Category Archives: Budgets
Fifteen Years after Tobacco Settlement, States Falling Short in Funding Tobacco Prevention: Q&A with Danny McGoldrick
On November 23, 1998, 46 states settled their lawsuits against the nation’s major tobacco companies to recover tobacco-related health care costs, joining four states—Mississippi, Texas, Florida and Minnesota—that had reached earlier, individual settlements.
These settlements require the tobacco companies to make annual payments to the states in perpetuity, with total payments estimated at $246 billion over the first 25 years.
Yesterday a coalition of health advocacy groups released the latest edition of A Broken Promise to Our Kids, an annual report on state use of tobacco funds for tobacco prevention and cessation efforts. As in years past, the report finds that most states fall short in the amount of money they allocate to prevent kids from smoking and to help current smokers quit.
The groups that jointly issued the report include the Campaign for Tobacco-Free Kids, the American Heart Association, American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights.
Key findings of the 2013 report include:
- Over the past 15 years, states have spent just 2.3 percent of their total tobacco-generated revenue on tobacco prevention and cessation programs.
- The states this year will collect $25 billion from the tobacco settlement and tobacco taxes, but will spend just 1.9 percent of it—$481.2 million—on tobacco prevention programs. This means the states are spending less than two cents of every dollar in tobacco revenue to fight tobacco use.
- States are falling short of the U.S. Centers for Disease Control and Prevention’s (CDC) recommended funding levels for tobacco prevention programs. Altogether, the states have budgeted just 13 percent of the $3.7 billion the CDC recommends.
- Only two states—Alaska and North Dakota—currently fund tobacco prevention programs at the CDC-recommended level.
To discuss the ramifications of the latest edition of the Broken Promises report, NewPublicHealth recently spoke with Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.
NewPublicHealth: Can you give us some background on the Tobacco Master Settlement Agreement?
Danny McGoldrick: This is the 15th anniversary of the Tobacco Master Settlement Agreement, when 46 states and the District of Columbia settled their lawsuits against the tobacco companies mostly to recover the costs that they’d incurred treating smoking-caused disease in their states. Four other states had settled individually with the tobacco companies prior to the Master Settlement Agreement, and so this provided for some restrictions on tobacco company marketing; they promised never to market to kids again, which is ironic, but it also resulted in the tobacco companies sending about $250 billion over just the first 25 years of the settlement for the states to spend as they saw fit. They left that to the province of the state legislators and governors to decide how those funds should be spent.
It’s no secret that public health department budgets have been shrinking in the past few years. In the face of the recession, public health professionals must seek new and diverse partnerships in order to achieve greater impact despite the lack of funding. The topic of one session at the American Public Health Association (APHA) Annual Meeting held in Boston was just that—how to increase impact through strategic partnerships with unlikely partners.
“The need for austerity and efficiency opens up the conversation for collective impact,” said Joseph Schuchter of the University of California-Berkeley School of Public Health. Partnerships can include a wide array of non-public health entities, including non-profit organizations, businesses and schools. The APHA panel discussed different approaches to successful partnerships that advance public health programs.
The Center for Health Leadership and Practice provides group leadership training for cross-sector teams that are working together to advance public health. “We may all be talking about the same thing, we’re just using different vocabulary and styles,” says VP of External Relations and Director Carmen Rita Nevarez. The Center provides existing partnerships with the tools and training needed to move forward in the same direction, while understanding that individual efforts may differ. More than 90 percent of program participants agree that the approach is effective in supporting intersectoral leadership development and most teams report regularly engaging other sectors as a result.
Networked and Entrepreneurial Approaches
Networked and entrepreneurial approaches to partnerships offer public health professionals with resources and allow them to reduce the negative externalities of the economy. The impact investment market constitutes an $8 billion industry that is eager to fund novel solutions to social problems. In order to succeed in these partnerships, the field of public health must work with social entrepreneurs and investors to highlight the potential return on investment for prevention programs and produce irrefutable outcomes.
