The CPH Foundation

May 7, 2012

Last week, the House Commerce Committee issued a press release in advance of a hearing planned for Wednesday entitled, EXAM ROOM: Obamacare Funnels Taxpayer Dollars to Grant Program that Funds Pet Neutering, Bike Clubs, and Lobbying Efforts to Increase Taxes

The release charges HHS and the CDC with mishandling taxpayer funds. Over the weekend, The CPH Foundation received a rebuttal that corrects some of the errors in the House release. It is an interesting read: 

BEGIN CDC BULLET POINTS HERE

CDC Analysis of Press Release Statements:

On May 2, the Energy and Commerce Committee issued a press release including references to activities of specific CDC grantees.  Below is CDC’s analysis of each statement and further information relevant to the work being done within these CPPW communities.

PITT COUNTY HEALTH DEPARTMENT, NORTH CAROLINA

Energy and Commerce Press Release Statement: “Pitt County, North Carolina, a recipient of a CPPW grant funded by health care law, used these federal taxpayer funds to place ‘signage to promote recreational destinations including public parks, bike lanes, and more.’”

CDC Analysis:

* Improving physical activity by placing signage about parks, bike lanes and safe routes to school is an effective, evidence-based activity that can increase physical activity

* CPPW staff in Pitt County, North Carolina has been working to implement a wide range of interventions to address obesity prevention within their community.

* One of the ten approved objectives included in Pitt County’s workplan is to evaluate county planning and include comprehensive land use plans, transportation plans, and other plans that set community standards for biking, walking, and zoning restrictions.

* Elements included incorporating elements to improve infrastructure for biking and walking, improve interconnectivity of existing and proposed mobility networks, and make it easier to establish access to healthy food. Among the steps was the implementation of bike racks, signage, and crosswalks once changes to planning documents were implemented. 

* According to Pitt County, approximately $66,000 of their $1.6 million in CPPW funding supported activities to implement bike racks and signage for cross walks, safe routes to schools, and other directional signs.

* This project is the only one of those in the Energy and Commerce release that is funded by PPHF. 

NASHVILLE/DAVIDSON COUNTY METRO PUBLIC HEALTH DEPARTMENT, TENNESSEE

Energy and Commerce Press Release Statement: The City of Nashville, which received a $7.5 million “Communities Putting Prevention to Work” grant, provided free pet spaying and neutering.

CDC Analysis:

* No CPPW funds were used to pay for spaying or neutering dogs.  Rather, a grant from PetSmart paid for the veterinary neutering services.

* A published report in The Hill on May 3, 2012 includes a direct account from the grantee that non-Federal funds were used. ( http://thehill.com/blogs/healthwatch/health-reform-implementation/225367—official-no-taxpayer-funds-went-to-neuter-tenn-dogs).

* The Nashville/Davidson County CPPW project has been working on a range of strategies to promote safe and accessible opportunities for physical activity.

* As part of the effort to increase outdoor physical activity in low income areas, CPPW has worked with other groups on a variety of activities to make parks safe.  These include enforcement of an existing leash law and other pet ordinances, increased community awareness of responsible dog ownership, and publicizing referrals to spay/neuter services supported by other funding sources.

* The Nashville/Davidson County CPPW project has been involved in promoting safe parks because the large number of loose/stray dogs was identified by the community as a safety risk and environmental barrier to increasing outdoor physical activity in low income areas.

* The Nashville/Davidson County CPPW project has been working on a range of strategies to promote safe and accessible opportunities for physical activity and improve nutrition - two modifiable risk factors to prevent obesity.

* The Community Guide for Preventive Services includes evidence-based recommendations that creation of or enhanced access to places for physical activity combined with informational outreach activities is effective in increasing levels of physical activity, as measured by an increase in the percentage of people engaging in physical activity or other measures of physical activity.

* Early data indicate that the public education campaign has been successful.

* This project was funded in 2009 by the Recovery Act, not by the PPHF.

BOSTON PUBLIC HEALTH COMMISSION, MASSACHUSETTS

Energy and Commerce Press Release Statement: “The City of Boston received $1 million for ‘urban gardening.’”

