April 4, 2013
This letter was sent to the House and Senate members of the Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies under the letterhead of our organization. We also delivered copies to all members of Congress.
The Honorable Tom Harkin, Chairman [Senate]
The Honorable Jerry Moran, Ranking Member [Senate]
The Honorable Jack Kingston, Chairman [House of Representatives]
The Honorable Rosa L. DeLauro, Ranking Member [House of Representatives]
Dear Chairman and Ranking Member:
As business leaders deeply involved with employee health and health care, and as former government officials who worked to set or implement national health policies, we are growing increasingly concerned by the federal government’s potential lack of investment into the prevention and control of disease. America’s corporate interests, the health of the public and our nation’s economy all benefit from a robust public health system.
Already this year, Congress has faced several opportunities to either fund or further diminish our nation’s public health infrastructure – and more debate lies ahead.
Automatic spending cuts enacted last year went into effect this winter, reducing federal prevention programs by 5 to 9 percent. On March 21, a continuing resolution passed Congress funding the last six months of FY13 that effectively level-funds prevention programs at this reduced level.
Our tight fiscal situation and the pending debt ceiling debate; the upcoming FY14 presidential budget request along with Congress’ related FY14 funding bills; and many other legislative proposals will all require that Congress again choose between strengthening, or further degrading, prevention initiatives.
The Centers for Disease Control and Prevention is recognized globally for disease outbreak prevention efforts, disaster preparedness and response work, research and immunization efforts, and on-the-ground operations that protect the public from injuries and illness. Most of its work is carried out with little or no fanfare.
Equally impressive are the CDC’s many targeted responses in our communities. Few realize that more than 70 percent of the CDC’s budget is redirected back to local prevention experts in our communities. This funding helps to bolster the local public health infrastructure needed to identify fungal meningitis in nationally distributed pharmaceuticals, discover foodborne disease outbreaks and respond to influenza pandemics – to highlight well-publicized incidents. In reality, the CDC does far more to protect and defend the population than the media could ever cover on a day-to-day basis.
Given all the CDC and its local partners do to keep our population from entering the ever-more costly health care system, the threat of additional CDC cuts is troubling.
There is little awareness, even in Congress, of the fact that pre-sequestration federal cutbacks have pushed the CDC’s 2012 core discretionary funding levels back to 2001 equivalents, and that state budget cuts have led to the elimination of tens of thousands of local prevention experts.
As businesses and governments both struggle to corral the unsustainable growth in health care expenses, we must address the fact that more than 70 percent of these costs are attributed to preventable health conditions. Unfortunately, neither the Congressional Budget Office nor the Administration’s Office of Management and Budget estimate the budgetary savings of prevention programs. Still, investments that control preventable health conditions will lower disability, disease and preventable death rates in the future.
This is not a time to further degrade the CDC’s budget and our state and local prevention efforts. As you grapple with the many legislative issues facing the 113th Congress, we encourage you to protect and strengthen our nation’s disease control and prevention infrastructure.
Roger P. Baxter, MD, Co-director, Vaccine Study Center, Kaiser Permanente
Sue Binder, MD, former Director, National Center for Injury Prevention and Control, at the Centers for Disease Control and Prevention
Ronald R Blanck, DO, Lieutenant General, US Army, Retired, former US Army Surgeon General
John J. Callahan, PhD, former Assistant Secretary of Management and Budget, U.S. Department of Health and Human Services
The Honorable Michael N. Castle, former two-term Governor, nine-term US Congressman, Lieutenant Governor, Deputy Attorney General and State Senator (Delaware)
David Fleming, MD, Director and Health Officer, Public Health - Seattle & King County, former Deputy Director of the Centers for Disease Control and Prevention
Steven K. Galson, MD, former Acting Surgeon General
Julie L. Gerberding, MD, MPH, former Director of the Centers for Disease Control and Prevention
George E. Hardy, Jr., MD, former Assistant Surgeon General, former Assistant Director of the Centers for Disease Control and Prevention, former Health Officer for the Jefferson County Department of Health in Birmingham (AL)
Jessica Herzstein, MD, MPH, Global Medical Director, Air Products
John H. Klippel, MD, former clinical director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, president and CEO of the Arthritis Foundation
Jeffrey P. Koplan, MD, MPH, former Director of the Centers for Disease Control and Prevention
Peter Lee, MD, MPH, Global Occupational Health and Wellness Leader, GE
The Honorable Mary Bono Mack, former member of Congress
Matthew Minson, MD, Medical Director, Superior Energy Services
Michael L. Moore, MD, FACP, Vice President, Chief Medical Director, Nationwide
