The Prevention and Public Health Fund

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The Prevention and Public Health Fund

• United Methodist Church
• March 15, 2103
• Richard Hamburg
• Sue Pechilio Polis

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Overview

• About Trust for Americas Health
• The Prevention and Public Health Fund
  Background, overview, funding, and how its
  working.
• Key PPHF programs including the Community
  Transformation Grants (CTGs)
• How the faith community is engaged and future
  opportunities

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About TFAH Who We Are

• Trust for Americas Health (TFAH) is a
  non-profit, non-partisan organization dedicated
  to saving lives by protecting the health of every
  community and working to make disease prevention
  a national priority.

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Building the Case for the Investment in Community
Prevention

• Initially released in July 2008
• Sen. Tom Harkin (D-IA) called it the report he
  had been waiting for.
• Key finding an investment of 10 per person per
  year in proven community-based prevention
  programs could save the country more than 16B
  annually within 5 years.
• This is a return of 5.60 for every 1 invested.

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Prevention for a Healthier America Financial
Return on Investment?
With a Strategic Investment in Proven
Community-Based Prevention Programs to Increase
Physical Activity and Good Nutrition and Prevent
Smoking and Other Tobacco Use
INVESTMENT 10 per person per year
HEATH CARE COST NET SAVINGS 16 Billion annually within 5 years
RETURN ON INVESTMENT (ROI) 5.60 for every 1
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How do we make the healthy choice the easy choice?

• Individuals, communities, schools, faith
  institutions, employers must help to assure
• We have the information we need
• We can access healthy foods
• We can find safe places to play and exercise
• We promote smoke free environments
• We create a culture of health

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Impetus for the Faith-Based Community

• Religious leaders have historically played a
  critical role in addressing the nations social
  challenges, especially in protecting children,
  seniors and other vulnerable populations.
  Allowing people to lead fuller lives through the
  prevention of chronic disease is a natural
  extension of these efforts.

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ACA Public Health

• Pillars for public health in health reform
• Universal coverage, including first coverage of
  clinical preventive services
• National Prevention Strategy
• Reliable funding stream through creation of a
  Prevention Fund (mandatory appropriation) to
  support
• Core public health functions
• Community prevention
• Public health workforce
• Public health and prevention research

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Prevention and Public Health Fund (PPHF)

• Prevention and Public Health Fund now 12.5
  billion over next 10 years (reaching full 2
  billion level in FY2022)
• 2.25 billion already allocated for FY10-12, 1
  billion annually for FY2013-2017.

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FY11 PPHF Cooperative Agreement / Grant Awards by
State (By Award Amount)
NH 3.0M
11.8M
1.2M
VT 4.0M
2.4M
11.6M
1.3M
5.6M
25.0M
10.7M
7.0M
ME 5.8M
1.8M
1.9M
MA 15.8M
5.9M
41.4M
RI 2.4M
7.7M
2.3M
4.6M
11.0M
5.2M
3.5M
CT 6.2M
3.4M
5.9M
6.6M
1.0M 5.6M
NJ 5.3M
5.1M
3.2M
5.4M
DE 1.3M
13.3M
MD 9.2M
4.0M
5.4M
DC 6.4M
6.8M
6.1M
4.1M
9.2M
18.5M
9.2M
4.5M
2.7M
2.9M
Key Total Award Amounts by State lt5M
5-10M 11-15M gt15M
3.5M

8.5M
4.0M
Totals include awards to states, cities/counties,
tribes, and partners (358.8M). Awards to
territories (4.3M) are excluded. 1Programs
included (16 total) National Public Health
Improvement Initiative (NPHII), Epidemiology and
Laboratory Capacity Program (ELC), Emerging
Infections Program (EIP), Healthcare Associated
Infections (HAI), Immunization, Prevention
Research Centers (PRCs), Public Health Prevention
Research, Chronic Disease State Grants, Tobacco
Quitlines, Community Guide, Public Health
Workforce, Community Transformation Grants (CTG),
Racial and Ethnic Approaches to Community Health
(REACH), Environmental Public Health Tracking
(EPHT), Division of Nutrition, Physical Activity,
and Obesity (DNPAO), and Preparedness and
Emergency Response Research Centers (PERRCs) /
Preparedness and Emergency Response Learning
Centers (PERLCs).
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Prevention Fund Overview

