What a Long Strange Year 2017 has been in Public Health: Historic Storms, “Banned Words,” and Deep Funding Cuts – Just to List a Few

By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

Chrissie Juliano, Director of the Big Cities Health Coalition

Chrissie Juliano, Director of the Big Cities Health Coalition

In 2017, governmental public health shined in our country. In the face of historic natural disasters in Texas, Florida, Puerto Rico, and California, public health staff on the front lines dedicated to serving the American people – no matter what – did their work and delivered. Many stayed behind when others fled, or travelled from their safe, dry homes to help those in danger, save lives, or clean up.

Multiple disease outbreaks, like the current Hepatitis A challenge affecting San Diego and Los Angeles Counties and Detroit (really all of Southeast Michigan) have been fought by dedicated, disciplined professionals, for months on end.

The opioid epidemic raged, killing adults who should have been in their prime, and orphaning countless children. Public health experts were nimble, creative, and simply impressive, as they helped everyone they could all day, every day, all year. 

In short, public health “showed up” this year, and the field’s ability to meet these varied challenges is the silver lining in a distressing string of events. 2017 showed the resilience of communities and first responders alike.

Meanwhile, the Centers for Disease Control and Prevention (CDC), the national and world leader charged with advancing public health science meant to prevent disease and death, was under unprecedented and sustained attack.  Like many of you, I was shocked this weekend when a Washington Post article alleged that CDC was “banned” from using seven words – “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based,” and “science-based.” While #7bannedwords swept Twitter and additional reporting revealed it to be HHS-wide, even more recent reporting suggested this was just a nervous career staffer trying to advocate for his/her program in a challenging political environment. Regardless of whether or not these words are or are not, “banned,” this continued effort to undermine science and the evidence-base – central to the work of our field – it is not new. And, the current Administration’s track record of following the science and deferring to experts when devising policy is questionable at best.

As in years past, but even more so in 2017, Congress seemed determined to underfund CDC to a point that undermines its mission, mostly through repeated attempts to “repeal and replace” the Affordable Care Act (ACA). Doing so would not just have meant millions of people losing access to their health care, but also repealing a much needed, and much relied upon, funding stream for public health: the Prevention and Public Health Fund (PPHF). The PPHF makes up 12% of CDC’s budget, and although it survived the health care debate, it remains under attack today.

As both the Children’s Health Insurance Program (CHIP), which is a crucial source of health insurance for millions of American families, and the entire Federal Government, are running out of funds, Congress is currently considering a stop-gap legislative measure, since they have failed to pass a budget (work generally done in the early fall, when the fiscal year starts). Unfortunately, in looking for a way to pay for the CHIP extension, they have yet again raided the Prevention Fund. This continued effort of “robbing Peter to pay Paul” is unacceptable. For Americans to be healthy, they not only need affordable access to care, but they also need a strong, well-funded public health system that prevents disease and suffering in the first place.

The PPHF is essential to local health departments, most of which rely very heavily on federal funding. It was designed to provide additional dollars to support disease prevention in communities across the country, including addressing many of the leading causes of death. These activities were meant to complement medical activities that newly found health insurance for millions would cover. It sought to spend dollars preventing conditions that drive our rising health care costs, including cancer, heart disease and stroke, diabetes, and asthma. Over time, these funds have come to make up 12% of the CDC’s annual budget and cover activities such as the 317 Immunization Program, which plays a critical role in insuring access to important immunizations, which help lead to reductions in preventable disease.

The Fund also helps identify and track emergent disease outbreaks, like Zika, and routine foodborne illness outbreaks, like salmonella, through epidemiology and lab capacity dollars, the way in which many local and state health agencies do this work. And, the incredibly small share of federal dollars that support preventing lead poisoning in communities across the country would be deeply cut. Incidentally, each dollar invested in lead poisoning prevention yields in a return on investment of $17–$221 or a net savings of $181–269 billion. As with so many prevention programs, we should be supporting these programs not just because it’s the “right” thing to do, but because, in the medium-to-long term, they will save us money.

