Public Health Funding Policy Activities

After decades of under-investment, our public health system lacks the resources it needs to tackle the full range of health threats, from potential chemical or biological attacks, to serious chronic disease epidemics, or emerging infectious diseases like avian influenza. As the lead federal agency for protecting the public's health, the Centers for Disease Control and Prevention's (CDC) budget must reflect the vital role it plays in the lives of every individual, every day, and its increasing responsibilities for homeland security.

Position Statements and Letters

Group Letter in Support of Increased Funding for National Center for Environmental Health (April 2013)
Read the Letter

Group Letter in Support of Increased Funding for National Center for Environmental Health (March 2012)
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Group Letter in Support of Increased Funding for Health Tracking and Biomonitoring (August 2011)
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Working Group on Pandemic Influenza Preparedness Letter in Support of Preparedness Funding (March 2010)
Read the Letter

Group Letter in Support of Increased Funding for Health Tracking and Biomonitoring (March 2010)
Read the Letter

Testimony

Written Statement of Jeffrey Levi, PhD, Executive Director of Trust for America's Health to House Appropriations Subcommittee on Labor, Health & Human Services, Education and Related Agencies (March 2013)
TFAH Testimony

Testimony of Jeffrey Levi, PhD, Executive Director of Trust for America's Health Before House Appropriations Subcommittee on Labor, Health & Human Services, Education and Related Agencies (April 2010)
TFAH Testimony

Testimony of Jeffrey Levi, PhD, Executive Director of Trust for America's Health Before House Energy & Commerce Subcommittee on Health (March 2009)
TFAH Testimony in Support of Reliable Funding for Public Health

Testimony of David Fleming, MD, Director of Public Health for Seattle-King County, Washington & Member, Board of Directors, Trust for America's Health, before to United States House of Representatives, Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education and Related Agencies (March 2008)
TFAH Testimony on FY09 Budget

Critical Care List - Fiscal Year 2014 Budget

The final continuing resolution for fiscal year (FY) 2013 will mean further cuts to the Centers for Disease Control and Prevention (CDC) budget authority, already reduced $1.4 billion from FY2010 to FY2012. At the same time, to some extent the Administration and Congress have been relying on the Prevention and Public Health Fund (Fund) to backfill cuts to CDC and other public health agencies' budgets. These cuts come at a time when the nation is on course to reach devastating levels of obesity by 2030; an estimated 46,000 state and local public health jobs have been list since 2008, 29 states cut their public health budgets, and we are at risk of losing nearly a decade of progress in building our preparedness in response to public health emergencies.

Below are the top FY 2014 funding priorities which TFAH submitted to the House and Senate Appropriations Committees. Severe tightening of federal resources has meant that, in many cases, TFAH has declined to request programmatic increases, which will undoubtedly be required in future years to rebuild the erosion of these investments. Together, these programs will help prevent disease, save lives, and reduce long-term health costs.

The Prevention and Public Health Fund:

The Prevention and Public Health Fund is the only dedicated funding for prevention and public health. The Fund will provide an additional $13.5 billion over the next 10 years (FY2014 to FY2023) to enable communities in every state to invest in effective, proven prevention efforts. To date, the Fund has invested $3.25 billion (FY2010 - 2013) to support state and local public health efforts to transform and revitalize communities, build epidemiology and laboratory capacity track and respond to disease outbreaks, train the nation's public health and health workforce, prevent the spread of HIV/AIDS, expand access to vaccines, reduce tobacco use, and help control the obesity epidemic.

The Fund was intended to supplement, not supplant, existing investments with the first-ever, reliable national funding stream for public health, while creating jobs, bending the health-care cost curve, and prioritizing disease prevention. The Fund's mandatory status gives Congress the authority to direct the investment, while at the same time guaranteeing an ongoing commitment to prevention unprecedented in today's "sick care" system. Further cuts or diversion for other purposes would be an enormous step backwards in our progress on cost containment, public health modernization, and wellness promotion. TFAH urges Congress to protect the Fund and ensure it is implemented in a manner that will reduce health care costs and help create a long-term path to a healthier and economically sound America.

Preventing and Reducing Chronic Disease:

Chronic diseases are responsible for 75 percent of health care costs in the United States, and the causes are often environmental, social, or economic and not addressed by the clinical care system. The Community Transformation Grant (CTG) program, administered by the Centers for Disease Control and Prevention, implements and evaluates evidence-based community prevention health activities to reduce chronic disease and address health disparities. The program focuses on innovative, cross-cutting approaches to reducing the risks that affect health. The program aligns with the National Prevention Strategy by funding multi-sector coalitions to make healthy living easier and more affordable where people work, live, learn, play, and exercise.

