Sebelius Announces New $250 Million Investment to Lay Foundation for Prevention and Public Health

U.S. Department of Health and Human Services Secretary Kathleen Sebelius on June 18 announced $250 million in new Affordable Care Act investments to support prevention activities and develop the nation’s public health infrastructure.

Chronic diseases, such as heart disease, cancer, stroke, and diabetes, are responsible for 7 of 10 deaths each year among Americans, and account for 75 percent of the nation’s health spending. Many Americans engage in behaviors such as tobacco use, poor diet, physical inactivity, and alcohol abuse, which harm their health.

“Investing in prevention and public health builds the foundation for improving the health and well-being of Americans, and for lowering costs in the health care system,” said Secretary Sebelius. “Investing in proven preventive services will help patients get the care they need early, avoiding costly and unnecessary care later. This prevention-focused approach is better for doctors, patients, and our national balance sheet.”

The investments announced today in prevention and public health are the second allocation for fiscal year 2010 from the new $500 million Prevention and Public Health fund created by the Affordable Care Act.

The $250 million investment in prevention and public health will go to:

* Community and Clinical Prevention: $126 million will support federal, state and community prevention initiatives; the integration of primary care services into publicly funded community-based behavioral health settings; obesity prevention and fitness; and tobacco cessation.
* Public Health Infrastructure: $70 million will support state, local, and tribal public health infrastructure and build state and local capacity to prevent, detect, and respond to infectious disease outbreaks.
* Research and Tracking: $31 million for data collection and analysis; to strengthen CDC’s Community Guide by supporting the Task Force on Community Preventive Services; and to improve transparency and public involvement in the Clinical Preventive Services Task Force.
* Public Health Training: $23 million to expand CDC’s public health workforce programs and public health training centers.

“With these investments, we are tackling the underlying causes of chronic diseases as well as strengthening our ability to meet the public health challenges of the 21st century,” said Surgeon General Regina M. Benjamin. “This moves America in the direction of becoming a fit and healthy nation.”

Earlier this week, Secretary Sebelius announced the allocation of the first half of the Prevention and Public Health fund to increase the number of clinicians and strengthen the primary care workforce. Building on the earlier investments made by the American Recovery and Reinvestment Act of 2009 and the Affordable Care Act, particularly for the National Health Service Corps, the investments will support the training and development of more than 16,000 new primary care providers over the next five years.

With these investments and others, the Affordable Care Act is continuing the Obama Administration’s historic work to promote wellness and reduce chronic disease. The new law also calls for a national strategy to improve the nation’s health, eliminates co-pays for key preventive services like cancer screenings, and provides new support for employer wellness programs.

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$120 Million for States Made Available as Part of Recovery Act Community Prevention and Wellness Initiative

The Department of Health and Human Services (HHS) today announced the release of $120 million in American Recovery and Reinvestment Act (ARRA) funds for prevention and wellness programs for U.S. states and territories, building on the recent announcement of the $373 million funding opportunity for communities and tribes around the country. In all, the comprehensive Communities Putting Prevention to Work initiative will make $650 million available for public health efforts to address obesity, increase physical activity, improve nutrition, and decrease smoking.

"Today's announcement is an important step toward a healthier America," said HHS Secretary Kathleen Sebelius. "We know that many chronic diseases are preventable, and the resources now available through the American Recovery and Reinvestment Act will assist states and
territories in the implementation of proven prevention and wellness programs that will save lives and lower health care costs for all Americans."

The $120 million in cooperative agreements will be awarded to states and territories for three components: statewide policy and environmental change, tobacco cessation through quitlines and media campaigns, and special initiatives to create health-promoting policies and environments. For the first two components, dollar amounts awarded to each state and territory will be based on population size and number of smokers. For the third component, states will apply for special funds through a competitive process based on the potential health impact of
the proposed activities. States and territories will have two years to complete their work. They will coordinate their efforts with other Communities Putting Prevention to Work initiatives in large cities, urban areas, small cities, rural areas, and tribal areas.

"State health departments are the backbone of the public health system and are uniquely positioned to support and leverage local efforts for chronic disease prevention and control," said Thomas Frieden, M.D., M.P.H., director of the Centers of Disease Control and Prevention (CDC).
"We expect that as a result of this nationwide project, most Americans will live in states with improved obesity-related and tobacco policies, we will make a national shift toward healthy environments, and we will increase significantly the number of people who are able to stop
smoking."