Kenneth P. Moritsugu, MD, MPH, former Acting Surgeon General of the United States, and the former Deputy Surgeon General
Michael T. Osterholm, PhD, MPH, former Special Advisor to then–Department of Health and Human Services Secretary Tommy G. Thompson on issues related to bioterrorism and public health preparedness
Sudip S. Parikh, PhD, Battelle Memorial Institute and the former Science Advisor and Professional Staff to the United States Senate Appropriations Committee
Brent Pawlecki, MD, Chief Health Officer, Goodyear Tire and Rubber Company
The Honorable John Edward Porter, JD, former member of Congress and Chairman of the United States House of Representatives Labor, Health and Humans Services and Education Appropriations Subcommittee
Jim Rooney, Vice President of Medical Affairs, Gilead Sciences
William L. Roper, MD, MPH, former Director of the Centers for Disease Control and Prevention
Mark L. Rosenberg, MD, MPP, former Assistant Surgeon General and former Director of the National Center for Injury Prevention and Control
David Satcher, MD, PhD, former Surgeon General, Assistant Secretary of Department of Health and Human Services and Director of the Centers for Disease Control and Prevention
John R. Seffrin, PhD, member, Advisory Group on Prevention, Health Promotion, and Integrative and Public Health and chief executive officer of the American Cancer Society
The Honorable Louis Stokes, former member of Congress and member of the United States House of Representatives Labor, Health and Humans Services and Education Appropriations Subcommittee
W. Craig Vanderwagen, MD, former Assistant Secretary for Preparedness and Response, US Department of Health and Human Services
Elias A. Zerhouni, MD, former Director, National Institutes of Health
CC: National Governors Association
Members of Congress
Guest Post by John R. Seffrin, PhD, Chief Executive Officer of American Cancer Society
There is an oft-quoted poem by Joseph Malins that highlights the merits of building a fence on a cliff to protect passersby – rather than sending an ambulance to treat those who fall from the precipice. The poem has long been a favorite of mine, for the strong argument it makes for prevention in support of the public health. As the poem reads:
“It’s a marvel to me/ that people give far more attention/ to repairing results than to stopping the cause,/ when they’d much better aim at prevention.”
This is a truth we at the American Cancer Society know all too well. Chronic diseases like cancer kill more than 1.7 million Americans each year – that’s 7 of every 10 deaths in the U.S. Cancer alone kills more than 1,500 Americans every day – more than 577,000 each year. And yet we know half of these deaths could be avoided by taking steps in the public health arena to prevent the disease from occurring in the first place.
Tobacco use alone kills half a million Americans every year. Another 188,000 deaths from cancer are due to poor nutrition, physical inactivity, and obesity-related disease. Yet we know more today than ever before about how to save more lives from cancer: the nearly 14 million cancer survivors in the U.S. are living proof of our progress. But we are not doing all we can to act on what we know.
If we are to tap into the great potential we have in the cancer fight, prevention and access to care must remain national priorities. Not only because saving lives is a moral imperative, but also because chronic diseases such as cancer are a major drain on our nation’s economy. This year, cancer is projected to siphon nearly $21 billion from the U.S. economy due to lost productivity, to cause an additional $104 billion in direct medical costs, and to create another $123 billion in losses as a result of premature death.
Earlier this month, a network of grassroots cancer advocates gathered in our nation’s capital to push for laws and policies that help fight cancer. This group, brought together by the American Cancer Society Cancer Action Network (ACS CAN), represents a nationwide volunteer force unlike any other, with proven successes in influencing public policy at all levels. One of their priorities is supporting a prevention-focused system, including initiatives such as the Prevention and Public Health fund, a home run in addressing chronic disease and saving lives.
ACS CAN this summer released a report on this fund, titled “Staying Well: Real Stories from the Prevention and Public Health Fund.” The report highlights some of the evidence-based programs across the U.S. that are helping to: control the obesity epidemic, reduce tobacco use, increase mammograms, fight health disparities that disproportionately impact low-income Americans, and fill the gaps in our health care workforce.
At a time when Congress is facing difficult choices about the federal budget, we must ensure our nation’s lawmakers use the prevention fund to supplement – and not supplant – other key prevention programs, including many at the National Centers for Disease Control and Prevention. Programs such as the National Breast and Cervical Cancer Early Detection Program are helping low-income and uninsured Americans get access to critical cancer screenings, and further cuts would deny lifesaving cancer prevention methods to our society’s most vulnerable populations.
If we can create a wellness-focused system – one that builds fences, rather than just sends ambulances – then we can and will bring cancer under control as a major public health problem in this nation. And we will in the process save more lives and create a world, as we like to say at the American Cancer Society, with many more birthdays.