CDC Analysis: 

* This project tackles two evidence-based strategies for addressing obesity:  increasing physical activity, and improving the availability of fresh fruits and vegetables to underserved areas.

* The CPPW project in Boston has supported a range of evidence based strategies to increase opportunities for physical activity and supported four evidence-based projects to improve nutrition among low-income residents in Boston – two modifiable risk factors to prevent obesity.  Boston has focused on improving access to fresh fruits and vegetables in neighborhoods that have limited access.   

* Up to 360,000 Bostonians now have increased access to fresh, fruits and vegetables as a result of this CPPW investment.

* CPPW funds are being used to improve access to affordable produce in Roxbury, Mattapan, and Dorchester, which have higher rates of obesity – at 40 percent, 33 percent, and 31 percent, respectively – and chronic disease than the city as a whole.

* The project includes hiring and training up to 250 youths to work with The Food Project to build 400 backyard gardens in the three neighborhoods; transforming a vacant 10,000-square foot greenhouse in the heart of Roxbury into a community growing and education center; doubling the number of community garden plots in Dorchester, and expanding the Nightingale Garden in Dorchester by 65,000 square-feet, so that it stretches across 1.5 acres. 

* To ensure the sustainability of these urban gardening gains, Boston has enacted city-wide changes regarding use of open city land to encourage temporary or permanent land utilization for community gardens and other agricultural use.

* An evaluation of a large urban gardening project found that gardeners reported a higher consumption of specific vegetables and a lower consumption sweet foods and drinks than non-gardeners.  Focus groups conducted with inner-city youth revealed that those involved in garden programs reported more willingness to eat healthy food and try unfamiliar food, than those not involved in a program.

* This project was funded in 2009 by the Recovery Act, not by the PPHF.

NEW YORK STATE DEPARTMENT OF HEALTH

Energy and Commerce Press Release Statement: “The New York Department of Health used a $3 million taxpayer-funded grant to lobby for a soda tax initiative.”

CDC Analysis:

* The press release mischaracterizes the program, which is not one that used CDC funding.

* CDC has been in contact with the grantee and the grantee reports that no CPPW funds were used by the New York State Department of Health (NYSDOH) to lobby the New York State Legislature for a soda tax.

* The actual use of CPPW funding by NYSDOH is to implement strategies to increase access to healthy food choices.

* CDC worked with NYSDOH at the beginning of the project period to ensure that activities were both appropriate and in compliance with applicable anti-lobbying provisions.  CDC has monitored the use of funds throughout project implementation.

* As background, prior to CPPW funds being awarded, the Governor’s office initiated and put forth a soda tax proposal. However, the Governor did not pursue implementing a tax and withdrew his proposal, and the grantee has stated no CPPW dollars were used to pursue this.

* This project was funded in 2009 by the Recovery Act, not by the PPHF.

COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC HEALTH, CALIFORNIA

Energy and Commerce Press Release Statement: “…moratorium on fast food construction in Baldwin Park, California…”

CDC Analysis:

* No Los Angeles County CPPW funds were used to lobby for a moratorium on fast food restaurants. The presentation referenced in the press release referred to a city-led and funded initiative supported by the California Center for Public Health Advocacy, an independent organization, and was not supported by CPPW funding.

* Los Angeles County work on a moratorium predated the inception of the CPPW program.  These efforts were documented to have started in 2008 by this independent organization.

* This independent organization has provided education and community-driven feedback to the City Planning Department in Baldwin Park, California. Los Angeles County reports that no CPPW funds were used to support lobbying activities.

* CDC staff regularly interact with grantees to ensure that they are implementing the activities and strategies set forth in the grantee’s work plan and that grantees are adhering to administrative requirements, including adhering to provisions relating to lobbying.

* This project was funded by the Recovery Act, not the PPHF.

SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL

Energy and Commerce Press Release Statement: “…increased cigarette taxes in South Carolina.”

CDC Analysis:

* The South Carolina Department of Health and Environmental Control reports that no CPPW funds supported lobbying for the South Carolina Cigarette Tax. 

* CPPW funds were used for public education efforts on the science of health effects of second hand smoke exposure. Activities included developing fact sheets for the public that provided scientific data.