The Community Health Improvement Partners (CHIP) serves as a backbone organization for a larger, cross-sector childhood obesity initiative. Cheryl Moder of CHIP shared her insights into the role of such an organization and how to successfully grow a diverse partnership. A backbone organization must serve as mission leaders by recruiting and retaining partners and support aligned activities so that they connect to one another. In addition, backbone organizations must navigate the challenges of larger partnerships—such as developing and retaining trust, encouraging equal partner recognition and shared measurement and evaluation—in a way that suits the needs of partners from different sectors.
>>NewPublicHealth was on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Find the complete coverage here.
Since 2008, local health departments have cut nearly 44,000 jobs, according to a recent survey conducted by the National Association of County and City Health Officials. Although workforce losses and gains were roughly equal in 2012, 41 percent of local health departments nationwide experienced some type of reduction in workforce capacity and 48 percent of all local health departments reduced or eliminated services in at least one program area. Currently, local health departments reporting cuts still exceed the percentage of local health departments reporting budget increases.
California’s Napa County has dealt with its budget cuts by revamping its health department in order to continue to stay on mission.
“I think we've come out the other end of all this as a much stronger health department,” said Karen Smith, MD, MPH, Health Officer and Deputy Director for Public Health at Napa County Health and Human Services. “We moved from what I think of as an ‘old style’ [public health agency] to a department that focuses on our role as a convener/partner, providing expertise and leadership, and helping to craft policy.”
NewPublicHealth recently spoke with Smith about the methods Napa Public Health used—and that other departments might follow—to adapt and improve in the face of budget cuts.
NewPublicHealth: How have budget changes impacted your department over the last five to ten years?
Karen Smith: Napa Public Health started out with a lean health division for the size of the county compared to some of our colleagues, and we remain lean. We have not really decreased services, however. We were able to get out ahead when we saw looming budget constraints.
Napa Public Health is part of the County’s Health and Human Service Agency, which includes social services, as well as mental health, drug and alcohol, child welfare services, comprehensive services for older adults and public health, and our administrative divisions. The previous director had a distinctive approach to budgeting: that the agency has a bottom-line budget and within that we have very detailed division budgets. So I have excruciatingly detailed budgets for every single program within public health, and that was crucial to our being able to respond to the budget shortfalls in creative ways that had limited impact on services.
Recent debate about the federal government shutdown that started two days ago for federal employees has included a wide range of concerns and viewpoints from different sides of the spectrum. But Forbes Magazine has a new article that points out that the shutdown means something else entirely for some often overlooked, but very influential, bodies outside the federal government: microbes.
According to the piece in Forbes, the shutdown has the potential:
to pose a threat to public health because [it will] allow microbes to gain footholds as our defenses against them falter.
The article reported that several federal agencies will reduce such critical work as research funding, food inspections and surveillance for the flu and other infectious diseases including the emerging MERS virus, which has caused dozens of deaths overseas. A recent post from The Atlantic also pointed out a related piece of reporting from The Wall Street Journal: "about 200 patients who otherwise would be admitted to the NIH Clinical Center into clinical trials each week will be turned away. This includes about 30 children, most of them cancer patients...."
>>Read more on how researchers are studying microbes in buildings to health create healthier spaces.
A review of a recent economic surveillance survey by the National Association of County and City Health Officials (NACCHO) finds that despite modest improvement, local health departments in the United States are still struggling to recover from the recent recession. NACCHO administered the survey as part of the National Profile of Local Health Departments in 2012, prior to the 2013 sequester cuts.
Just under 80 percent of the 2,700 local health departments in the country responded to the survey, which included questions about budgets, staffing and program cuts. Close to half of the health departments responding to the survey reported reductions in, or elimination of, services in at least one health department program area for last year, and 27 percent reported budget cuts. Analysis of the survey results also found that local health departments lost 43,900 jobs through layoffs or attrition since 2008. While positions remained stable last year, many local health departments have been unable to fill positions that were cut in previous years.
The survey also found that certain program areas have been especially hard hit by budget cuts, including immunization (22 percent of local health departments faced cuts ); emergency preparedness (15 percent); and maternal and child health (15 percent).