We recommend the Committee allocate $300 million for the CTG program in FY2014, which will permit CDC to continue funding the current grantees and fund additional communities to broaden the scope and success of the program to reach millions more Americans. Additional funds will be used to help more communities implement targeted interventions to reduce the prevalence of the leading causes of death, associated risk factors and health disparities.

Congress should maintain investment in CDC's National Center for Chronic Disease Prevention and Health Promotion. Doing so will help to ensure that recent efforts to integrate funding streams and fund all 50 states to build, maintain, and improve core capacity to conduct chronic disease prevention and health promotion activities.

Racial and Ethnic Approaches to Community Health (REACH) programs work in communities across the country to eliminate racial and ethnic disparities in health and to reduce the burden of chronic disease among at-risk populations.REACH programs are culturally-tailored interventions that use evidence- and practice-based strategies to address the root causes of chronic diseases and reduce health disparities among racial and ethnic communities. TFAH recommends funding REACH at $63.9 million to ensure continued support and evaluation of the six national organization model and to fund additional grants to local communities directly affected by health disparities.

Fighting Environmental Causes of Disease:

Beyond visits to the doctor and the choices we make, much of our health is determined by the environment in which we live and work. We must continue to support research, translation, and implementation of knowledge and practices into creating safe, healthy environments that are free of environmental toxics, chemicals, and other hazards and enable citizens to make healthy choices that are not possible in many communities across America today. TFAH recommends:

Since 2002, the mission of the National Environmental Public Health Tracking Network has been to provide information that communities can use to improve their health; the information will come from a nationwide network that brings together health and environmental data. The program currently operates in 23 states and one city. TFAH recommends $35 million for the National Environmental Public Health Tracking Network to expand the program to link environmental and health data to identify problems and effective solutions that will reduce the burden of chronic disease. This level of funding would enable CDC to maintain its current work in this area, although the current level of funding is still not sufficient to fill the health and environmental data gap that is preventing our full understanding of how our health is affected by the environment.

CDC's Built Environment and Health Program would support Healthy Community Design activities, previously funded from the general environmental health line. TFAH recommends a specific budget item of $4 million for the Built Environment and Health initiative to support CDC's ability to maintain resources aimed at helping states and communities build healthier communities. CDC would support up to eight states or organizations to train workers statewide on health impact assessments (HIA), which serve to answer the basic question "How do the communities we build affect our health?" Grantees would also conduct prospective HIAs and work on transportation and other community design projects. CDC would continue its partnerships with national organizations to develop and make tools and training available to non-health sectors. CDC would also improve surveillance, emphasize collaborative partnerships with planning and transportation organizations, and will work to leverage these funds and more fully integrate built environment activities within existing health promotion activities.

For over 30 years, the Environmental Health Laboratory (EHL) of the National Center for Environmental (NCEH) has been performing biomonitoring measurements-direct measurements of people's exposure to toxic substances in the environment. By analyzing blood, urine, and tissues, scientists can measure actual levels of more than 450 chemicals and nutritional indicators in people's bodies. This information helps public health officials to determine which population groups are at high risk for exposure and adverse health effects, assess public health interventions, and monitor exposure trends over time. TFAH recommends a level funding of $42.383 million to enable the Division of Laboratory Sciences to continue its work.

Preparing for Public Health Emergencies and Pandemics:

Significant progress in preparedness has been made since September 11th and the anthrax tragedies, but the current fiscal situation has put a decade of gains at risk though recent cuts at federal, state and local levels. More than any other source, federal dollars are used to fund states and local areas to ensure they have the critical public health infrastructure and capacity to prepare and respond to acts of terrorism, natural disasters, and infectious disease outbreaks. The CDC and the HHS Assistant Secretary for Preparedness Response (ASPR) work to ensure that public health and health systems can respond adequately and effectively in the event of a disaster. TFAH recommends:

The State & Local Preparedness & Response Capability program at the Centers for Disease Control and Prevention is the only federal program that supports the work of health departments to prepare for and respond to all types of disasters, including bioterror attacks, natural disasters, and infectious disease outbreaks. The centerpiece of the program is the Public Health Emergency Preparedness (PHEP) Cooperative Agreements. PHEP grants support 15 core public health capabilities identified by CDC, including in the areas of biosurveillance, community resilience, countermeasures and mitigation, incident management, information management, and surge management. According to TFAH's most recent report on public health preparedness - Ready or Not? - Protecting the Public's Health from Diseases, Disasters and Bioterrorism - in the past decade these investments have led to significant improvements in planning and coordination, public health laboratory capacity, pharmaceutical and medical equipment distribution, surveillance, communications, and staff training and preparation. In 2012 the nation saw the benefits of PHEP investments in early detection and response to the fungal meningitis outbreaks and whooping cough epidemics. And because of advanced planning and training supported by PHEP, New York and New Jersey did not require additional CDC assistance in responding to Hurricane Sandy.

