Health Reform Offers New Resources and New Opportunities for Public Health
Lost amid the yearlong debate over health reform and the heated talk of death panels and socialism were some major changes to the way in which the United States funds public health, prevention, and wellness programs as a result of the passage of health reform legislation.
The new law emphasizes access to care. However, it also contains significant public health, prevention, and wellness provisions, including a national prevention, health promotion, and public health council; a national prevention and health promotion strategy; a prevention and public health fund; community transformation grants; essential health benefits requirements; and coverage of preventive health services.
For state and local public health officials, whose budgets have been stripped of millions of dollars over the course of the economic recession, the creation of the prevention and public health fund—which provides $15 billion in mandatory appropriations for public health and prevention programs over the next 10 years—is a major breakthrough. The fund offers an opportunity to rebuild core capacity, which could include the public health workforce, and to fund innovative community-based programs.
Even better news: The money kicks in immediately. By the end of September 2010, U.S. Department of Health and Human Services officials have to decide which agencies and organizations will receive the first $500 million from the fund. An additional $750 million must be obligated by the end of September 2011 through the traditional appropriations process.
While a major boost to U.S. public health, the total investment of $15 billion alone is not enough to achieve the long-term transformation of the nation’s public health system. However, if these funds are awarded strategically, they can be used to leverage change throughout the public health system.
Under the current system, America’s health priorities are backwards. Health care practitioners most often see patients after they have become sick, instead of working to keep them healthy in the first place. Obviously, the shortage of nurses and primary care doctors doesn’t help. However, simply adding more health care workers won’t do the trick. Instead, a fundamental shift in how Americans think of health and wellness is needed.
According to the Centers for Disease Control and Prevention, the majority of chronic diseases could be prevented through lifestyle and environmental changes. Unfortunately, for too many Americans right now, the deck is stacked against making healthy choices.
It’s easy to tell people to eat healthy, but in many neighborhoods, nutritious, affordable foods are not regularly available. In fact, the only restaurants often available in lower-income areas are fast-food restaurants, where healthy options are limited. It’s also easy to tell people to get more physical activity and exercise, but many Americans live in communities without access to safe places to exercise and play.
As a result, millions of Americans are suffering from preventable diseases, and billions of dollars are spent on treating sick people. More than two-thirds of American adults are overweight or obese. One in three has one or more types of cardiovascular disease. Nearly 24 million Americans have type 2 diabetes and another 57 million are pre-diabetic. America’s children aren’t immune to these problems, either. A recent report found that more than a quarter of young adults are too overweight to join the military.
In using the billions of dollars in new investments from the prevention and public health fund, the public health community’s goal should be to optimize the health of everyone by creating healthier, safer, and more resilient communities through policy, systems, organizational, and environmental change. We must work to make healthy choices easy choices.
How can we accomplish this? There is a growing body of evidence touting the benefits and cost-effectiveness of community-based prevention programs. The prevention and public health fund provides an opportunity to expand this research base and conduct more prevention research and evaluation of community-based programs.
What are the next steps?
First, the national prevention and health promotion strategy mandated by health reform should provide a basis for defining the goals of a transforming public health system, identifying gaps in the current system, and detailing how the fund can be used to help close these gaps. Law mandates that this initial strategy is due to be drafted by March 23, 2011.
Second, while the national strategy is being developed over the next year, federal health officials should prioritize the Fiscal Year 2010 and 2011 appropriations. By focusing on three keys areas, health officials can begin the long overdue transformation of public health:
1. Community Prevention: The American Recovery and Reinvestment Act included $1 billion in stimulus funds for prevention efforts, including $650 million for evidence-based clinical and community-based prevention and wellness strategies. Communities Putting Prevention to Work is the centerpiece of this comprehensive public health initiative. CPPW’s goal is to change systems and environments (e.g., improving access to healthy foods and opportunities for physical activity) and put into place policies that will promote the health of populations. Health reform should build on this initial investment in community prevention. Money from the prevention and public health fund can be used for the new cross-cutting community transformation grants, which aim to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective community-based prevention programming.
2. Core Capacity: Money from the prevention and public health fund should be used to enhance state and local health departments’ capacity to design and manage community interventions that focus on policy and environmental changes. It will be easy for states and localities to use this money to fill the gaps left by the brutal economic recession. However, if the country is serious about transforming public health, the prevention and public health fund cannot be used to replace lost state and local revenues or support the status quo. Instead, policymakers must recommit to state and local funding of public health.
3. Research, Development, and Dissemination of Best Practices: Those who control the purse strings are always asking for more evidence-based practice. They want to fund programs that have a proven track record. Meanwhile, in public health circles, the demand is for more practice-based evidence. The prevention and public health fund offers public health professionals an opportunity to expand the science of prevention based on the real-world experiences of community prevention programs.
Health reform offers new resources and new opportunities for public health. It is now up to the public health community to seize the opportunity to transform the U.S. health system. U.S. public health has been at the forefront of many societal changes. Clearly public health has the potential to lead the way as Americans shift to focus on prevention and wellness. Revitalizing the system will require public health leaders around the country to come together to maintain the momentum to turn the vision of a modern public health system into a reality.
Next time, I’ll be blogging about innovative care delivery in public health. If you know of any promising practices around community-based prevention, comment here or drop me a line at firstname.lastname@example.org. Let’s keep the conversation going around prevention and wellness.
Special Contributor Serena Vinter is a Senior Research Associate at Trust for America’s Health. Her bi-monthly column for the Health Policy Forum focuses on the need to include prevention and wellness in our discussions about the health system in the United States. “Special Contributors” are regular contributors to the Health Policy Forum who pose their own opinions and policy positions in the realm of health care and health policy. As a leading nonprofit health care research and consulting institute dedicated to improving human health, Altarum encourages open discussion and debate about the many challenges in health care today. All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions, or policy positions.