Public Health Investment Fund

Transcription

1 . Public Health Investment Fund General Talking Points We need a strong public health system to help fight ever increasing chronic disease levels and to protect us from health threats, natural disasters, and potential acts of terrorism that are beyond our control. Yet, our public health system has been, and continues to be, severely underfunded, and that compromises the ability of public health professionals to protect all of us. Of the dollars spent nationally on health care in the U.S. every year (more than any other nation in the world), only approximately four percent is estimated to be spent on prevention and public health. Chronic diseases alone cost the U.S. an additional $1 trillion each year in lost productivity. We need to rethink our public health spending priorities and emphasize prevention. Most public health funding is unpredictable and generally provided for through discretionary appropriations. For example, after adjusting for inflation, CDC funding for emergency preparedness decreased $342 million from FY 2005 to FY 2008, and chronic disease prevention, health promotion and genomics funding at CDC decreased by $176 million during the same time frame. This puts us all at risk. Federal public health funding for chronic disease prevention is not even adequate to support funding in all states. Only 25 states have anti-obesity funding funds that are used for states to form a comprehensive state obesity plan, and only 23 states have funding for a Coordinated School Health Program. CDC cannot fund heart disease prevention programs in all 50 states, and less than half of states are funded for oral health programs, as well as many injury prevention programs. The demand for community prevention dollars also far exceeds the supply as CDC has approved hundreds of health departments, cities and tribes for the Healthy Communities program but is not able to fund them. We need a stable and reliable funding stream for public health to ensure that all states have the core capacity to carry out critical public health functions and so that communities can engage in prevention programs proven to improve health outcomes for chronic diseases and other conditions. This investment would also be cost-effective. A study by Trust for America s Health, entitled Prevention for a Healthier America, found that investing $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent

2 smoking and other tobacco use, could save the country more than $16 billion annually within five years. Out of the $16 billion in savings, Medicare could save more than $5 billion, Medicaid could save more than $1.9 billion, and private payers could save more than $9 billion. Discretionary appropriations simply cannot provide the necessary funding for public health. Prevention dollars cannot compete with treatment dollars. The Investment Fund would be a reliable, dedicated funding stream for public health and prevention that is needed to meet the many emerging health threats we must face, and the persistent chronic disease rates that we must begin to control. We already know that prevention programs are effective in changing health behaviors. This fund would allow us to build upon what we know already works and to test new approaches. It would ensure accountability by evaluating all dollars that are expended and would enable us to prioritize prevention and health, instead of just treatment. The fund does not earmark every dollar because the prevention needs of the nation may change over the course of the investment, but it invests in key priority areas: Workforce Talking Points Focusing on Public Health There is a great need for the workforce programs authorized in this bill that would be financed through the Investment Fund. From primary care physicians to public health professionals, we are experiencing widespread shortages throughout the health field. Providing scholarship and loan assistance to those entering health fields with shortages will help us recruit the next generation of health professionals. In the field of public health, our efforts to recruit and retain governmental public health workers have been insufficient. There isn t an adequate supply of individuals willing to work in governmental public health agencies. Yet, we rely on their services. Public health departments provide immunizations, protect our food and water supply, prepare for and respond to natural disasters, acts of bioterrorism and other public health emergencies, conduct surveillance, detect and monitor emerging infectious diseases, inspect restaurants, and help prevent disease. The U.S. has an estimated 50,000 fewer public health workers than it did 20 years ago. 1 1 Association of Schools of Public Health