* CDC staff regularly interact with grantees to ensure that they are implementing the activities and strategies set forth in the grantee’s work plan and that grantees are adhering to administrative requirements, including adhering to provisions relating to lobbying.

* This project was funded in 2009 by the Recovery Act, not by the PPHF.

PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH, PENNSYLVANIA

Energy and Commerce Press Release Statement: “The Philadelphia Department of Public Health used their taxpayer-funded grant to push for higher state cigarette excise tax rates.”

CDC Analysis:

* No CPPW funds are being used by PDPH for lobbying or for any other activities in support of a state cigarette excise tax.

* Philadelphia Department of Public Health (PDPH) has been researching potential opportunities for a higher cigarette excise tax at the local level, but this does not fall within the scope of CPPW activity and is not being paid for by CPPW funds.

* This project was funded in 2009 by the Recovery Act, not by the PPHF.

SEATTLE AND KING COUNTY PUBLIC HEALTH, WASHINGTON

Energy and Commerce Press Release Statement: “The Cascade Bicycle Club Education Foundation received a portion of the $3 million grant awarded to Seattle and King County Public Health and used the taxpayer dollars to ‘improve the walking and biking environment.’”

CDC Analysis:

* CPPW project in Seattle/King County has been working to implement a wide range of evidence-based strategies to address obesity prevention.

* One of the seventeen approved objectives included within Seattle and King County’s CPPW obesity workplan is to increase opportunities for physical activity through changes made to local transportation plans and other planning tools.

* Evidence-based infrastructure changes to support bicycling and walking are interventions that aim to increase physical activity as means to combat obesity, and are working in Seattle/King County where 327,000 residents already benefit from sustainable changes made in their neighborhoods.

* Sustainable changes have come from technical assistance from the project that led to improvements in approaches to new and reconstructed roadways in the area meet safety and mobility needs of all travelers, including pedestrians and bicyclists and also community members who have visual or mobility impairments.  

* This project was funded in 2009 by the Recovery Act, not by the PPHF.

Background:  CDC’s Communities Putting Prevention to Work initiative:

* Communities Putting Prevention to Work (CPPW) is primarily a Recovery Act funded program that provides states and localities with resources to support locally designed efforts to create healthy environments for their residents.

* The preponderance of work under the CPPW program has been completed; most were one-time awards made in FY 2009.

* Only one community listed in the press release, Pitt County North Carolina, is funded by the Prevention and Public Health Fund (PPHF).

* Each CPPW community selected strategies from evidence-based interventions based on local context, priorities, and capacity.  CDC provided support to these communities through a competitive process.  Awardees then developed a locally relevant workplan, which allowed CDC to monitor progress on an ongoing basis.

* CPPW programs are funded under a 2-year cooperative agreement to implement evidence- and practice-based strategies, with overarching goals, such as increasing availability of healthy foods and beverages, improving access to safe places for physical activity, discouraging tobacco use, and encouraging smoke-free environments.

* Each workplan represents a multi-pronged approach to address obesity and/or tobacco prevention.  All objectives and activities included within the workplan must comply with federal lobbying restrictions.

* CDC does not allow funding to be used for lobbying at the Federal, state, or local level.  Awards include specific language to this effect; grantees are educated on this requirement; and CDC monitors the use of grant funds by grantees and their sub-recipients to ensure compliance.

What problem was CPPW designed to address?

* CPPW provides a significant investment in the prevention of chronic diseases.

* Obesity and tobacco are two leading causes of preventable death and disability.

* CPPW aims to address poor nutrition, lack of physical activity and tobacco use to make an impact on preventing serious health problems such as heart disease, stroke, type 2 diabetes, and cancer.

* Annually obesity-related medical spending costs our nation $147 billion.

* Annually, tobacco use costs our nation $96 billion in direct medical expenses.

* 7 out of ten deaths among Americans each year are from chronic diseases.

Background:  CDC Steps to Prevent Lobbying with Federal Funding

* CDC is committed to ensuring the proper use of appropriated funds, and to ensuring awardees’ compliance with all applicable regulations and statutes related to lobbying activities.   CDC’s policy prohibits lobbying at the federal, state, and local levels.  These restrictions apply to CDC grants, including the CPPW and CTG programs.

