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

By GRETCHEN MUSICANT 

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.

Gretchan Musicant, MPH, BSN, Commissioner of the Minneapolis Health Department

Gretchan Musicant, MPH, BSN, Commissioner of the Minneapolis Health Department

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.

This part of the law, which benefits every American, helps to keep all healthy and safe; it will essentially be undone with the repeal of the ACA. If there is no comparable replacement, communities across the nation are poised to lose $3 billion in federal funds over the next five years through a mechanism called the Prevention and Public Health Fund, which is currently a component of the ACA.

The Prevention and Public Health Fund was designed as an important, complementary component to the promise of insurance coverage for most Americans. It was meant to help us prevent disease instead of just treating it when it strikes, and to address many of the other factors that make us ill and cause our health care costs to keep rising.

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Researchers have found that our ZIP code is actually a greater predictor of our health than our genetic code. Strategies supported by the fund are aimed at addressing our nation’s sky-high rate of chronic disease, in particular diabetes, obesity, cancer, asthma, and heart disease. These health problems now touch almost every family in every community.

The resources that flow from the ACA are now being used to backfill funding cuts to support core public health programs by funding a large portion of the Centers for Disease Control and Prevention (CDC), the part of the federal government that works 24/7 to protect America from health, safety and security threats. It is responsible for ensuring access to vaccines to protect against flu and other diseases; supporting local and state first responders in mitigating the effects of outbreaks like Zika or Ebola; and preparing for and responding to natural disasters like hurricanes and earthquakes. The CDC works to protect every American, every single day. Without the funding provided by the Affordable Care Act, its reach will be dramatically reduced.

What would eliminating this funding mean for everyday Americans and their families? Perhaps the most damage would be done to the nation’s largest vaccine program, which would shrink by a whopping 53 percent. Immunizations continue to be one of the most cost-effective public health interventions. Over the past 20 years, childhood immunization has prevented 322 million illnesses, 732,000 deaths, and nearly $1.4 trillion in societal costs.

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To End HIV/AIDS, Cities like Ours are Leading the Way by Setting Bold Goals

On December 1st, communities across the nation will commemorate World AIDS Day. First memorialized in 1988, World AIDS Day offers the opportunity for people worldwide to unite in the fight against HIV, show support for people living with HIV, and remember those who have died. We know that in the U.S. the number of people living with HIV and AIDS is concentrated in cities, and that cities are also the most ambitious leaders in the fight against the disease. This World AIDS Day, Denver can report some major victories in fighting the disease that policy makers at every level should study carefully.

Live Today: The Big Cities Health Inventory 2.0 – Success and Challenges

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

Today we launch version 2.0 of our Big Cities Health Inventory (BCHI), an online, open access data platform that allows the public health field, media, researchers, the public, and policymakers to look across more than 50 health and socio-demographic indicators from 28 cities – in total more than 17,000 data points. We also have a number of case studies available, highlighting innovative work in our member cities.

November is National Diabetes Month: How We’re Fighting Diabetes in Long Beach, CA

By Kelly Colopy, Director, Long Beach Department of Health & Human Services

November marks National Diabetes Month in America, and it could not be more important for us to seize this chance to educate more Americans about the disease, and help them find out more about what they can do to fight it. More than 29 million U.S. adults have diabetes, and 25% of them don’t know it. Additionally, about 86 million adults—more than a third—have prediabetes, and 90% of them don’t know it. This wave of chronic disease costs money. More than 20% of health care spending is for people with diagnosed diabetes. A 2012 study estimates the total costs of diagnosed diabetes at $245 billion.

Congress Took 233 Days To Respond. Here’s How To Prepare For The Next Zika

Dr. Ferrer is a member of the Coalition's Alumni Council, as the Former Director of the Boston Public Health Commission. This blog originally appeared on HealthAffairs.com.

Barbara Ferrer

October 27, 2016

Congress recently passed federal funding for the nation’s response to the Zika virus, and the manner in which they provided those funds exposed a serious flaw in the way our nation handles disease outbreaks. In the time between the White House’s initial request for funding in February and the passage of the bill in September, the outbreak escalated dramatically, nearly unchecked by federal lawmakers. The entire process took a grand total of 233 days, which is simply far too long. It did not need to be this way.

