ISSUE REPORT A H E A LT H I E R A M E R I C A : 10 Top Priorities Ourfor a Vision Healthier for Prevention MARCH 2008 PREVENTING EPIDEMICS. PROTECTING PEOPLE. Ourfor a Vision Healthier A HEALTHIER AMERICA: 10 Top Priorities for Prevention A merica spends more than $2 trillion annually on health care, more than any other nation. Yet tens of millions of Americans still suffer every day from preventable illness and chronic disease. Additionally, the skyrocketing costs of health insurance threaten to bankrupt American businesses and weaken our economy. Some companies have already begun sending jobs to other countries where health care costs are lower, and this trend is likely to continue unless the health of the nation improves and costs are contained. Several factors contribute to the health care It’s time for the country to change course. crisis. One of the most important is our Solutions to the problem must begin with health care system’s focus on caring for peo- stopping illness or harm before they occur. ple after they have become sick or harmed. Prevention must drive America’s health strategy. TFAH IS A NON-PROFIT, TRUST FOR AMERICA’S HEALTH (TFAH) HAS IDENTIFIED 10 TOP NON-PARTISAN ORGANIZATION DEDICATED TO SAVING LIVES COMPONENTS OF AN EFFECTIVE NATIONAL PREVENTION STRATEGY: BY PROTECTING THE I Promoting Disease Prevention HEALTH OF EVERY COMMUNITY I Combating the Obesity Epidemic AND WORKING TO MAKE I Preventing Tobacco Use and Exposure DISEASE PREVENTION A NATIONAL PRIORITY. I Preventing and Controlling Infectious Diseases I Preparing for Potential Health Emergencies and Bioterrorism Attacks I Recognizing the Relationship Between Health and U.S. Economic Competitiveness I Safeguarding the Nation’s Food Supply I Planning for Changing Health Care Needs of Seniors FIND OUT MORE AT I Improving the Health of Low-Income and Minority Communities www.healthyamericans.org I Reducing Environmental Threats OR CONTACT TRUST FOR AMERICA’S HEALTH DIRECTOR OF GOVERNMENT RELATIONS PLUS A CROSS-CUTTING RECOMMENDATION FOR: RICHARD HAMBURG, I Holding Government Accountable for Protecting the Health of Americans RHAMBURG@TFAH.ORG OR 202-223-9870 X 18 A H E A LT H I E R A M E R I C A : 10 TOP PRIORITIES FOR PREVENTION Promoting Disease Prevention WHY ARE CHRONIC DISEASES A THREAT TO OUR NATION’S HEALTH? “THE U.S. HAS THE Preventable Diseases Are Pervasive: I Routine childhood vaccinations prevent HIGHEST RATE OF I More than half of all Americans live with more than 14 million cases of disease PREVENTABLE one or more chronic disease, including annually.6 DEATHS AMONG heart disease, stroke, diabetes, and cancer.2 Prevention Efforts Also Lower Health 19 INDUSTRIALIZED I Seven out of 10 deaths in the U.S. are due Care Spending: NATIONS.” I to chronic diseases.3 I Of the more than $1.7 trillion in health care spent nationally every year, less than -- Health Affairs Prevention Efforts Could Greatly Reduce 4 cents out of every dollar is spent on pre- Disease Rates: vention and public health, even though I According to the U.S. Centers for Disease studies show that disease prevention is Control and Prevention (CDC), the major- one of the most effective ways to reduce ity of chronic diseases could be prevented health care spending.7, 8 through lifestyle and environmental changes. For instance: I Between 1990 and 1998, the California Tobacco Control Program saved more L Reducing adult smoking rates by one than $3 billion in smoking-caused percent could result in more than health costs.9 30,000 fewer heart attacks, 16,000 fewer strokes, and savings of over $1.5 I Routine childhood vaccinations result in billion over five years.4 $50 billion saved annually in direct and indirect costs.10 L If one-tenth of Americans began a regular walking program, $5.6 billion could be saved in the treatment of heart disease.5 MARCH 2008 PREVENTING EPIDEMICS. PROTECTING PEOPLE. WHAT CAN BE DONE TO REDUCE PREVENTABLE DISEASES? I Implement a National Prevention ties across the nation. Special emphasis Strategy. The federal government should should be placed on developing cultural- develop and implement a National ly competent communication campaigns Prevention Strategy focusing on ways to that use respected and trusted messen- lower disease rates that is a shared respon- gers and appropriate channels for high- sibility, involving every federal govern- risk communities. ment agency, defines clear roles