• Preventing disease and injury by making healthy
  choices the easy choices is the most effective,
  common-sense way to improve health and reduce
  health costs for families and businesses.
• The Prevention and Public Health Fund gives us a
  chance to turn our sick care system into a health
  care system by bringing communities together on
  innovative projects that will help reverse the
  obesity epidemic and bring health costs down.
  Congress should not make any further attempts to
  reduce, eliminate or divert its funding.
• The Prevention Fund is the first federal funding
  source dedicated to public health and prevention.
  This year, the Fund will invest 1 billion in
  every state to allow communities to move forward
  on proven, effective ways to keep Americans
  healthier and more productive. Over the course
  of the next 10 years the Fund will invest a total
  of 12.5 billion in cross-cutting prevention
  programs that have the potential to transform our
  public health system.
• The Fund is supporting new programs such as
  Community Transformation Grants, a National
  Tobacco Education Campaign, and new strategies to
  reduce hospital associated infections. It is
  also supporting grants to allow every state to
  begin to build core, comprehensive capacity to
  address common risk factors and determinants of
  health.

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PPHF Funding By Agency

• Approximately 800 million to CDC 37 million to
  HRSA 88 million to SAMHSA 50 million Office
  of the Secretary smaller amounts to AOA and AHRQ
• 69 of funding to states in 2010-11
• Of the state dollars in 2010-11, 429 million to
  infrastructure and workforce 222 million to
  community prevention 156 million to clinical
  prevention and 52 million to research and
  tracking

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Selected CDC PPHF FY 2012 Investments
Investment Area Amount
Community Transformation Grants 226m
Immunization 190m
Tobacco Prevention 83m
Worksite Wellness 10m
Public Health Infrastructure 40.2m
Environmental Laboratories 40m
Healthy Weight Taskforce 5m
Healthcare Surveillance 35m
Public Health Workforce 25m
REACH 40m
Healthcare Associated Infections 11.75m
Diabetes 10m
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Early PPHF Successes

• CDC supported a national tobacco education
  campaign, including the airing of Tips from
  Former Smokers, the first federally funded
  national, paid-media campaign. In a 12 week
  period, the quitline received more than 365,000
  calls, and there were 630,000 unique visitors to
  the website, up 428 from the previous year.
• The New Mexico Department of Health is increasing
  access to physical activity opportunities for
  over 50,000 children by creating active outdoor
  school spaces for public use during non-school
  hours
• The University of Rochester Medical Center has
  implemented a program to provide intensive
  clinical and community prevention services,
  including the Diabetes Prevention Program, to
  more than 700,000 people.
• HRSA supported 24 Mental and Behavioral Health
  Training Grants to institutions of higher
  learning to increase social workers and
  psychologists prepared to serve high-need
  populations.

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Prevention Fund Broad support from multiple
sectors

• Over 780 local, state and national organizations
  including hundreds of traditional public health
  groups, but also
• Faith-based groups National Council of Jewish
  Women, United Church of Christ, Ascension Health,
  Justice and Witness Ministries, Adventist
  HealthCare, Inc.
• Medical providers American Academy of
  Pediatrics, American College of Cardiology,
  American Nurses Association
• National advocacy groups AARP, USPIRG, Families
  USA
• Business groups National Business Coalition on
  Health, Small Business Majority, Pacific Business
  Group on Health
• Policymakers US Conference of Mayors, National
  Association of Counties

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Community Transformation grants True
community-based prevention

• Requires detailed plan for policy, environmental,
  programmatic and infrastructure changes to
  promote healthy living and reduce disparities
• Create healthier school environments, including
  healthy food options, physical activity
  opportunities, promotion of healthy lifestyles
• Develop and promote programs targeting increased
  access to nutrition, physical activity, smoking
  cessation and safety
• Highlight healthy options at restaurants and food
  venues
• NOT limited to chronic diseases or one disease at
  a time
• Leadership teams for capacity building and
  represent over 900 organizations over the 60
  grants in FY2011. This includes 24 public
  health, 19 healthcare 14 education 14
  agriculture/food services plus faith-based,
  parks and rec. housing and business groups.

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CTGs in practice Community Engagement

• Awarded competitively, based on proposals
• Available to state and local health departments,
  nonprofits, national networks of community-based
  organizations and tribal organizations
• At least 20 of funding to go to community
  prevention programs in rural and frontier areas
• Applicants must define concrete, achievable
  targets for meeting prevention goals, and
  specific objectives to reduce health disparities
• Applicants must demonstrate the ability to
  coordinate with multiple community sectors i.e.
  transportation, faith-based, businesses,
  education, etc. to achieve broad-based
  participation in community prevention activities.
  