“While workforce reductions and program cuts may have slowed in some areas of the country in 2012, on the whole, the budgets of our nation’s local health departments are not keeping pace with the general recovery,” said NACCHO Executive Director Robert M. Pestronk. “In fact,” added Pestronk, who previously served as the director of Genesee County health department in Michigan, “continuing annual draconian cuts associated with sequestration will further erode local health departments’ capacity to serve and respond. If keeping people healthy and safe is a priority, then we should rebuild local response capacity and health security, not keep cutting it.”
Examples of the impact budget cuts have had on health departments include:
- The Boston Public Health Commission (BPHC) was forced to limit its support of prenatal care services due to a five percent cut in federal funds for the Healthy Start Initiative. Other cuts resulted in the Health Commission losing community health worker positions that provided home visits to young families; case management for children and teens at risk of truancy; and services at school-based health centers.
- Because of statewide budget cuts to local health departments in Maryland in 2009, the state’s Frederick County Health Department eliminated a third of its nursing positions. Before those cuts that health department held three flu clinics simultaneously, but now supports one clinic at a time, which has reduced the number of residents getting vaccines and keeps the department from achieving its public health emergency preparedness goals.
>>Read NACCHO's release on the new survey.
The Supplemental Nutrition Assistance Program (SNAP) is the federal government’s principal program for helping low-income families purchase enough food. More than 47 million Americans currently receive SNAP benefits; approximately half of the beneficiaries are children. As part of the debate over the Farm Bill—legislation that authorizes SNAP and other federal nutrition programs—Congress is considering legislation that would cut SNAP benefits and limit who qualifies for the benefits.
Yesterday, the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, released a white paper that provides a rigorous, objective and nonpartisan analysis of the potential health impacts of the proposed changes to SNAP.
NewPublicHealth spoke with Aaron Wernham, MD, director of the Health Impact Project, along with lead researcher Marjory Givens, to learn more about the study’s findings.
NewPublicHealth: What is the goal of the health impact assessment on the potential changes to the SNAP program?
Aaron Wernham: Congress is deliberating reauthorizing the U.S. Farm Bill, and one of the parts of that is the Supplemental Nutrition Assistance Program or SNAP, which was formerly known as food stamps. This is one of the federal government’s main programs for ensuring that people who have low incomes are able to get enough to eat. We did this health impact assessment because so far the public health effects of these proposed policy changes have not really been a part of the political debate. We wanted to make sure that the best available public health evidence was brought to bear to help ensure that everyone has complete information—those affected by the change, the general public and decision-makers in Congress.
NPH: What’s the big picture on what SNAP has to do with health in the first place?
Wernham: Not having enough to eat—or being what’s called “food insecure”—is attached to a higher risk of a lot of diseases. So, adults who are food insecure have a higher risk of heart disease, high blood pressure, diabetes and some other problems. Children who are food insecure are more likely to be reported by their parents as being in poor health, are more likely to be hospitalized and also have a higher risk for a number of health related problems from asthma, to depression and anxiety. We actually have a number of studies that have looked at the health benefits of receiving SNAP and found, for example, that adults who had access to SNAP when they were children are less likely to have problems in adulthood, such as obesity, high blood pressure and heart disease.
NPH: What did the health impact assessment find?
Wernham: We looked at ways in which the House and Senate have proposed to change how eligibility for SNAP benefits is determined and how the amount of benefits is determined. Both the House and Senate have proposed changes, and we found that as many as 5.1 million people could actually lose eligibility under changes proposed by the House. Under the changes in the Senate, about 500,000 people might receive lower benefit amounts. With the House changes, as many as 1.4 million children and nearly 900,000 older adults would be among those five million people who could be affected. So, for those people, they would lose upward of an average of 35 percent of their total income and would be at higher risk for the health problems that relate to food insecurity.