TFAH recommends providing $657.4 million for State and Local Preparedness and Response Capability, equivalent to the FY2012 allocation, and the amount authorized in the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA). Preparedness is dependent on maintaining a well-trained public health workforce, and inconsistent funding results in serious gaps in our ability to respond to new health threats.

In the event of a major disease outbreak or bioterror attack, the public health and health care systems would be severely overstretched. TheHospital Preparedness Program (HPP), administered by the Assistant Secretary for Preparedness and Response (ASPR), provides funding and technical assistance to prepare the health system to respond to and recover from a disaster. The program, which began in response to 9/11, has evolved from one focused on equipment and supplies held by individual hospitals to respond to a terrorist event to a system-wide, all-hazards approach. The new HPP is working toward building the capacity of healthcare coalitions - regional collaborations between healthcare organizations, providers, emergency managers, public sector agencies, and other private partners - to meet the disaster healthcare needs of communities. TFAH recommends $374 million for FY2014 for HPP, equivalent to the FY2012 allocation. Although TFAH is supportive of the move to fund community-based healthcare coalitions, even with a strategic overhaul of the program, it would be impossible to build or maintain health system preparedness with additional drastic cuts. This appropriation would allow enough funding of existing healthcare coalitions to maintain preparedness activities nationwide, rather than focusing on certain regions.

The 2011 H1N1 flu outbreak demonstrated how rapidly a new strain of flu can emerge and spread around the world. The 2012-2013 season has been one of the worst we have experienced in a decade. The virus has been a significant contributor to hospitalizations and deaths among seniors, and over 90 percent of flu-related deaths have been among seniors this season. Also in 2012-2013, CDC received reports of 309 cases of the variant H3N2v influenza, associated with agricultural fairs, and rare human cases of H7N9 in China. The emergence of these variations illustrate how quickly the virus can mutate and spread. As a result, funding for research, prevention, and response cannot simply be provided after a pandemic emerges. For FY2014 influenza activities, TFAH recommends $160 million for CDC's seasonal and pandemic influenza program, equivalent to the FY2012 allocation, to ensure preparedness for this deadly infectious disease. In FY2014, CDC will use the funding to continue to protect the public against seasonal flu, track the H3N2 and H7N9 variants, monitor changes in the deadly H5N1 virus, work to reduce ongoing racial and ethnic disparities in adult vaccine demand, and plan for deploying new advances in vaccine formulations and diagnostics.

Medical Countermeasures Development:

The Biomedical Advanced Research and Development Authority (BARDA), within the office of the Assistant Secretary for Preparedness and Response (ASPR) was established in 2006 to jumpstart a new cycle of innovation in vaccines, diagnostics and therapeutics in order to combat emerging health threats, products that would not be developed in the private market without these investments. BARDA provides incentives and guidance for research and development of products to counter bioterrorism and pandemic flu and manages Project BioShield, which includes the procurement and advanced development of medical countermeasures for chemical, biological, radiological, and nuclear (CBRN) agents. In 2012, BARDA investments led to the first FDA approval of a cell-based flu vaccine, significant new contracts for novel flu antivirals, diagnostics and treatments, seed stocks to prepare pandemic vaccine domestically, and expansion of the Broad Spectrum Antimicrobial Program. Since the beginning of the program, HHS has added 11 new products to the Strategic National Stockpile, and another 80 products are in various stages of development.

TFAH recommends $415 million for BARDA for FY2014 to continue investment in the development and acquisition of medical products key to America's biodefense strategy. BARDA will use this funding to continue existing chemical, biological, radiological, and nuclear (CBRN) MCM development projects, but with very little support to replace product candidates that fail or to add new product candidates for young programs (e.g. broad spectrum antimicrobials and chemical antidotes). Without secure and robust funding, BARDA's ability to achieve its mission of developing improved MCM against a variety of threats will be compromised. BARDA will have limited scope to pursue new products and may not be able to sustain the broad portfolio that its mission requires.

The Food and Drug Administration (FDA's) Medical Countermeasures Initiative (MCMi) seeks to enhance the agency's scientific, regulatory, and legal capacity to review, approve, and monitor critical technologies for disaster and outbreak response. Since the program began in 2010, the FDA has approved several MCMs including for treatment and prophylaxis of plague, inhalational anthrax, and several diagnostic tests for influenza; established MCMi Action Teams; launched a MCM regulatory science program, for activities such as developing and qualifying tools to assess efficacy (e.g., animal models); and built a MCM scientific infrastructure at FDA, including hiring 77 full time employees and investing in laboratory equipment and software; TFAH recommends $24 million for FDA's MCM program, which will allow FDA to sustain its full, current MCMi operating level of 77 full-time employees and support partnerships with industry, academia, and with government partners to shorten MCM development timelines and improve the success rate for MCMs. FDA will also expand technical assistance to developers, focusing on the highest priority MCMs.