and I Promote Healthy Communities. Every responsibilities for states and localities, segment of society has a role to play in and engages private industry and com- prevention, including families, health munity groups. Developing and imple- care providers, schools, businesses, and menting policies aimed at reducing obesi- communities. Federal, state, and local ty and tobacco use should be key objec- governments should take a leadership tives of the strategy. role in engaging all of these sectors to I Expand Preventive Care Benefits. find ways to make communities healthier Federal, state, and local governments and make it easier for people to make must enhance Medicare and Medicaid healthy choices. programs and work with private employ- I Expand Disease Prevention Research. ers and insurers to make certain that all More resources must be devoted to Americans have access to preventive researching ways to prevent and reduce health care. disease, including ways to encourage peo- I Increase Preventive Services and Public ple to make healthy lifestyle choices, such Education Campaigns in Communities. as avoiding smoking and participating in Proven prevention measures, such as more physical activity. Currently, the fed- immunizations and cancer screenings eral government spends 94 percent of and public information campaigns to health dollars on diagnosis and treatment encourage healthy eating, increased phys- of disease, and only 6 percent of health ical activity, and tobacco cessation, should dollars on researching causes and pre- be funded and carried out in communi- venting disease. ENDNOTES Program. Atlanta, GA: U.S. Department of Health and 1 E. Nolte and C. Martin McKee. “Measuring the Health Human Services, February 2007. of Nations: Updating an Earlier Analysis.” Health 7 J. M. Lambrew. A Wellness Trust to Prioritize Disease Affairs, 27, no. 1 (2008): 58-71. Prevention. Washington, D.C.: Brookings Institution, 2 R. DeVol and A. Bedroussian, et al. An Unhealthy April 2007. http://www.brookings.edu/papers/2007/ America: The Economic Burden of Chronic Disease. Santa ~/media/Files/rc/papers/2007/04useconomics_lam- Monica, CA: Milken Institute, October 2007. brew/04useconomics_lambrew.pdf (accessed January http://www.milkeninstitute.org/publications/publica- 11, 2008). tions.taf?function=detail&ID=38801020&cat=ResRep. 8 Prevention Institute and The California Endowment (accessed October 10, 2007). with the Urban Institute. “Reducing Health Care Costs 3 U.S. Centers for Disease Control and Prevention. Through Prevention: Working Document.” August The Burden of Chronic Diseases and Their Risk Factors: 2007. http://www.preventioninstitute.org/docu- National and State Perspectives 2004. Atlanta: GA: U.S. ments/HE_HealthCareReformPolicyDraft_091507.pdf Department of Health and Human Services, 2004. (accessed January 28, 2008). http://0-www.cdc.gov.mill1.sjlibrary.org:80/nccd- 9 California Department of Health Services. “Economic php/ burdenbook2004. (accessed May 7, 2007). and Health Effects of a State Cigarette Excise Tax 4 J.M. Lightwood and S.A. Glantz. “Short-Term Increase in California.” California Department of Economic and Health Benefits of Smoking Cessation -- Health Services, Tobacco Control Section, May 26, Myocardial Infarction and Stroke,” Circulation 96 2006. http://www.calhealth.org/public/press/ (1997): 1089-1096. Article%5C103%5CTax%20Impact%20Exec%20Sum mary.pdf (accessed January 11, 2008). 5 B. Bulwar. “Sedentary Lifestyles, Physical Activity, and Cardiovascular Disease: From Research to Practice.” 10 R. DeVol and A. Bedroussian, et al. An Unhealthy Critical Pathways in Cardiology 3, no. 4 (December America: The Economic Burden of Chronic Disease. Santa 2004): 184-193. Monica, CA: Milken Institute, October 2007. http://www.milkeninstitute.org/publications/publica- 6 U.S. Centers for Disease Control and Prevention. tions.taf?function=detail&ID=38801020&cat=ResRep. Program in Brief: Section 317 Immunization Grant (accessed October 10, 2007). A H E A LT H I E R A M E R I C A : 10 TOP PRIORITIES FOR PREVENTION Combating the Obesity Epidemic WHY IS THE OBESITY EPIDEMIC A THREAT TO OUR NATION’S HEALTH? “DESPITE STEADY A Growing Problem: High Costs: PROGRESS OVER MOST OF I Two-thirds of Americans are obese or I Obesity-related health care costs approxi- THE PAST CENTURY overweight.2 mately $117 billion annually.12 TOWARD ENSURING THE I Rates of adult