Fall 2010 Vol. 3, No. 1
Topic of the Quarter: Prevention Opportunities in Health Reform
Americans are plagued by chronic health conditions that increase the nation’s health care costs. Chronic conditions, often preventable, account for more than 75 percent of U.S. health care costs, but 95 percent of health care dollars go to treat diseases and injuries after they occur.
States have often taken the lead in addressing risk factors such as physical inactivity, poor diet and smoking that can lead to chronic diseases such as heart disease, diabetes and cancer. State innovations have included: time standards for physical education; requirements for physical activity and recess at school; joint community use of school recreational facilities; land use policies and transportation plans that encourage walking and biking; design and implementation of school and preschool nutrition standards; farm-to-school programs; incentives for grocery development in underserved communities; state employee wellness programs; smoke-free policies; and support for tobacco cessation programs. To move the nation from the current “sick care” model to a “health” system that encourages well-being and prevention, states will once again be called upon to be leaders.
The Patient Protection and Affordable Care Act (PPACA) created a National Prevention, Health Promotion and Public Health Council to coordinate prevention efforts across government agencies, including health, human services, agriculture, education, transportation, labor, environmental protection and Indian affairs. The legislation also created the Prevention and Public Health Fund (PPHF), which includes $500 million in 2010 (with $250 million for training primary care providers) and increases to $2 billion by 2014 to expand and sustain national investment in prevention and public health programs. PPHF dollars will support a variety of initiatives, including, among others, strengthened public health infrastructure; enhanced chronic disease screening; and Community Transformation Grants (CTGs). The CTG grants currently are being developed and will support evidence-based community preventive health activities to reduce the leading causes of death, which include many chronic diseases.
Many other policies included in the health reform legislation (PPACA) build on state innovations, including work breaks for nursing mothers (§4207); menu labeling for restaurants and vending machine retailers (§4205); coverage for evidence-based preventive health services in new health plans without cost-sharing (§1001\2713); coordination by U.S. Preventive and Community Services task forces for evidence-based prevention recommendations (§4003); childhood obesity demonstration projects (§4306); school-based health center grants (§4101); and incentives within Medicaid for losing weight, lowering cholesterol, improving blood pressure, preventing diabetes and stopping tobacco use (§4108).
“Investing in public health builds a foundation for a strong and healthy society and contributes to lowering the cost of health care. Investing in proven preventive services and strong policies helps us to avoid unnecessary costs later,” says CDC Director Thomas R. Frieden, M.D., M.P.H.
Upcoming Events and NCSL Resources
Fall Forum, December 9-10, 2010, Phoenix, AZ. Come to NCSL's Fall Forum to dig into the issues and learn how changes in Congress may affect states in 2011. Listen to the nation’s leading experts as they assess the fall election and evaluate the ways the state-federal relationship will shift with new perspectives in office.
NCSL can provide testimony to legislatures on chronic disease prevention; health promotion; preventing injuries and violence; reducing health disparities; access to health care; community health centers; and other health policy topics. Contact Alise Garcia at Healthemail@example.com.
LegisBrief - Healthy Communities: New Opportunities for Promoting Health
State Legislatures Magazine Article - Chronic Costs
LegisBrief - Improving Child Nutrition
NCSL Web Pages
Healthy Eating, Physical Activity and Food Systems to Support Healthy Communities
Chronic Disease Prevention and Health Promotion
Trans Fat and Menu Labeling Legislation
In the News
The U.S. Department of Health and Human Services released a Draft Framework for National Prevention and Health Promotion Strategy that is expected to be finalized in March 2011. U.S. Surgeon General Regina M. Benjamin, M.D. hosted a nationwide conference call to engage the public in development of the Strategy.
Menu of Suggested Provisions For State Tuberculosis Prevention and Control Laws - The CDC's Division of Tuberculosis Elimination and its Public Health Law Program together with the National Tuberculosis Controllers Association have developed this menu of TB prevention and control laws for public health officials and their legal counsel to consider.
The U.S. Department of Health and Human Services announced $42.5 million in funding for a five-year program, Strengthening Public Health Infrastructure for Improved Health Outcomes, National Public Health Improvement Program for 94 projects in 49 states, nine local communities, five territories, eight tribes, the District of Columbia and three Pacific Island jurisdictions. Grant funds are part of the new Prevention and Public Health Fund created by the Affordable Care Act.
The health reform law also authorized Community Transformation Grants (§4202) to help local communities reduce chronic disease by promoting healthy living and addressing social and economic causes of poor health. These grants, currently being developed, are expected to be awarded in 2011 to state and local agencies, nonprofits, national networks of community-based organizations and Indian tribes.
The U.S. Department of Health and Human Services announced phase two of the Communities Putting Prevention to Work program (CPPW). An additional $31 million was awarded to ten communities in eight states, and one award went to a state health department, to support public health efforts to reduce obesity and smoking, increase physical activity and improve nutrition. Also announced was $10 million in additional funding for "Community Mentoring" to six communities from the original 44 CPPW sites funded by ARRA in 2009.
Smoking Cessation: The Economic Benefits - The American Lung Association released state-by-state information on the benefits of smoking cessation treatments. Research from Pennsylvania State University indicates that for every $1 spent on helping smokers quit, states would see a $1.26 return on investment.
The Robert Wood Johnson Foundation and partners launched a new Public Health Law Network. The network will provide technical assistance to professionals seeking legal or policy solutions for complex public health challenges on a wide range of issues including environmental health and injury prevention.
The Director of the Centers for Disease Control and Prevention, Thomas Frieden, M.D., M.P.H. has outlined six priority "winnable battles" to address in public health: smoking, HIV/AIDS, obesity/nutrition, teen pregnancy, auto injuries and hospital acquired infections.
Public Health Project Partner News
NCSL collaborates with the Centers for Disease Control and Prevention and other national organizations—including the National Governors Association, the Association of State and Territorial Health Officials and the Society for Public Health Education—on public health projects. Recent resources available from partner organizations on public health topics include the following.
NGA Report: State Roles in Delivery System Reform
A recently released report examines health reform in the states and includes discussion on: health care quality improvement, care coordination and disease management, primary care and prevention, health care payment systems and Medicaid's role in the health delivery system.
ASTHO Submits Comments to FDA on Federal Menu Labeling
ASTHO submitted recommendations in response to a docket for soliciting comments and information pertinent to the implementation of the new federal menu labeling requirements [Section 4205] of the Affordable Care Act. ASTHO supports increasing the availability of nutritional information through menu labeling, but strongly encourages the FDA to consider the costs of implementation and enforcement to state and local jurisdictions.
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