Finally, the deficits created by the tax bill also create an undetermined, ticking time bomb threat to the PPHF, not to mention a host of other non-defense programs across the entire federal government. Because deficits are projected to be so large, they will trigger a provision called the Statutory Pay-As-You-Go Act (SPAYGO), which will mandate deep cuts. Congress must, as soon as it returns in the new year, agree on a path forward on so-called budgetary caps and how they will address SPAYGO.

As many of us in Washington continue to fight for the funding and policy battles “inside the beltway,” we cannot forget the importance of the CDC to the work happening in communities across the country. The agency is a key advisor, source of critical funding, and leader to those practicing local public health around the world. It should be a beacon for science, both in research and practice. Unfortunately, all too often public health professionals are not given the tools they need to fully do their jobs, even when that need seems greater than ever. The CDC, along with governmental public health departments across the country, have become accustomed to doing more with less.

In times where policymakers are making hard decisions about spending scarce dollars, both the Trump Administration and the Congress should be following the science, looking at the evidence-base, and funding programs that are based on best- or promising-practices. Unfortunately, their actions time and again, whether by failing to allocate dollars as part of the opioids emergency, or doing away with regulations that protect our food, air, and water, have shown that when the science isn’t convenient, it doesn’t matter.

The bottom line is, science, the evidence-base, and protecting our communities must be the number one priority of a government that serves its people. When our government censors experts, ignores the science, or cuts critical public health programs to the bone, it fails us. Our field of public health fought hard in 2017, and we should be proud of that. But, no one should expect us to let up in 2018 either.

Fighting Flu in Big Cities: Lots of Germs in that Big Petri Dish

By Chrissie Juliano, Director of the Big Cities Health Coalition

Fighting seasonal influenza (the flu) is serious business. It may sound rather pedestrian compared to headline-grabbing diseases like Ebola or Zika, but fighting flu, and other such “routine” outbreaks, is what local public health departments do every day to protect lives.

In a moderate to severe year, seasonal flu kills more Americans than car accidents. Over the past 30 years, it’s killed anywhere between 3,000 and 49,000 people in single a flu season. It also costs Americans $87 billion in direct costs and lost productivity. In short, there are many reasons to fight flu.

Beyond Thoughts and Prayers

By Dr. Rex Archer, Director of Health, Kansas City, Missouri Health Department

After the trauma of the events surrounding the Las Vegas mass shooting, stories of horror and heroism unfolded from that horrible act.  My compassion and prayers felt somewhat hollow.  I am in a position to move my compassion to actions that make a difference and to save many lives.  That is why I am in public health. Yet, the enormity of the challenge seems daunting.

Acts of Nature are Public Health Emergencies

By Meredith Li-Vollmer, Public Health - Seattle-King County

The news from Hurricane Harvey has been heart wrenching. Among the memorable images that emerged was one of nursing home residents sitting in wheelchairs, waist-deep in flood water as they waited for help to arrive. As reported by the New York Times, among the thousands of posts to volunteer rescue groups were common pleas such as “East Houston, 9:53 p.m.: Needs evacuation, one elderly person in a wheel chair” and “Northeast Houston5:36 a.m.: He’s on bottled oxygen now, and running out. Nausea from lack of oxygen has already started.” As some of the most vulnerable in the community struggled, news also covered the toll that the hurricane has taken on the world-class hospitals in the Houston area who were well prepared with back-up generators but hampered by the extremity of the weather and flooded roadways to evacuate patients and bring in emergency vehicles, food, and supplies. Hurricanes and floods aren’t just acts of nature. They are also public health emergencies.