Funded projects will emphasize state-level policy and environmental changes that will help communities and schools support healthy choices. For example, states will make use of their collective purchasing power to improve the selection and availability of healthy foods in public
venues.

"Chronic diseases are the leading cause of premature death in the country, account for spiraling health care costs, and cause disability and suffering for millions of Americans," said Janet Collins, Ph.D., director of CDC's National Center for Chronic Disease Prevention and Health Promotion. "The good news is that we can greatly reduce the toll of chronic disease by reducing just four risk factors -- tobacco use, physical inactivity, poor nutrition, and obesity. With these new funds, states and territories will work to improve the environments where their residents live, work, learn, and play so that healthy choices become the easy choice."

States and territories interested in applying for cooperative agreements can find more information at www.grants.gov. The application deadline is Nov. 24, 2009. Deadlines for additional projects that are part of the Communities Putting Prevention to Work initiative will be announced soon.

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National Health Care Experts Say, "Time is now" for Health Care Reform

Reforming America¿s health care system requires innovative strategies for disease prevention, primary care and finance and payment, leaders from the health and policymaking communities declared during three days of panel discussions recently held at Emory University.

Participants in the Center for Entitlement Reform's expert panel meetings also agreed that comprehensive health reform encompassing those three key areas is essential to controlling the rise in chronic diseases and stemming the growth in health care spending that threatens to overtop federal budgets.

The meetings convened a bipartisan group of national health leaders and were sponsored by the Emory University Center for Entitlement Reform and the Peter G. Peterson Foundation.

"There is an urgent need to develop effective models of primary care that link up clinicians and community-based prevention," says Kenneth E. Thorpe, PhD, professor and chair of health policy and management at Emory's Rollins School of Public Health, and executive director of the Center for Entitlement Reform.

"America consistently spends more for care than any other industrialized nation, but it's not necessarily the right care," says Thorpe. "Our intent with these meetings is to develop true consensus in health care reform. Across the board, thought leaders agreed that better public and private policies to promote prevention and management of chronic illness, strengthen primary care and modernize finance and payment are needed."

Leaders from some of the most influential organizations in the health care debate assembled at Emory to discuss priorities for health reform in 2009, and how they will lend their efforts to finding consensus recommendations. Janet Collins, PhD, participated in the prevention-focused meeting. She directs the National Center for Chronic Disease Prevention and Promotion at the federal Centers for Disease Control and Prevention (CDC).

"Population-based preventive care is the missing book-end to clinical care, and an important factor in moving the focus of the system to disease prevention and health promotion," says Collins. "In short, real health reform starts with prevention."

Robert Berenson, MD, a senior fellow at the Urban Institute, participated in the panel tackling reforms in care delivery. He outlined recommendations on patient-centered medical homes that he said could facilitate partnerships between individual patients, their personal physicians, and patients¿ families and communities to improve individual health and health system functioning.

According Berenson, 20 percent of the Medicare population suffers from five or more chronic conditions, and at least two thirds of Medicare spending goes toward chronic care.

Chronic diseases increasingly affect younger Americans as well. According to the CDC, chronic disease accounts for about 75 percent of the nation's aggregate health care spending - or about $5,300 per person in the U.S. each year.

"Cost control currently is impossible, but it is absolutely vital," says Henry Aaron, PhD, a senior fellow at the Brookings Institution. Speaking on health care finance and payment, Aaron warns, "Large and growing federal health care spending threatens unsustainable budget deficits, while large and growing private health care spending threatens to crowd out growth of consumption other than on health care." Aaron argues that current payment arrangements should be modified so patients and providers have incentives to economize, and that research should be undertaken so that they have information to do so sensibly.

Peter G. Peterson Foundation Vice President Gene Steuerle notes the importance the Obama Administration and leaders in the 111th Congress have placed on moving forward a comprehensive health reform bill to address prevention, delivery, cost, quality and coverage early in 2009.

"The new Administration has already begun to lay the framework for health care reform legislation," says Steuerle. "I congratulate the Center for Entitlement Reform on assembling this respected group of bipartisan health care leaders and outlining their consensus recommendations. We have a unique opportunity to reform our health care and entitlement programs to reflect current economic realities and longer life spans, while also making the programs solvent, sustainable and more savings-oriented."

Consensus priorities from each of the three expert panel meetings will be compiled by the Center for Entitlement Reform to make policy recommendations that inform and educate business and labor leaders, health services and health care professionals, the media and the public.

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