Sara Gardner, MPH
The ongoing debate about health, health care and our current health care system rages on. It was a major flashpoint during the elections and it continues to be a source of controversy and confusion. There are no simple answers, but there are some basic facts that we should all understand:
We spend more on our health care then any other industrialized nation and we are sicker than most.
Nearly half of all Americans have one or more chronic diseases.
For the first time in decades, our nation is seeing a decline in life expectancy.
We are clearly doing something wrong! For starters, we continue to under-invest in prevention while our spending on treatment continues to skyrocket.
Earlier this month public health professionals celebrated National Public Health Week, April 3–9 to shine a spotlight on public health through organizing educational events and disseminating messages about the importance of public health. Congress even got in on the action by introducing resolutions in both houses to urge greater support for public health. The resolutions recognize the tremendous need for sustained investment in prevention and that the goal of “making America the healthiest nation in one generation” is achievable.
Resolutions aside, it’s ironic that the American Health Care Act, which failed to pass last month, proposed eliminating the Prevention and Public Health Fund, the nation’s first mandatory funding stream dedicated to prevention and improving our public health system. Thousands and thousands of Americans have benefitted from this fund since it was established in 2010. However, federal funding for public health has been on a steady decline during the last decade and the President’s Budget Blueprint issued in March proposes additional cuts.
The Prevention and Public Health Fund, which was created as part of the Affordable Care Act or “Obamacare,” was initially allotted $15 billion. Most of the money is routed through the Centers for Disease Control and Prevention (CDC) and goes toward activities and programs designed to keep people from becoming sick with preventable diseases and protecting children and adults through immunization. “By law, the Prevention Fund must be used ‘to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public health care costs’.”
If this sounds like a rational investment strategy and common sense approach that’s because it is. We have the information and data to prove it. Ensuring everyone has opportunities to achieve good health means we must move beyond our current medical model and invest in programs that make it easier for people to live healthy lives starting at the community level where we live, work, and raise our families. The Prevention and Public Health Fund has done just that by enabling a series of grants targeted at the community level to address the leading preventable causes of death and disability using evidence- and practice-based strategies.
In New York City, the grants enabled under the Fund, such as Communities Putting Prevention to Work, Community Transformation Grants, and the current grant called Partnership to Improve Community Health have all contributed to major health improvements. One great example is in the decline in adult smoking rates which resulted from a sustained, multi-pronged approach including legislation, like smoking bans in public spaces and higher cigarette taxes, access to treatment, and media campaigns, all of which made it harder to smoke and easier to quit. Smoking rates in NYC are down from a high of 21.6 percent of adult residents who smoked to the current 14.3.
We have been making similar strides with our efforts to combat obesity and increase health and wellness activities for communities throughout NYC. Architects, community organizations, and design professionals are creating healthier urban spaces and programs that promote stair use, active recreation, and healthy eating. Greater access to healthier food options through SNAP and Healthy Bucks programs have contributed to a 12 percent drop in sugary drink consumption and a record $1 million dollars spent on fruit and vegetables at greenmarkets throughout NYC.
It may be a slow climb, but public health works. If the cuts continue, many of the positive effects may be lost, and efforts to prevent chronic and infectious diseases will lose strength. Though the ongoing narrative about our nation’s health and our healthcare system is extremely complex, one solution is relatively simple. Benjamin Franklin understood this when he said: “an ounce of prevention is worth a pound of cure.” As the healthcare debate rages on, we could use a little of Ben’s wisdom. Prevention works.