“Back to School” Season: Backpacks, school supplies and cancer prevention

By Dr. Julie Morita, Commissioner of Health, Chicago Department of Public Health

Flipping my calendar from July to August, always yields a sense of melancholy as I can see the less structured, long, warm days of summer rapidly disappearing and the busy, regimented, new school year entering into sight. While many people overcome the sorrow of the summer ending with “Back to School” shopping for backpacks, new clothes and school supplies, since becoming a pediatrician almost 25 years ago, I have sought consolation in knowing that “Back to School” means that millions of school-aged children throughout the US will be receiving health examinations and vaccines, which prevent serious diseases including measles, mumps, whooping cough, and polio.

How the Senate's Obamacare repeal bill would wallop the urban poor, and especially those who rely on Medicaid and public hospitals

If there was any hope that Senate Republicans could bring some sanity into the national discussion around the future of our health care system, such hope completely vanished on Thursday. Like the House's health care bill, the Senate's proposal is nothing less than an all-out attack on public health and our public hospital system, and its consequences will be devastating for New York City and the country.

Showing up for LGBTQ communities

By Jesse Chipps, HIV Planning Council Administrator, Public Health - Seattle & King County

June is National Lesbian, Gay, Bisexual and Transgender (LGBT) Pride Month, and each year at this time hundreds of King County employees, department directors and public officials march together in Seattle’s Pride Parade. Rainbow tinsel laden vehicles, bubble machines, and matching t-shirts pull the group together as One King County.

The Zika Fight of 2017

By Chrissie Juliano, Director of the Big Cities Health Coalition

Last year’s high profile infectious disease outbreak of the Zika virus is still fresh in our minds. While official announcements last week told Americans that the outbreak is waning in the U.S., all of the same conditions that created a Zika emergency last year are still present today. And just like then, the consequences of inaction are very real for those at risk, especially pregnant women and their babies. Unlike last year, we are also dealing with an Administration proposing an absurdly large –$1.2 billion – cut to the U.S. Centers for Disease Control and Prevention’s (CDC) budget in a way that would severely hamper its ability to fight, not to mention prevent, disease.

Combining Disciplines, Reducing Stigma: How Long Beach Incorporates Mental Health into Public Health

By Kelly Colopy, MPP, Director, Long Beach Health Department

May is Mental Health Awareness Month, which brings a heightened awareness and opportunity to support the mental and emotional health of those in our communities experiencing a mental illness.  As individuals and families, as well as communities and organizations, we are learning that we all know someone, often close to us, who has experienced some level of mental illness in their lifetime.  Nearly 1 in 5 adults (43 million) in the United States experiences a mental illness each year.  The impacts of mental illness diagnosis vary widely; some have serious impacts on the ability to perform major life activities.  Access to treatment has improved with the passage of the Mental Health Parity and Addiction Equity Act of 2008 and under the Affordable Care Act in 2010, yet more capacity for treatment is needed.  The conversations are increasing at the systems level as we work to grow healthy supportive environments and increase access to mental health resources in our community.  Yet, at an individual and community level, the conversations continue to be difficult.  The stigma, while lessened, still remains.

Four Ways We Are Measuring Affordable Care Act Proposals

By Patty Hayes, Director, Public Health—Seattle & King County

This blog originally appeared in Public Health Insider

Any reform or replacement for the Affordable Care Act should help people lead healthier lives. We believe that’s the underlying purpose for health care reform (while acknowledging that there are economic and other reasons to reform, as well). We’re tracking four key areas that help us measure each proposal.

Health Equity and Minority Health in Bexar County and the City of San Antonio

By Vincent R. Nathan, PhD, MPH, San Antonio Metropolitan Health District

Bridging Health Equity Across Communities" is the theme of this April’s U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) National Minority Health Month. Over the past month,  HHS OMH, with their partners, worked to raise awareness about efforts across health, education, justice, housing, transportation and employment sectors to address the factors known as the social determinants of health – environmental, social and economic conditions that impact health.  San Antonio, Texas joins DHHS in celebrating, and more importantly, recognizing the disparities in health among different groups.