obesity now exceed 20 per- HEALTH OF OUR Alarming Trends: cent in 47 states and D.C and 25 percent I Twenty-two percent of American adults COUNTRY’S CHILDREN, WE in 19 states. In 1991, rates did not exceed 20 percent in a single state.3 report that they do not engage in any BEGIN THE 21ST CENTURY physical activity.13 I Approximately 25 million U.S. children are WITH A STARTLING obese or overweight. Rates of childhood L Only 54 percent of high school stu- SETBACK -- AN EPIDEMIC obesity have more than tripled since 1980.4 dents had a physical education class at OF CHILDHOOD OBESITY. least once a week, and only 33 percent Health Consequences: of high school students had daily phys- THIS EPIDEMIC IS ical education.14 I Obesity and physical inactivity are risk fac- OCCURRING IN BOYS tors in more than 20 chronic diseases, L More than 35 percent of high school AND GIRLS IN ALL 50 including type 2 diabetes, heart disease, students watch 3 or more hours of TV STATES, IN YOUNGER and some forms of cancer.5 and more than 20 percent of high school students played video or com- CHILDREN AS WELL AS L More than 20 million American adults puter games or used a computer for ADOLESCENTS, ACROSS ALL have type 2 diabetes, and 54 million non-school activities for 3 or more more are pre-diabetic.6 Two million SOCIOECONOMIC STRATA, hours on an average school day.15 adolescents have pre-diabetes.7 AND AMONG ALL ETHNIC I Consumption of added sugar in the aver- L More than 75 percent of hypertension GROUPS...”I age diet has increased 22 percent since cases can be attributed to obesity.8 the 1980s.16 L Approximately 20 percent of cancer in -- INSTITUTE OF MEDICINE’S I Spending in fast food restaurants has women and 15 percent of cancer in PREVENTING CHILDHOOD grown more than 18 times (from $6 bil- men can be attributed to obesity.9 OBESITY: HEALTH IN THE lion to $110 billion) in the past 30 years.17 L Obesity increases a child’s risk for a range BALANCE of health problems and negatively impacts mental health and school performance.10, 11 MARCH 2008 PREVENTING EPIDEMICS. PROTECTING PEOPLE. WHAT CAN BE DONE TO COMBAT THE EPIDEMIC? I Implement a National Strategy to with private employers and insurers to Combat Obesity. The federal govern- make certain that every working American ment should develop and implement a has access to a workplace wellness pro- national strategy that is a shared responsi- gram and preventive care benefits. bility, involving every federal government I Make Healthy Choices Easy Choices: agency, define clear roles and responsibil- Creating Opportunities for Exercise and ities for states and localities, and engage Healthy Eating. Americans must be given private industry and community groups. the tools they need to engage in more phys- I Improve Nutrition and Promote Physical ical activity, since even small amounts of Activity in Schools. School meal programs activity can lead to major health improve- should concentrate on setting high nutri- ments. Children should be given the tional standards for foods served in schools, opportunity to be more physically active instead of focusing on minimum nutrition throughout the day, both in and out of standards. The USDA should immediately school. The communities we live in should require schools to meet or exceed the 2005 allow greater opportunities for activity, Dietary Guidelines for Americans, and including places for safe and affordable implement the Institute of Medicine’s nutri- public recreation and increased availability tion standards for foods sold à la carte in of sidewalks. Americans must also be given schools by vending machines or other com- the tools to take responsibility for their eat- petitive marketers. Since physical activity ing habits, including nutritional recom- has been shown to improve health as well as mendations and information and access to academic performance, schools must also supermarkets and affordable healthy foods. increase the amount of time kids spend in I Invest in Research. What are the most effec- physical education classes and work to tive school-based, community-based and ensure that students spend time engaging family-based prevention strategies? What are in moderate-to-vigorous physical activity the factors that put children most at-risk of before school, between classes and after the obesity? What is the real cost of childhood school day school ends. obesity to the economy? We need to invest I Encourage Every Employer to Offer a in research to answer these and other ques- Workplace Wellness Program. Federal, tions to find real, science-based solutions state, and local governments must work that will work in the long-term. ENDNOTES http://www.obesity.org/subs/fastfacts/Health_Effects.s 1 Institute of Medicine. Preventing Childhood Obesity: html (accessed June 6, 2005). Health in the Balance. Washington, D.C.: National 9 U.S. Centers for Disease Control and Prevention. Academies Press, 2005. “Obesity in the News: Helping Clear the Confusion.” 