1. Health and a New Presidential Term Jeffrey Levi, PhD Coalition for Healthier Schools Meeting January 8, 2012

2. Context  Health policy driven by Affordable Care Act (ACA) implementation Is it about insurance and cost containment? Is it a new vision for creating/addressing health?  New expectations of public health Working across silos Providing an ROI

3. National Prevention Council= Setting a Larger Table for Health Bureau of Indian AffairsDepartment of Labor Corporation for National and Community Service Department of Transportation Department of AgricultureDepartment of Veterans Affairs Department of DefenseEnvironmental Protection Agency Department of EducationFederal Trade Commission Department of Health and Human Services Office of Management and Budget Department of Homeland SecurityOffice of National Drug Control Policy Department of Housing and Urban Development White House Domestic Policy Council Department of Justice

4. National Prevention Strategy

5. Healthy and Safe Environments  Education sector: “Implement policies and practices that promote healthy and safe environments (e.g., improving indoor air quality; addressing mold problems; reducing exposure to pesticides and lead; ensuring that drinking water sources are free from bacteria and other toxins; implementing and enforcing tobacco free policies).”  National Prevention Strategy, page 17

6. National Prevention Council Commitments  Consider prevention and health within departments and encourage partners to do so voluntarily as appropriate.  Increase tobacco free environments within its departments and encourage partners to do so voluntarily as appropriate.  Increase access to healthy, affordable food within its departments and encourage partners to do so voluntarily as appropriate.

7. Create health equity through HIAP  Addressing social determinants of health requires new partnerships  National Prevention Council/National Prevention Strategy as a federal base  Building new constituencies for HIAP—and accessing new resources  Building social capital through engagement and policy/programmatic change

8. Prevention and Public Health Fund  Funding levels now $12.5 billion over next 10 years $2.25 billion already allocated for FY10-12 $1 billion annually for FY2013-2017 Reaches full $2 billion level in FY2022  Support new and innovative public health programs Also making up for cuts in public health base

9. Selected CDC PPHF FY 2012 Investments Investment Area Amount Community Transformation Grants $226m Immunization $190m Tobacco Prevention $83m Worksite Wellness $10m Public Health Infrastructure $40.2m Environmental Laboratories $40m Environmental Public Health Tracking $ 35m Healthcare Surveillance $35m Public Health Workforce $25m REACH $40m Healthcare Associated Infections $11.75m Diabetes $10m

10. CDC Environmental Health  Budget cuts have meant setbacks for federal environmental health efforts CDC/National Center for Environmental Health has lost 25% of funding since 2009  Near elimination of the lead control program  Dwindling state resources as well  Bleak outlook for 2013 and beyond in light of Budget Control Act discretionary caps

11. CDC Health Tracking Network  Top-notch data set for primary research exploring the connections between environment and health  Received $35 million from Prevention and Public Health Fund in FY 2011 and FY 2012  Has supplanted and supplemented the program to add existing data sets to the network that are critical for children’s environmental health, including: Asthma Childhood cancers Developmental disabilities Lead Socioeconomic conditions

12. FY11 PPHF Cooperative Agreement / Grant Awards by State (By Award Amount) $4.1M $3.5M $11.6M $10.7M $7.0M $9.2M $1.0M $5.6M $5.9M $2.4M $5.1M $3.4M $4.6M $3.2M $4.0M $8.5M $5.9M $2.3M $5.2M $1.9M $6.6M $5.4M $18.5M $1.3M $1.8M $3.5M $5.4M $6.1M $7.7M $11.0M $41.4M $2.7M $4.5M $9.2M $13.3M $25.0M Key: Total Award Amounts by State <$5M $5-10M $11-15M >$15M Totals include awards to states, cities/counties, tribes, and partners ($358.8M). Awards to territories ($4.3M) are excluded. 1 Programs included (16 total): National Public Health Improvement Initiative (NPHII), Epidemiology and Laboratory Capacity Program (ELC), Emerging Infections Program (EIP), Healthcare Associated Infections (HAI), Immunization, Prevention Research Centers (PRCs), Public Health Prevention Research, Chronic Disease State Grants, Tobacco Quitlines, Community Guide, Public Health Workforce, Community Transformation Grants (CTG), Racial and Ethnic Approaches to Community Health (REACH), Environmental Public Health Tracking (EPHT), Division of Nutrition, Physical Activity, and Obesity (DNPAO), and Preparedness and Emergency Response Research Centers (PERRCs) / Preparedness and Emergency Response Learning Centers (PERLCs). CT $6.2M DC $6.4M DE $1.3M ME $5.8M MD $9.2M MA $15.8M NH $3.0M NJ $5.3M RI $2.4M VT $4.0M $4.0M $1.2M 12 $5.6M $11.8M $6.8M $2.9M

13. Community Transformation Grants $900 million over 5 years  Building capacity to implement evidence- and practice-based policy, environmental, programmatic, and infrastructure changes to prevent chronic disease  Supporting implementation of interventions across five broad areas: Tobacco–Free Living Active Living and Healthy Eating Community-Clinical and Other Preventive Services Social and Emotional Wellness Healthy and Safe Physical Environment

14. CTGs as a model  Creating health locally  Public-private partnerships/coalitions Implementation and capacity building New relationships with health system (ACC, community benefit  Health grants are not just for health departments—also local education agencies Creating context for healthy choice

15. Other “partnerships” in ACA  Accountable Care Organizations  Medicaid Health Homes  School based clinics  FQHC expansion  Community benefit requirements

16. New partnerships with health  Structural integration of prevention and public health—from Accountable Care Organizations/Medicaid Health Homes to Accountable Care Communities  Making the ROI case for prevention – within the health system and more broadly  Inclusion of prevention/public health funding as part of any global budget initiatives  Expand use of new tools such as community benefit

17. Cross-sector partnerships  Federal Reserve Bank and community reinvestment programs  Adding overt health goals to existing federal initiatives Sustainable Communities Promise Neighborhoods

18. Change in the context of hard fiscal times  Status quo is not an option  Breaking down silos Within public health/between environmental health and public health Across agencies and sectors: Health in All Policies New Partnerships – leverage resources so all have a better chance of achieving their goals  Decentralized decision making

19. Four years, four goals  Creating health equity by building the culture of “health in all policies”  Prioritizing prevention – especially community change/prevention – as part of the redesign of the US health care system and how it is financed  Restructuring health programs and agencies to break down silos and reflect new health infrastructure  Providing a stable base of funding for state and local public health

20. For more information  www.healthyamericans.org www.healthyamericans.org  Wellness and Prevention Health Reform Digest: https://tfah.wufoo.com/forms/register-for-the- digest/ https://tfah.wufoo.com/forms/register-for-the- digest/  jlevi@tfah.org jlevi@tfah.org