* CDC awardees, including those in the CPPW and the CTG programs, are informed about the federal laws relating to use of federal funds, including applicable anti-lobbying provisions.  Included within funding opportunity announcements is specific language restricting lobbying, including “any activity designed to influence action in regard to a particular piece of pending legislation.”  This lobbying prohibition was also included within the terms and conditions to which each grantee agreed prior to receiving federal funds.  In addition, CDC staffs has conducted trainings for CPPW and CTG awardees on these prohibitions.

* Applicable lobbying restrictions do not prohibit awardees from interacting with policymakers.  Federal law allows many activities that are not considered lobbying and that community awardees may decide to pursue.  For example, awardees may use funds to disseminate information about public health problems and science-based solutions and to implement specific programs, such as evidence-based educational materials and media on the health effects of increasing physical activity or decreasing exposure to secondhand smoke. 

* We take our responsibility as stewards of taxpayer dollars very seriously.  CDC staff interact with awardees regularly to monitor implementation of the activities and strategies set forth in awardees’ work plans and compliance with administrative requirements, including provisions related to lobbying.  In addition, CDC staff monitors the use of federal funds by awardees using tools such as on-site review and risk mitigation plans.

* CDC continues to review all reported allegations regarding grantee activities.  Thus far, we have not found among these examples any instance in which the anti-lobbying prohibitions have been violated.  Many allegations relate to activities that were performed by outside organizations not using federal funds, or activities that actually took place before CDC funding was even awarded to the grantee. Other activities are, in fact, permissible under the restrictions, such as educating the public on health risks.

April 16, 2012

Perhaps all policy makers can agree that disease control and prevention – exemplified in today’s release of a terrific report on childhood injury from the Centers for Disease Control and Prevention – represents one area where the federal government is providing a great service. CDC’s report and recommendations to the public provide information no state, nonprofit, corporation or individual could have gathered alone.

Americans have been haggling over the role of the states and the reach of federal government for hundreds of years. In the very first session of our First Congress, George Washington and Secretary of the Treasury Alexander Hamilton proposed setting up a national bank – locking horns with Thomas Jefferson and other small-federal-government advocates. Today, sound-bites from the divided 112^th Congress, the news reels from the presidential campaign trail and the Supreme Court’s review of President Obama’s signature health reform legislation all echo this central and ongoing debate.

As our bipartisan-supported military pools our common resources to “provide for the common defense” against foreign enemies, public health provides for the common defense by pooling national and global data. This information provides us with the tools we need to defend ourselves and our children against foreign diseases, preventable injuries and avoidable illnesses or deaths. Because of this data, policy makers can see which communities can learn from others and gauge how our nation fares in comparison to other countries. This research is our foundation for making improvements and saving more lives.

The CDC, and its state partners, gathered years of data on childhood injuries, compared that information to past studies and determined what areas are trending in the wrong direction. This level of national data is critical to saving the lives of more children. Today the CDC’s science-based results are available to millions of parents and caregivers and simple research-based tips can keep thousands more children alive and millions more out of the hospital.

According to the CDC’s report, our nation lost 9,143 children to injury in 2009. For every death, 1,000 children received medical attention and our cost (in 2005) was $11.5 billion in medical expenses [see data in MMWR here]. While the unintentional injury death rate dropped 29% from 2000 to 2009, we still face challenges from suffocation and poisoning – both of which are on the rise. Thanks to this report and the work of the CDC, we know what those challenges are and can begin to address them through behavior and policy changes.

Americans will continue to disagree on the role of government overall, but I do wonder if even small-government-advocate Thomas Jefferson would have approved of a nation that invested in protecting its children from needless injuries and death.

Guest Blog by Research!America’s Mandy Goldberg, MPH

Like all of us, I generally focus on what is going on in my community, on my block and in my home. Like you, perhaps, I don’t often stop to think about what health scare might be developing half a world away. World TB Day – March 24 – serves as just one sobering reminder that what happens around the world does matter.  The world is interconnected, and perhaps nowhere is this more apparent than in the field of public health.

Fortunately here in the U.S., we have a federal agency whose job it is to constantly remember that global health is America’s health. In addition to its domestic presence, the Centers for Disease Control and Prevention (CDC) works in over 60 countries to prevent, detect, track and control diseases to protect Americans.