2 National Center on Vital Statistics. Health, United States. Power Point Presentation, May 25, 2005. Atlanta, GA: U.S. Centers for Disease Control and 10 W.H. Dietz. “Health Consequences of Obesity in Prevention, 2003. Youth: Childhood Predictors of Adult Disease.” 3 Trust for America’s Health. F as in Fat: How Obesity Pediatrics 101, no. 3 (1998): 518-525. Policies Are Failing in America. Washington, D.C.: Trust 11 A. Datar and R. Strum. “Childhood Overweight and for America’s Health, 2007. Elementary School Outcomes.” International Journal of 4 National Center for Health Statistics. Press Release: Obesity 30, (2006): 1449-1460. Obesity Still a Major Problem. Atlanta, GA: U.S. Centers 12 U.S. Department of Health and Human Services. for Disease Control and Prevention, April 14, 2006. Prevention Makes Common “Cents”. Washington, D.C.: <http://www.cdc.gov/nchs/pressroom/06facts/ U.S. Department of Health and Human Services, obesity03_04.htm>. 2003. 5 Office of the Surgeon General. The Surgeon General’s 13 U.S. Centers for Disease Control and Prevention. Call to Action to Prevent and Decrease Overweight and Behavioral Risk Factor Surveillance System Survey Data. Obesity. Rockville, MD: U.S. Department of Health and Atlanta, GA: U.S. Department of Health and Human Human Services, Public Health Service, Office of the Services, Centers for Disease Control and Prevention, Surgeon General, 2001. 2006. 6 C.C. Cowie, et al. “Prevalence of Diabetes and 14 U.S. Centers for Disease Control and Prevention, Imparted Fasting Glucose in Adults in the U.S. “Youth Risk Behavior Surveillance -- United States Population: NHANES 1999-2002.” Diabetes Care 29 2005,” MMWR Surveillance Summaries 55, no. SS05 (2006): 1263-8. (2006):1-108. 7 American Diabetes Association. “Total Prevalence of 15 Ibid. Diabetes & Pre-diabetes.” American Diabetes 16 Ibid. Association. http://diabetes.org/diabetes- statistics/prevalence.jsp (accessed July 10 2007). 17 E. Schlosser. Fast Food Nation: The Dark Side of the All- American Meal. New York, NY: Houghton Mifflin 8 American Obesity Association. “Health Affects of Books, 2001. Obesity.” American Obesity Association. A H E A LT H I E R A M E R I C A : 10 TOP PRIORITIES FOR PREVENTION Preventing Tobacco Use and Exposure WHY IS TOBACCO USE A THREAT TO OUR NATION’S HEALTH? “IT IS TROUBLING NEWS A Lingering Problem: and business. Productivity losses from pre- FOR AMERICA’S HEALTH I Worldwide, tobacco use causes nearly 5 mature death total another $97 billion.12 THAT PROGRESS HAS million deaths per year.2 I People exposed to secondhand smoke STALLED IN REDUCING I Tobacco use is the leading preventable cause run up an average $10 billion annually in TOBACCO USE, THE of death in the U.S. Every year, smoking and health care costs.13 NATION’S NUMBER ONE secondhand smoke kill about 440,000 people in the U.S. by causing lung cancer, emphyse- Alarming Trends: PREVENTABLE CAUSE OF ma, heart disease and other illnesses.3 I Every day in America, 4,000 kids try their DEATH. IT IS ALSO first cigarette. Another 1,000 kids become I Exposure to second-hand smoke is respon- INEXCUSABLE THAT daily smokers and one-third of them will sible for approximately 38,000 of these ELECTED LEADERS HAVE die prematurely as a result.14 deaths each year.4 I Progress in reducing smoking has stalled NOT DONE MORE GIVEN I Nearly 21 percent of U.S. adults still smoke, among both youth and adults. In 2006, 20.8 THE OVERWHELMING as do 23 percent of U.S. high school stu- percent of adults smoked cigarettes, about SCIENTIFIC EVIDENCE OF dents.5 While significant reductions were the same as the 20.9 percent in 2004 and achieved in the late 1990’s and early 2000’s, WHAT WORKS TO 2005. Among high school students, smok- progress has stalled in recent years. ing increased from 21.9 percent in 2003 to REDUCE TOBACCO USE 23 percent