Tainted Salad Mix Linked to Parasite Outbreak in Two States; 13 Other States Still Looking for Answers
State and federal health officials have narrowed in on a prepackaged salad mix as the possible source of a cyclospora outbreak that has sickened 370 people in 15 states. Both Nebraska and Iowa officials have identified the salad as the source; a total of 221 people in those states have fallen ill so far from the stomach-sickening parasite. The U.S. Food and Drug Administration (FDA) is still working to identify the cause in the 13 other states. “FDA will continue to work with its federal, state and local partners in the investigation to determine whether this conclusion applies to the increased number of cases of cyclosporiasis in other states,” the FDA said in a statement. ”Should a specific food item be identified, the FDA, the U.S. Centers for Disease Control and Prevention, state and local partners will work to track it to its source, determine why the outbreak occurred, and if contamination is still a risk, implement preventive action, which will help to keep an outbreak like this from happening again.” Read more on food safety.
New Model Shows Kids Consuming Far More Calories than Previously Realized
It takes far more calories for kids to gain weight than was previously realized, according to a new study in The Lancet Diabetes & Endocrinology. And, given the high rate of childhood obesity, this means kids are consuming far more calories than either their parents or health care providers realize. The new caloric model takes into account the energy requirements for boys and girls; the fact that kids generally have higher metabolisms than adults; the average drop in physical activity as kids age; and the energy required to maintain a bigger body size as they age. Whereas the old model said a normal-weight girl at age 5 would need to consume about 40 extra calories a day to be 22 pounds overweight by age 10, the new model shows its actually 400 extra calories. "Importantly, given the rather large calorie excesses fueling childhood obesity, this model is a rebuttal to the food industry arguments that exercise alone can be the answer," said David Katz, MD, director of the Yale Prevention Research Center and editor of the journal Childhood Obesity, who was not involved in the study. "For our kids to achieve healthy weight, control of calories in, not just calories out, will have to be part of the formula." Read more on obesity.
Sequester to Close all HUD Offices on Friday, August 2
Every office of the U.S. Department of Housing and Urban Development (HUD) will be closed on Friday, August 2 as part of the sequester which is being felt across all of government. The automatic spending cuts took effect March 1. HUD’s plan is to pair its seven required furlough days with holidays and weekends. HUD is encouraging people and businesses that work with the agency to plan around the schedule day of shutdown. Read more on budgets.
NIH: Greater Physical Activity Linked to Lower Stroke Risk
People who exercise vigorously enough to work up a sweat are at reduced risk for stroke, according to a new study in the journal Stroke. Inactivity is one of the main risk factors for stroke, along with high blood pressure, diabetes and smoking. Researchers found that inactive people were 20 percent more likely to experience a stroke or transient ischemic attack (TIA) than subjects who exercised at least four times a week. Researches utilized data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a long-term study funded by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke that looks at the reasons behind the higher rates of stroke mortality among African-Americans and others in the Southeastern United States. “Our results confirm other research findings but our study has the distinct advantage of including larger numbers, especially larger numbers of women as well as blacks, in a national population sample so these provide somewhat more generalizable results than other studies,” said Virginia Howard, PhD, senior author of the study from the School of Public Health, University of Alabama at Birmingham. Read more on stroke.
Study: Calorie Guidance on Menus Doesn’t Lead to Healthier Eating
Research had already shown that providing calorie counts on restaurant menus did little to improve food selection. New research now shows that offering general daily or per-meal calorie guidelines also does little to help people make healthier eating choices, according to a study in the American Journal of Public Health. "The general inability of calorie labeling to result in an overall reduction in the number of calories consumed has already been pretty widely shown," said study lead author Julie Downs, an associate research professor of social and decision sciences in the Dietrich College of Humanities and Social Sciences at Carnegie Mellon University. "So that's nothing new. But in the face of that, there has been the growing thought that perhaps the problem is that people don't know how to use the information without some framework, some guidance." Instead, the study found that people given calorie guidance not only didn’t make overall better use of calorie labeling or consume fewer calories, but they actually consumed slightly more calories. Lona Sandon, a registered dietitian and assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center at Dallas, said the findings help illustrate that “[k]nowledge is just one piece of the puzzle. We must consider people's attitudes, beliefs and values surrounding healthier eating and body weight.” Read more on nutrition.