Earth Day – A Celebration of Environmentalism and Environmental Justice for All

By Cynthia Harding, MPH, Robert Gilchick, MD, MPH and Angelo J. Bellomo, REHS, QEP, Los Angeles County Department of Public Health

Earth Day, celebrated each year on April 22, commemorates the birth of the modern environmental protection movement.  Started in 1970 during an era when pollution was rampant in our country, Earth Day is credited with bringing the concept of environmental protection into the national political agenda.  The first Earth Day was marked by massive rallies and demonstrations advocating for a healthy and sustainable environment.  In 2017, Earth Day will be marked by a national call to action around science, with a march in Washington DC and other communities throughout the nation.

The Chief Health Strategist Role in Tarrant County, Texas: Building Walkable Streets and Greener Food Carts

By Vinny Taneja, MBBS, MPH, Director of Tarrant County Public Health

Fort Worth and Arlington are both located in Tarrant County, a fast growing community of approximately 2 million individuals living within 902 square miles. Like many large urban communities, neighborhoods vary significantly by culture, race/ethnic background, income, education, green space, housing, crime and many of other social determinants of health.

More than the ACA: We Can’t Stop Fighting Now

By Dr. Oxiris Barbot, First Deputy Commissioner, NYC Health Department

This op-ed originally appeared on huffingtonpost.com

Since the start of the new presidential administration, the onslaught of policies and executive orders have been met with outcries from communities, organizations and elected officials. In the medical community, there was an almost unprecedented bipartisan opposition to the White House’s proposed American Health Care Act. To some, the protection of the Affordable Care Act has given us a rare time to celebrate, rest and regroup.

Now is not that time.

Marking National Public Health Week, “Healthiest Nation 2030,” by Defending the CDC’s Support for Prevention in Local Communities

By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

This year’s American Public Health Association’s (APHA) National Public Health Week (NPHW) challenges us to think about what the “Healthiest Nation 2030” means. As we focus on this charge, we find ourselves again working to defend huge cuts in public health funding at the Centers for Disease Control and Prevention (CDC) and elsewhere.

Fighting TB in San Jose: New Urgency with Federal Funding at Risk

By Tara Perti, MD, MPH, Assistant Health Officer and Tuberculosis Controller at the Santa Clara County Public Health Department

Tuberculosis (TB) remains an enormous global problem and is one of the top ten causes of death in the world.  As we live in a global community, infectious diseases common in other countries also affect the United States.  In the United States, in 2015, 9,557 patients were diagnosed with TB disease

The ACA Replacement Would Devastate America’s Health

By Leana Wen, MD, MSc, FAAEM, Baltimore City Health Commissioner

This blog originally appeared on statnews.com. 

As a physician who has treated patients in the emergency department before and after the Affordable Care Act was instituted, I have seen firsthand how it has transformed the lives of many of my patients. And as the health commissioner for Baltimore city, I have seen how it has safeguarded the lives of more than 40,000 residents in my city, and millions more around the country, who would otherwise be uninsured.

ACA Repeal Would Mean Massive Cuts To Public Health, Leaving Cities And States At Risk

By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

This blog was originally posted in Health Affairs.

When the Affordable Care Act (ACA) was passed a little over six years ago, it brought with it the promise of health insurance for all Americans. It also sought to begin to shift the paradigm for health care in this country, emphasizing value over volume, and recognizing the importance of prevention coupled with appropriate access to care.

Repeal of ACA would imperil a little-known part with a huge impact

By Gretchen Musicant, MPH, BSN,Commissioner,  Minneapolis Health Department

The debate about the future of the Affordable Care Act (ACA) is in full swing, and many know that repealing the ACA would leave almost 20 million Americans without health care coverage. This is of great concern.

But the fact that repealing the law would also decimate the already-fragile public health system in America is not known to many policymakers or members of the public.