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CTG Funding

• Funding allocated for Fiscal Year 2011/2012
• Total of 145 million, including 103 million
  awarded to 61 states and communities, serving 120
  million Americans
• 26 capacity-building grants (147,000 - 500,000)
• 35 for implementation of evidence and
  practice-based programs (500,000 - 10 million)
• 4.2 million to national networks, APHA, Asian
  Pacific Partners for Empowerment, Community
  Anti-Drug Coalition, National Farm to School
  Network, ALA, REACH Coalition, and YMCA.
• 70 million to 40 communities under 500,000
  population. 

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CTG Goals

• CTG National Goals
• Five year, measurable performance goals
• Reduce death and disability due to tobacco use by
  5
• Reduce the rate of obesity through nutrition and
  physical activity interventions by 5
• Reduce death/disability due to heart disease and
  stroke by 5.

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Examples of CTG Grants

• Full implementation
• Alaska Southeast Alaska Regional Health
  Consortium
• Florida Broward Regional Health Planning Council
  
• Illinois Department of Public Health
• Maryland Department of Health and Mental Hygiene
• Massachusetts Department of Public Health (to
  serve state minus large counties)
  Massachusetts Department of Public Health (to
  serve Middlesex County)
• New York The Fund for Public Health in New York
  University of Rochester Medical Center
• Capacity Building
• Alaska Yukon-Kuskokwim Health Corporation
• Michigan Spectrum Health Hospitals
• Mississippi My Brother's Keeper Inc.
• New Mexico Bernalillo County Office of
  Environmental Health
• Ohio Austen BioInnovation Institute and Public
  Health-Dayton and Montgomery County
• Virginia Fairfax County Department of
  Neighborhood and Community Services

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CTG Small Community Awards - 2012

• Cherokee Nation (Oklahoma)
• Community Health Councils (California)
• County of Sonoma (California)
• St. Helena Hospital Clear Lake (California)
• County of Santa Clara (California)
• Nemours Hospital for Children (Delaware)
• DC Department of Health
• Miami-Dade County School Board (Florida)
• Tanner Medical Center (Georgia)
• Chicago Public Schools (Illinois)
• Quality Quest for Health of Illinois
• Welborn Baptist Foundation (Indiana)
• YMCA of Wichita (Kansas)
• Microclinic International (Kentucky)
• Linking the Parish (Louisiana)
• Maine General Medical Center (Maine)
• Maine Development Foundation
• Maine Health
• Healthy Acadia (Maine)

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CTGs in Practice

• Maryland CTG
• Overview The Maryland Department of Health and
  Mental Hygiene is receiving 1,945,289 to serve
  the entire state of Maryland minus large
  counties, an estimated population of 1,900,000
  including a rural population of over 300,000.
  Work will focus on expanding efforts in
  tobacco-free living, active living and healthy
  eating, and quality clinical and other preventive
  services.
• Key Sectors Engaged Business, community-based
  orgs, education, faith-based, an public health
• Subgrants awarded to multiple groups, including
  faith-based organizations including
• Union Bethel African Methodist Church
• Bethel AME Church
• St. James AME Zion Church

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CTGs in Practice

• Fairfax County, VA CTG
• Overview The Fairfax County Department of
  Neighborhood and Community Services
  in Virginia is receiving a 499,559 planning
  award to build capacity to support healthy
  lifestyles in large county of Fairfax, an
  estimated population of over 1,000,000. Work will
  target tobacco-free living, active living and
  healthy eating, quality clinical and other
  preventive services, social and emotional
  wellness, and healthy and safe physical
  environments.
• Key Sectors Engaged Leadership Team includes
  business, education, foundations, parks and
  recreation, planning and transportation and
  faith-based organizations including
• GRACE ministries of United Methodist Church

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Whats Ahead Challenges to the Prevention Fund

• PPHF Why defend it?
• Mandatory nature only source of assured new
  funding in tight fiscal times
• Source of for transformative change, like CTGs
• Whats the objection?
• Its part of the ACA
• Mandatory contributes to deficit
• Being used to backfill cuts in discretionary
  funding
• Claim that Congress has no control over how spent

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What Can We Do?

• Take at least one action
• Join the supporters list for the PPHF /or
  recruit other organizations
• Schedule in-district meetings with Members of
  Congress
• Send a letter
• Blog or write an op-ed/Letter-to-the-Editor
• Report back!

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For more information

• Please visit www.healthyamericans.org to view the
  full range of Trust for Americas health policy
  reports.
• Or www.healthyamericans.org/health-reform for
  health reform implementation information.
• Can also contact rhamburg_at_tfah.org to sign up for
  our Wellness and Prevention in Health Reform
  Digest
• Thank you!