Sequester to Close all HUD Offices on July 22
Every office of the U.S. Department of Housing and Urban Development (HUD) will be closed on Monday, July 22 as part of the sequester which is being felt across all of government. The automatic spending cuts took effect March 1. HUD’s plan is to pair its seven required furlough days with holidays and weekends. HUD is encouraging people and businesses that work with the agency to plan around the schedule day of shutdown. Read more on budgets.
A new report funded by the Robert Wood Johnson Foundation (RWJF) and produced by the University of Michigan Center of Excellence in Public Health Workforce Studies offers—for the first time ever—a comprehensive assessment of the state of nursing and nurses in state and local health departments. Enumeration and Characterization of the Public Health Nurse Workforce: Findings of the 2012 Public Health Nurse Workforce Surveys looked at—among other things—size, composition, educational background experience, retirement intention, job function and job satisfaction of nurses.
RWJF recently spoke with Paul Kuehnert, MS, RN, CPNP, team director of Public Health at RWJF, and an alumnus of the RWJF Executive Nurse Fellows program, to discuss the report.
Among the report’s findings is that while public health nurses report high levels of job satisfaction, they’re also concerned with issues such as job stability, compensation and the lack of opportunities for advancement. It also found that about 40 percent of public health departments have “a great deal of difficulty” hiring nurses.
“It should be a high priority to address gaps and take steps to strengthen the public health nursing workforce,” said Pamela G. Russo, MD, MPH, RWJF senior program officer. “Public health nurses are likely to need training to keep pace with the changes as health care reform is implemented and public health agencies focus more on population health. The size, makeup, and preparation of the public health nursing workforce greatly affect the ability of agencies to protect and improve the health of people in their jurisdictions.”
CDC Releases Tools to Help People Keep Cool this Summer
A new study in the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report shows that there were 7,233 heat-related deaths in the United States in the decade from 1999 to 2009, with an analysis of 2012 data showing the death rate is climbing. “No one should die from a heat wave, but every year on average, extreme heat causes 658 deaths in the United States—more than tornadoes, hurricanes, floods, and lightning combined,” said Robin Ikeda, MD, MPH, acting director of the National Center for Environmental Health and Agency for Toxic Substances and Disease Registry. “Taking common sense steps in extreme temperatures can prevent heat-related illnesses and deaths.” The CDC has released a series of tools to help people stay cool, hydrated and informed during the extreme that will most likely occur in much of the country over the hot summer months. They include the Extreme Heat and Your Health Website; Environmental Public Health Tracking Data; a Climate Change and Extreme Heat Events Guidebook; and Workplace Solutions Bulletin. Read more on environment.
Study: More than One-third of Designated Drivers End up Drinking
More than one-third of designated drivers end up drinking, according to a new study in the Journal of Studies on Alcohol and Drugs. The researchers spoke with approximately 1,100 bar patrons (mostly white, male, college-aged) in an unidentified college town and gave blood alcohol (BAL) tests to 165 who said they were designated drivers. About 65 percent had no alcohol in their systems; 17 percent had a BAL between 0.02 and 0.049; and 18 percent had a BAL of at least 0.05. The legal limit is 0.08. "While more of the designated drivers didn't drink than did drink, which is a good thing, you have people being selected because they're the least drunk, or the least intoxicated or they've driven drunk before," said study author Adam Barry, an assistant professor at the University of Florida. "The only real safe option is to completely abstain." Read more on alcohol.
Sequester to Close all HUD Offices on June 14
Though the schedule could still change, as it stands at the moment every office of the U.S. Department of Housing and Urban Development (HUD) will be closed on Friday, June 14 as part of the sequester which is being felt across all of government. The automatic spending cuts took effect March 1. HUD’s plan is to pair its seven required furlough days with holidays and weekends. HUD is encouraging people and businesses that work with the agency to plan around the schedule day of shutdown. Read more on budgets.