The CDC also plays an important role in global health research and development (R&D), partnering with both public- and private-sector partners to develop new health technologies to prevent, diagnose and treat some of the world’s deadliest diseases.  To address a common but serious threat, the CDC is the largest single contributor to flu preparedness efforts and emerging health threats, and CDC field research and global surveillance help guide partners in their development of effective flu vaccines. 

And what is the CDC doing about the TB cases recently in the news?  The CDC collaborates with the United States Agency for International Development (USAID) and other governmental and private partners to support research for improved technologies to diagnose TB and more effective treatment drugs for TB and drug resistant TB.  The CDC also plays a role in capacity-building, case detection and drug delivery in many countries whose high TB burden poses a particular threat to Americans.

Because of CDC’s mission to protect Americans’ health—my health—from global threats, I have the luxury of focusing my attention on my own corner of the world.  What’s more, the global efforts of the CDC are making a tangible difference in both the health and economic status right here at home.  The CDC’s investment in R&D, in addition to protecting lives at home and abroad, also promotes a stable global economy and supports jobs in the U.S., where more than 11,000 people are employed by the CDC.

And finally, a critical result of the CDC’s work overseas is the goodwill these U.S. scientists build among their host nation’s people and government. Our international disease control efforts show the U.S. in a positive light and are critical to our nation’s diplomatic efforts.

Increased funding for the CDC is needed in order to continue the remarkable progress that has been made in global health R&D and to further stimulate the U.S. economy.  And Americans agree: according to a 2011 Research!America poll, 83% of Americans believe it is important to increase CDC funding.  At such an important economic and political time, the U.S. cannot afford to lose its place as a leader in global health. 

For more information on how global health R&D is the smart thing for the U.S. and the right thing for the world, please visit www.researchamerica.org/global_health. 

March 14, 2012

Guest Blog by Larry Hausner

CEO of the American Diabetes Association

Diabetes is a growing epidemic that is taking a physical, emotional and financial toll on our country.  The costs of Diabetes are enormous, and without a strong effort to reverse them, these costs – in lives and in treasure – promise to rise as the epidemic grows.  

In 2007, the economic price of diagnosed diabetes in the United States was $174 billion, and people with diagnosed diabetes have total health care costs 2.3 times those of people without diabetes.  These costs skyrocket to $218 billion a year if you account for prediabetes, gestational diabetes and those with undiagnosed diabetes.

A vision of life free of diabetes and all its burdens is the vision that guides all of our work at the American Diabetes Association. There is a great deal we can all do to make this happen.

At our national office, not far from the US Capitol, we are working along side The CPH Foundation and many others to ensure that national leaders understand the burden diabetes is placing on our medical system, our families and on our economy. And as we work to assure our government is doing all it can to help us save more lives through prevention, there is a great deal you can do at home, too. 

Because we can’t continue to let these startling statistics spiral out of control, the American Diabetes Association has launched the movement to Stop Diabetes®. Research shows three simple changes can reduce the risk for type 2 diabetes by 58%: 

• being mindful about healthy food choices 
• reducing weight by 7% if you are overweight 
• being physically active, such as brisk walking, for 30 minutes a day 5 or more times per week.  

In addition to adopting these simple lifestyle changes, I invite you to take the American Diabetes Association Risk Test.  This free test asks users simple questions about weight, age, family history and other potential risks for type 2 diabetes.  Preventative tips are provided for everyone who takes the test, including encouraging those at high risk to talk with their health care provider. You can get your Diabetes Risk Test by visiting us on Facebook, or by calling 1-800-DIABETES (1-800-342-2383).  

Together, we have to do more to Stop Diabetes. Fortunately, making small lifestyle changes and taking a quick test are effective–and free–first steps.

Find out more at http://www.diabetes.org.

March 5, 2011

Here is another example of a preventable outbreak among those who have chosen not to get vaccinated or did not complete the full course.

The quote is fitting:

Most of the cases under investigation could have been prevented by MMR vaccine”

- Judy Hart Public Health Wales

Perhaps “most” is too weak? Read the full story here on BBC.com

February 22, 2012

Washington, DC

Last week, Dr. Tom Frieden, director of the CDC, held a meeting with public health groups to review the CDC portion of the Administration’s FY2013 budget request to Congress. He began, rightfully so, by saying, “We are not suffering from a scarcity of complexity.”

