Challenges to public health are never-ending and experts argue that budget cuts that will be made through the American Health Care Act (AHCA) will have dire consequences to how we can respond.
The challenges facing public health are seemingly never-ending.
Which is too bad—especially considering that programs designed to prevent and/or contain the problems posed by infectious diseases may be drawing their dying breaths, at least if ongoing media coverage of efforts to reform US healthcare are any indication.
According to a June 13, 2017 report in The Wall Street Journal, public health officials in several states are concerned that changes proposed under the American Health Care Act (AHCA)—the legislation crafted by Republicans in the House of Representatives, with input from President Donald Trump, to replace the Affordable Care Act (ACA; or “Obamacare”)—will strip some $1 billion in federal funds earmarked for health programs at the local level across the country, including vaccination campaigns and educational initiatives. Monies for these “prevention programs” come from the Centers for Disease Control and Prevention (CDC), which would be unable to finance them should the proposed legislation be approved, as written, by the Senate (an unlikely scenario, according to most observers).
As we reported in the Public Health Watch back on May 10, 2017, the so-called Prevention and Public Health Fund (PPHF), from which the nearly $1 billion in funding is derived, currently accounts for 12% of the CDC’s annual budget. The fund was established under the ACA, and it received $931 million in fiscal year 2017 and is slated to receive $837 million in fiscal year 2018. Republican critics of the program say it has been used to create initiatives with questionable utility, such as Zumba classes and massage therapy offerings.
However, its supporters say the funds have been essential in helping set up influenza vaccination programs in impoverished areas where access to healthcare is limited and educational efforts designed to inform the general public on diseases such as Zika in high-risk areas and, hopefully, prevent new infections.
According to The Wall Street Journal, earlier this year more than 300 organizations wrote a letter to Congressional leaders and President Trump asking them to preserve the PPHF; since then, some 200 additional societies, educational institutions, and advocacy groups have added their signatures. Signatories of the letter now include the Infectious Disease Society of America, American Academy of Pediatrics, and Johns Hopkins Bloomberg School of Public Health, The Journal notes. The letter warns of “dire consequences” should the fund be eliminated.
It continues: “Discretionary programs, including public health, education, and job training programs funded through the Labor-Health and Human Services-Education (LHHS) appropriations spending bill have been cut dramatically and disproportionately in recent years as lawmakers have worked to reduce the deficit, even though experts across the political spectrum agree these programs are not a driving factor behind our nation’s mid- and long-term fiscal challenges. Funding prevention not only saves lives but it saves money. A comprehensive study of evidence-based prevention programs found that every dollar invested yields $5.60 in savings.”
That’s roughly $5 billion for those of you scoring at home—a significant amount for most of us, though only a small fraction of the federal budget, which for 2017 is in excess of $4.1 trillion (with a deficit of more than $500 billion).
Makes you wonder what we are really arguing about here, doesn’t it?
Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.