address the city’s chronic homelessness crisis. A 2020 survey, City of Chicago 2020 Homeless Point-in-Time Count & Survey Report, measured the number of individuals who experienced homelessness within the city on a single night. The survey found a total of 5,390 people living on the streets or in shelters, which represents a 2 percent increase over the 2019 data.

According to Lisa Morrison Butler, the Commissioner of the Department of Family and Support Services for the city of Chicago, “[t]here are 106,000 Chicagoans who are both housing insecure, rent insecure specifically, and also work in occupations that were really heavily impacted by the first wave of COVID.”

People who are chonically homeless die younger than people with stable housing. Additionally, an individual that experiences a lack of housing stability incurs healthcare costs that are 2.5 to 160 times that of the average patient in Chicago. Data shows that emergency rooms (ER) are flooded with individuals experiencing homelessness seeking treatment. It is not uncommon for people without housing to suffer from congestive heart failure, kidney disease, mental illness, and substance abuse.

To address this problem, in November 2015, the University of Illinois Hospital & Health Sciences System and the Center for Housing and Health, launched the Better Health Through Housing (BHTH) initiative to reduce healthcare costs and provide stability for the chronically homeless by moving individuals directly from the hospital ER into stable, supportive housing while also offering intensive care management services based on the Housing First Strategy. The program is designed for adult individuals expericing homelessness who are frequent users of crisis services. It uses a network of apartments and privately owned buildings to provide housing for program participants. If the prospective tenant is employed or receives disability income, the tenant contributes 30% of their income toward the housing cost. If there is no source of income, the individual does not pay rent until income is secured. “The program has housed over 80 homeless patients, the most of any hospital in the U.S. It has seen significant drops in ED utlization (-41%), inpatient admissions (-52%) and significant mortality (-38.5% over 5 years)” said Stephen Brown, Director of Preventative Emergency Medicine at the University of Illinois Hospital and Health Sciences System.

The orgins of the BHTH program are rooted in a HUD subsidy that was awarded to the Center for Housing and Health and has since grown into the Flexible Housing Pool (FHP). The housing pool combines grants and investments from private and philanthropic organizations to provide sustainable housing for those experiencing chronic homelessness. Contributors to BHTH program’s flexible funding pool include University of Illinois Hospital & Health Sciences System, Cook County Health, Blue Cross Blue Shield, and the City of Chicago among many other organizations. Approximately $13.4 million of program funding has been allocated for use over the next three years to expand support services and to secure current and additional housing for program participants.

In addition, the program has expanded to providing secure housing for young adults ages 18 to 24 years of age who have experienced housing insecurity.

The program identifies qualifying individuals who received emergency room services from the University of Illinois Hospital & Health Sciences System and Cook County Health System. Once an individual is identified as a candidate and agrees to the terms of the program, the Center for Housing and Health locates housing for the individual. Once housing is secured, a team of caseworkers connect the individual to needed resources, including healthcare services to facilitate a successful transition. In addition, housing case managers work with program participants to secure appropriate benefits and employment options. Since implementation of the program, in addition to directly addressing the issue of homelessness, use of the emergency rooms has decreased by 67% among program participants. “The reductions of repeat visits and reducing cost are their primary measure of success. In addition, biomarkers such as managing hemoglobin A1c in diabetics, blood pressure, and hypertentions are also being observed to measure the success of securing stable housing for these individuals,” said Brown.

Moreover, despite disruptions from COVID-19, the program continues to provide suitable housing solutions for Chicagoans. Brown stated “the pandemic resulted in the creation of Chicago Homelessness and Health Response Group for Equity (CHHRGE) that has acted in a city-wide-collaborative fashion. The 100+ member coalition includes multiple hospitals, FQHCs, city officials, shelters, housing advocates, and others working to expand services and to advocate for polices to help individuals experiencing homelessness. More than 1,300 units have been made available to homeless individuals. Now, we have been able to provide health care to most of the cities shelters,” said. Dr. Brown. “Through housing, health care, and case management we can improve the health of individuals and comummunities while at the same time reduce cost.”

For more information on the Better Health through Housing Program, please visit here.

New Website Helps Local Health Departments Support Older Adults

Washington, DC (April 28, 2021) – Trust for America’s Health (TFAH), with funding from The John A. Hartford Foundation, has developed and launched the Age-Friendly Public Health Systems Initiative (AFPHS) online resource portal.

Older adults are the fastest growing demographic of the U.S. population. Every day more than 10,000 people reach age 65. The new AFPHS.org site is designed to be a hub resource of the many programs, recommendations, guidelines, and tool kits the AFPHS initiative and network partners have developed to help state and local public health departments make healthy aging a core component of their operations.

Healthy aging related content on the site includes information on ageism, the age-friendly ecosystem, caregiving, COVID-19, physical and mental health, the social determinants of health, health equity and partnership and collaborations, as well as future events and past recordings of AFPHS training sessions.

The site also houses the Age-Friendly Public Health Systems Recognition Program, in which state and local health departments are invited to enroll. Health departments that enroll will receive guidance and technical assistance from TFAH to complete action in 10 areas considered foundational to becoming age friendly.

Practitioners in public health, aging and disability services, and healthcare organizations will find useful resources on the site as well as a community of like-minded professionals and a place to exchange resources, ideas, and questions. State and Local health departments are invited to learn more about the AFPHS network that currently includes Florida, Michigan, Mississippi, and Washington State. Interested individuals can sign-up for the AFPHS newsletter on the site.

A Conversation with Dr. Rochelle Walensky

Aired on: March 30, 2021

CDC Director Dr. Rochelle Walensky and TFAH President and CEO John Auerbach sat down for an extensive interview about COVID-19 messaging. During the interview, Walensky reflected on her first months as Director and discussed the critical need for the agency to lead based on the best available science and to partner with state and local public health agencies. She also shared how she prepares for media interviews and uses data to educate the public and respond to critics.