Over the past week, The CPH Foundation has deconstructed the Administration’s FY13 proposal for the CDC’s budget. As we have done before, we compared the President’s budget request to past CDC budgets, focusing mainly on the CDC’s core discretionary budget as enacted by Congress. To ensure we were comparing apples to apples, we used the consumer price index (CPI) to deflate each year’s appropriation into constant 2001 dollars.

CLICK HERE TO SEE THE GRAPH ON OUR WEBSITE

Our findings in the graph above are yet another troubling sign for the future of disease control and prevention efforts. You might notice:

• The CDC’s overall core budget has remained stagnant, funded at nearly the same level in FY2012 as it was in 2003.
• To make matters worse, President Obama’s FY13 proposal would cut the nation’s prevention-focused agency, in real dollar terms, below 2003 funding levels next year.
• Also, despite large investments in bioterrorism preparedness since the terrorist attacks of September 11th, 2001, inflation has cut those gains to the CDC’s core budget in half today. Those gains would be erased entirely if the Administration’s plan is enacted.

Policy – Wise or Pound Foolish?

Deficit reduction is not a math equation alone but involves choices and policy considerations. Those with a singular focus on deficit reduction might consider this stagnant agency budget chart a good sign at first, but consider:

1. Federal health spending (i.e., our tax dollars going to doctors, hospitals and others who treat the sick) is rising at an unsustainable rate - outstripping inflation, wages and economic growth - and promises to do so for some time to come.
2. More than 70 percent of that spending is used to treat preventable diseases.

From a policy perspective, it does not make sense to put in a stagnant effort to control and prevent disease while treatment costs continue to rise out of control.

Mr. Obama’s Offsets

Some clarification on the Administration’s efforts to back-fill their proposed cuts to the CDC’s core budget is warranted, as this last bit of complexity threatens to make these proposed cuts larger still.

1.     The Prevention and Public Health Fund

First, the Obama budget seems to be the nail in the coffin for the Prevention and Public Health Fund’s true intent. The Prevention Fund was intended to get a step ahead of the grim reality that we spend so many tax dollars treating preventable illness. Going above and beyond our meager prevention efforts to actually keep more people healthy in the first place was the goal, and maybe we’d even save some money. But today – and in Mr. Obama’s proposed budget even more so – the Prevention Fund is doing no more than filling holes left behind from cuts to the CDC’s core budget.

And still on the horizon is the willingness of some in Congress (and some within the Administration, too) to negotiate downward or even eradicate the Prevention Fund. The purple box on the graph above is hardly a sure thing. In fact, $5 billion of the fund was just used this past Friday (just one week after the Administration’s budget made it to Capitol Hill) to make sure doctors who treat Medicare patients didn’t see a planned reduction in pay; more than 70 percent of whose patients are suffering from preventable … oh, but anyway.

2.     Transfers

Public Health Evaluation Transfers are perhaps one of the most mystical parts of the CDC’s budget, and in Mr. Obama’s request they nearly double, from $371 million to $667 million. Without getting into the long story of what they are, consider that Congress may oppose pulling nearly $300 million more from other HHS agencies in FY13. This risk puts the second large chunk of the President’s backfill funding sources in danger, too.

A FINAL NOTE

This year the Administration is using the total CDC budget in their charts – proudly showing a $39.4 million increase to the CDC’s overall funding. But looking at the entire CDC budget is misleading, as the CDC’s Vaccines for Children Program is a mandatory funding stream and grows each year by law, based on a series of formulas and the vaccination schedule for children. VFC dollars flow into the CDC from the federal government and are sent right back out again to state Medicaid plans. To imply that VFC increases provide more to the agency is somewhat disingenuous, to put it nicely.

Our History Tracking CDC’s Budget

The CDC’s budget is one of the most challenging federal agency budgets to follow. Our sister organization first began tracking the agency’s budget trends in 2005 because three of the nation’s largest newspapers were reporting three different numbers for the CDC’s FY05 budget – numbers that varied by billions of dollars. Today our Foundation still embraces the challenge of making the CDC’s budget more accessible to the public, the media and policy makers.