Battling AIDS in Houston Latin-American communities

Note: this article was originally printed as an op-ed in The Hill newspaper.

By Chrissie Juliano, contributor

October 15 will mark National Latinx AIDS Day across America, which is an opportunity to take stock of the great strides made towards defeating the virus and eliminating the stigma it can create. (The term Latinx serves as a gender-neutral alternative to Latino/Latina).

Science has come a long way since HIV and AIDS became a part of the national consciousness in the early 1980’s, but as experts have learned, if those advances are not shared with everyday people, and if awareness about the disease and how to prevent it does not grow, then disease rates can continue to climb, despite breakthroughs in the laboratory.

New York Leading the Way with Paid Family Leave

Today is National Child Health Day. On this day, and every other day, we at the New York City Department of Health and Mental Hygiene are pursuing an ambitious child health agenda with the goal of advancing health equity by undoing injustice.  

For New York City’s children, inequities in social, environmental and economic conditions can determine health outcomes well before birth. Strong family relationships and community supports, however, can protect against toxic environments shaped by poverty and racism. Unfortunately, many working parents must choose between bonding with a new child and returning to work because their jobs fail to provide paid time off, making paid family leave a key policy for advancing child health equity.  

Congress Finally Funded the Zika Fight – Here’s How We Can Respond Quicker to the Next Outbreak

Before Congress left town this week for the end of this year’s campaign season, they provided funds to respond to the Zika outbreak – an exercise that took them far too long.

Since Zika emerged in the U.S., and the Administration first requested funds in February, the Zika virus has infected more than 3,300 Americans in the states and almost 20,000 in the U.S. territories, and those numbers continue to rise daily. In Puerto Rico alone, an estimated 50 pregnant women are infected each day, presenting daunting odds for their unborn children. Mosquito season is winding down in some parts of the country, and exists year round in others, but regardless, experts believe the worst is yet to come, as additional cases of Zika surface and the health system begins to care for these Zika-disabled children.

In Houston, Flood Response Success is about Taking the Long View

September is National Preparedness Month, so we asked the City of Houston, a Big Cities Health Coalition member, to share the lessons learned from their 2016 "Tax Day Day Flood." How did the public health department assist Houston residents, and did they consider their job done once the streets were dry?

by Raouf R Arafat, MD,MPH, Assistant Director, Houston Health Department

From April 16-18, 2016, the Houston area experienced widespread flooding.  First responders conducted 1,200 high-water rescues; over 6,700 houses were damaged in the region; overall property damage was estimated at $5 billion. Eight residents perished when their vehicles were trapped in high water. Four months later, Houston Health Department employees are still attempting to address the needs of flood victims through long-term case management.

The View from Boston: As the World Gathers in Rio, It’s Time for All of Us to See Zika as a Global Outbreak

With the Olympics in Rio, a high-risk area for Zika infection, people around the world are thinking about taking precautions. While the games are occurring during the winter months in Brazil, when the risk of mosquito-borne diseases is lower, much of the buzz around the Zika virus has been focused on Rio, where the disease is transmitted locally because the main vector, the Aedes Aegypti mosquito, is plentiful. Although the disease burden is heaviest in hotter, climates, residents of Northern cities like Boston are not immune from this virus and have a role in stopping its spread.

What Does Health Equity in Action Look Like?

Public Health – Seattle and King County (PHSKC) serves over 2 million people with a staff of 1500 employees and is the 13th most populous county in the United States. In addition to the city of Seattle, our County includes 38 other cities, international air and seaports, and a diverse population that speaks about 150 different languages. We have an annual budget of about $318 million and are the largest health department in Washington State.

Philadelphia’s Historic Win-Win for Kids: Funding Poverty Reduction Programs with a New Tax on Sweetened Beverages

On June 16, 2016, 13 of the 17 members of Philadelphia’s City Council voted in favor of Bill No. 160176, the Sugar-Sweetened Beverage Tax. Cheers erupted from the groups that had rallied in favor of the tax: pre-K providers, city parks advocates, parents committed to better educational opportunities for their children, the public health community, and many more. And social media went wild.