3 According to a survey conducted by the Association of State & Territorial Health Officials (ASTHO), the vacancy rates at state health departments range from 2 percent to 17 percent, with 41 percent of states having a vacancy rate of 10 percent or higher. 2 Shortages will likely be exacerbated through retirements and the current economic downturn. Twenty percent of the average state health agency s workforce will be eligible to retire within three years, and by 2012, over 50 percent of some state health agency workforces will be eligible to retire. 3 Approximately 20 percent of local health department employees will be eligible for retirement by We don t have a pipeline of young workers to take over for the retirees - the average age of new hires in state health agencies is Since public health professionals are providing a public service that we all benefit from, we need make public health careers more attractive. The creation of a Public Health Workforce Corps, modeled after the National Health Service Corps, will help accomplish this goal and is a very valuable use of dollars from the Public Health Investment Fund. Prevention & Wellness Research & Task Forces The USPSTF and the USCSTF are independent entities that review the scientific evidence and cost-effectiveness data related to clinical preventive services and preventive community interventions, and they develop recommendations resulting from their findings. Clinical and community prevention can be effective and in many cases result in cost savings. Yet not all preventive services and community programs are equally effective. These Task Forces help ensure the effective use of science-based preventive services. The Community Preventive Services Task Force has a large backlog of interventions to review because it has been underfunded and understaffed. The Task Force has a backlog of almost 600 interventions to review, but a budget that only permits 10 reviews per year. This is pennywise and pound foolish: we are leaving health departments and communities without the information they need to determine what are the most cost-effective interventions. The authorization and financing (through the Investment Fund) of these task forces gives them the resources they need to do their job that is, to provide the health community and policy makers with the information they need to make the best decisions about preventive health. 2 ASTHO. PHPSESSID=298bfa1c48356c80047bbbc20f State Public Health Workforce Survey Results, Association of State and Territorial Health Officers, Profile of Local Health Departments, National Association of County and City Health Officials (NACCHO) State Public Health Workforce Survey Results, Association of State and Territorial Health Officers, 2008.

4 This will assure that as we expand our investment in prevention, that we fund programs and interventions that are evidence based and cost effective. Delivery of Community-Based Prevention and Wellness Services The Investment Fund would also help finance the delivery of community-based prevention and wellness services grants. Health does not occur in a vacuum. If we want to change behaviors, we need to implement the policy changes, outreach, and interventions necessary to enable and encourage healthy choices. These programs and interventions must be tailored to the specific community in which they are occurring to maximize their effectiveness. Research has shown that effective community level prevention activities focusing on nutrition, physical activity and smoking cessation can reduce chronic disease rates and have a significant return on investment A report from Trust for America s Health entitled Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities concluded that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save the country more than $16 billion annually within five years. This is a return of $5.60 for every $1.00. Community prevention efforts can result in an even higher return on investment if targeted to communities where there is high prevalence of chronic conditions. Thus focusing funding in Health Empowerment Zones where there is high prevalence of multiple chronic diseases is likely to make the investment even more effective. There is currently an unmet demand for community prevention funding that this program would help satisfy. For example, when CDC puts out a solicitation for community funding, for every community the agency funds, at least 10 communities cannot be funded. The community-based prevention and wellness services grants are appropriately flexible, instead of dictating in the legislation what each community must implement, because the prevention needs of each population are different. Applying the same program in Manhattan and rural Idaho would be ineffective and inefficient. They recognize that communities may be at different stages of readiness and allow some grantees to be funded to make a community-based prevention and wellness services plan, while funding others for implementation. They are structured in a way to emphasize effectiveness Starting in FY 2013, the Secretary can only award grants for implementing services recommended by the Task Force on Community Preventive Services or a review body of comparable rigor.

5 They are a smart federal investment. When states and communities receive funding from CDC, often they are able to leverage additional funds. For example, what started as a $40,000 investment from CDC in Grand Rapids Michigan (through Pioneering Healthier Communities) has become a $2.2 million investment in community prevention as the community has leveraged funding from other sources. We already know that community prevention programs are effective in helping to move people across a continuum of health starting with policy changes that then result in changes in health behaviors, and ultimately achieving better health outcomes and cost reductions. This program would enable a sustained investment in the comprehensive changes that are needed to move across this continuum. There are many examples of the types of successful programs that could be initiated through this program and are worth of being financed through the Investment Fund. Core Public Health Infrastructure Another important use of funds is core public health infrastructure. The nature and scope of responsibilities that public health officials are responsible for continues to grow. Traditional responsibilities of a health department include assessing, monitoring, diagnosing and evaluating community health problems; developing, enforcing and researching policies to improve community health; educating the public about health issues; and mobilizing community partnerships to identify and solve health problems. These responsibilities have expanded to entail emergency preparedness and response, an increasing role in food safety, and now even helping to prevent, prepare for and adapt to the health effects of climate change. Despite these growing responsibilities, the federal government provides just $100 million each year to support core public health services through the Preventive Health and Health Services Block Grant. Core public health infrastructure funds would help state, local and tribal health departments meet their responsibilities and would ensure accountability by requiring that states address needs, including those identified in an accreditation process. Without a strong public health infrastructure, the impact of health reform will be weakened. We need effective public health agencies to assure that we are monitoring disease trends and providing the preventive interventions inside and outside the clinical setting that will improve the health of all Americans and make them less dependent on the health care system.

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