Washington Awaits the President’s Budget Request

February 10, 2012
Karl B. Moeller, MPA
Executive Director

It’s priority-setting season in Washington.

Soon after this coming Monday’s release of the President’s FY 2013 budget request to Congress, groups will fine-tune their annual “ask” and gear-up their members for meetings with congressional leaders.

PUBLIC HEALTH SETS PRIORITIES

In late January, The CPH Foundation joined APHA and a few dozen other nonprofit groups interested in disease control and prevention at a meeting in downtown DC. The goal? To agree on an FY 2013 funding request for the CDC that the groups could then take back to their membership (and up to the Hill). While we made a lot of headway, the consensus was to wait, and reconvene after the President released his budget request.

WHAT IS A REASONABLE ASK?

At a Trust for America’s Health briefing on the Hill last Friday, public health experts from Harris County, Texas, North Carolina and New York’s Columbia University presented local stories echoing the National Association of State and Territorial Health Officials numbers cited in TFAH’s Ready or Not? publication:

• Forty states (and Washington DC) have cut their public health budgets, 29 of them for the second year in a row, and 15 of them for the third straight year. Since 2008, 49,310 state and local public health jobs – or 20% of the workforce - have been lost to layoffs and attrition.

At TFAH’s briefing, the presenters’ stories echoed what is happening all over the country – and gave it some local color.

• In Harris County, just since 2009, about 33 percent of local health positions have been lost. While this region of Texas stood up an overnight response for 25,000-plus victims of Hurricane Katrina in 2005, responded to Hurricane Ike in 2008, vaccinated thousands during the 2009 H1N1 outbreak, and so on – audience members were left wondering how they could possibly respond to a similar challenge with today’s resources and the lack of experienced staff.

• The state health department in North Carolina has lost 60 positions and several dozen local experts. They have, for example, eliminated their public health pest management program and no longer have an entomologist on staff.  For a state prone to ocean storms, floods and mosquito borne illnesses, these cuts did not come easily and are having a negative impact on human health – especially in poorer counties.

Polls show that American’s regularly – and in a bipartisan fashion – agree that the PREVENTION of disease should receive more focus, attention and funding. Still, prevention rarely gains a foothold when forced to compete for dollars with health care providers and other ‘sexier’ priorities.

While disease control and prevention funding is getting cut, the number of people heading into hospitals and clinics seeking treatments preventable conditions has not.

Our blog post earlier today lays out one (admittedly wonkish) idea on how we could turn this around in 2 years, but my crystal ball says the CDC is headed for level funding… at best.

Sure, we can’t keep spending more than we take into the national treasury. It seems equally crazy, however, to spend 70% of our health care dollar (a full $2 trillion annually) to treat PREVENTABLE conditions. Presidential candidate Newt Gingrich – who singed our sister organization’s letter in the Fall of ’09 asking Congress to ensure that Health Reform included a strong prevention provision – has also said Congress needs to be “smart rather than cheap” when making budget-balancing cuts. While his February 2011 Op Ed was discussing the National Institutes of Health, cutting CDC and our local prevention efforts just does not seem smart, either.

STAY TUNED

This is certainly expected to be a roller coaster legislative year, with most of the big questions getting answered after the November elections.

The first of many unknowns, clearly, is the real direction the President’s Budget Request to Congress will take. Will Mr. Obama propose an increase, a decrease or level funding for the CDC? Will the Administration suggest cutting the CDC’s budget authority again this year, would they propose cutting back the Prevention Fund as they have hinted at in the past, or is the Administration heading in a new direction on prevention?

Also unknown is the end result of last year’s difficult budget agreement, which set an automatic switch (called “sequestration”) on the table for the end of this year. If Congress can’t find their way to an agreement on spending by December 31, sequestration will automatically cut $1.2 trillion in spending from all federal discretionary programs (see our blog post about this) beginning on January 1, 2013.

And of course, just what will be the future of the endangered Prevention and Public Health Fund? It seems that every bill in the House of Representatives these days threatens to take money from the prevention fund to pay other priorities… and Congress hasn’t even started debating spending bills yet.

Hang onto your seats. On Monday, the first set of questions will be answered.