Blanket Prescription: How Every Citizen in Baltimore Can Now Save a Life from Opioid Overdose

Every year, tens of thousands across our country die from a preventable illness. We have seen the number of people dying from overdose quadruple nationally and in Baltimore City, where I serve as Health Commissioner, we continue to see more people dying from overdose than from homicide. This is particularly tragic because there is a medication, naloxone, which can completely reverse the effect of an opioid overdose, and has been proven to save lives.

Reflecting on the Tragedy in Orlando Through a Public Health Lens

Only days ago, our nation experienced another mass shooting, the largest and most deadly to date. Forty-nine innocent, young people were murdered in a nightclub in Orlando, where they came together simply to hang out and dance. We as a nation experience these violent events far too often, and today, our Coalition stands in solidarity with the LGBTQ community, at whom this attack was directed; with the victims and their families of this latest event; and with all Americans who experience the trauma of gun violence each and every day. We stand committed to them no matter their race, ethnicity, religion, sexual orientation, gender identity, or place of birth. This is a time for our nation to come together to mourn the loss, find solutions, and discourage bigotry and hatred in all its forms.

Get real about minimizing risk of future Zika and Ebola cases

The debate over how to respond to the Zika virus has produced some of the most dramatic political theater seen in Congress since the Ebola outbreak in 2014. It’s an edge-of-your seat drama, and Washington, D.C.,’s media brain trust knows it: a mysterious, life-threatening virus with tropical origins, high stakes for American families and a national leadership at war over how to deal with it.

How the Windy City is Stopping Kids from Lighting Up

Today is World No Tobacco Day, a day dedicated to bringing attention to the devastating health risks associated with tobacco use and to build momentum for passing effective policies to reduce tobacco use across the globe. This year’s theme is “Get ready for plain packaging” – a bold approach from the WHO Framework Convention on Tobacco Control to reduce the promotional appeal of cigarette packs and communicate health information with graphic warnings.

Zika is Here. It’s Time for Congress to Catch Up to the Science

Congress left for recess last week without providing funding for the latest public health emergency, the Zika virus. Let’s give them the benefit of the doubt: until recently, the Zika virus was a moving target. The science was straining to catch up with the threat, and therefore, the costs of failing to prepare and respond were more vague. We weren’t 100% sure if Zika caused microcephaly in babies. We hadn’t seen the maps showing where the mosquito vectors lived. We didn’t know it could be sexual transmitted. Now, the facts are clear. Alexandra Phelan and Lawrence O. Gostin (Georgetown University public health/law professors), writing in Health Affairs last week, got it exactly right, saying “It is one thing to fail to prepare for an emerging infectious disease if the risks are uncertain. But it is quite another to fail to act when the facts are clear.” It is time for the U.S. Congress to allocate dollars to prepare for, and respond to, what could become a major public health disaster. 

How Did Tobacco 21 Pass in Kansas City? With a Unique Coalition.

The movement to raise the age of sale of tobacco products to 21 in Kansas City is a tale of collaboration, casting, and finding the best messengers.  It’s about telling the right story at the right time. 

Tobacco 21, or “T21,” is about raising the age of sale from 18 to 21 years of age and has been around for at least ten years. From a health point of view, making the case is relatively easy.  Since 95% of smokers start by the age of 21, this policy stops a harmful addictive behavior before it even starts.  It may be more legally complicated in your community, but in most places, it can be passed with a simple ordinance. What made our effort in Kansas City different was the makeup and leadership of our Tobacco 21 campaign team, which included hundreds of members of the business community, legislative bodies, public health officials, and local youth.  The synergy of this group helped move Kansas City to pass T21.

Tuberculosis Hits Home in Las Vegas

March 24 is World Tuberculosis (TB) Day, and this year, the theme is Unite to End TB. We reached out to Dr. Joseph Iser, Chief Health Officer of the Southern Nevada Health District, which includes Las Vegas, to ask how his local health department fights the disease. We know that tuberculosis disproportionately affects communities of color and immigrant communities. We asked him to talk about how his office has successfully reached these populations in Las Vegas to fight against the spread of the disease.