in 2005. This increase followed AMONG BOTH CHILDREN Health Consequences: a 40 percent decline in high school smok- I Smoking harms nearly every organ of the ing between 1997, when rates peaked at AND ADULTS.”1 body; causing many diseases and reducing 36.4 percent, and 2003.15 the health of smokers in general.6 -- WILLIAM V. CORR, I Tobacco company marketing expenditures I Cancer is the second leading cause of have skyrocketed since the 1998 state tobac- EXECUTIVE DIRECTOR, death in the U.S.; more than 80 percent of co settlement. From 1998 to 2005, tobacco CAMPAIGN FOR lung cancer deaths and about 20 percent marketing expenditures nearly doubled TOBACCO-FREE KIDS of all cancer deaths are caused by tobacco.7 from $6.9 billion to $13.4 billion, according I Smoking causes cancers of the bladder, to the Federal Trade Commission’s most oral cavity, pharynx, larynx, esophagus, recent report on tobacco marketing.16 cervix, kidney, lung, pancreas, and stom- I Most states still fail to fund tobacco preven- ach, and causes acute myeloid leukemia.8 tion programs at levels recommended by I Smoking causes coronary heart disease, the the CDC. In FY 2008, states will spend less leading cause of death in the United States.9 than 3 percent of the $24.9 billion available Smoking triples the risk of dying from heart dis- to them from tobacco excise taxes and the ease among middle-aged men and women.10 1998 Master Settlement Agreement (MSA) with the tobacco companies on tobacco I Cigarette smoking causes 80-90 percent of prevention and cessation programs. deaths from chronic obstructive lung disease.11 Investing only 15 percent of these funds would allow every state tobacco control High Costs: program to be funded at the level recom- I Tobacco use costs the U.S. almost $100 bil- mended by the U.S. Centers for Disease MARCH 2008 lion annually in health care bills, imposing Control and Prevention (CDC).17 a hidden tax on every individual, family PREVENTING EPIDEMICS. PROTECTING PEOPLE. WHAT CAN BE DONE TO STAMP OUT SMOKING? I Regulate Tobacco Products. Congress hand smoke. These include tobacco taxes, should enact long-standing legislation to comprehensive laws to make all workplaces grant the U.S. Food and Drug Administration and public places smoke-free, full funding of (FDA) regulatory authority over tobacco tobacco prevention and cessation programs, products. FDA should have the authority to and access to proven smoking cessation crack down on tobacco marketing and sales methods (e.g., counseling, FDA approved to children, stop tobacco companies from medications) for all tobacco users. misleading consumers and require changes I Reduce Global Tobacco Use and Exposure. in tobacco products to make them less harm- Nations around the world should ratify and ful and less addictive. Currently, FDA regu- implement the new international tobacco lates food, drugs, cosmetics, and even dog control treaty, the Framework Convention food but does not regulate the products that on Tobacco Control, in order to reduce kill more than 400,000 Americans every year. tobacco use and save lives. I Expand Proven Tobacco Control Measures. I Fund Tobacco Prevention Initiatives. State and local leaders should implement Congress and the President should increase proven measures to reduce tobacco use and the amount the CDC receives in federal gov- protect everyone from the harms of second- ernment funding for tobacco prevention. ENDNOTES 42(1993): 645-648. http://www.cdc.gov/mmwr/PDF/ wk/mm4233.pdf (accessed February 15, 2008) 1 Campaign for Tobacco Free Kids. “Press Release: CDC Reports Adult Smoking Declines Have Stalled; Elected 10 Ibid. Officials Should Step Up Fight Against Tobacco.” 11 Office of the Surgeon General. The Health Consequences Washington, D.C.: Campaign for Tobacco Free Kids, of Smoking: A Report of the Surgeon General. Washington, November 8, 2007. http://www.tobaccofreekids.org/ D.C.: U.S. Department of Health and Human Services, Script/DisplayPressRelease.php3?Display=1042 Centers for Disease Control and Prevention, National (accessed February 19, 2008). Center for Chronic Disease Prevention and Health 2 World Health Organization. The World Health Report Promotion, Office on Smoking and Health, 2004. 2002: Reducing Risks, Promoting Healthy Life. Geneva: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2 World Health Organization, 2002. 004/index.htm#full (accessed February 15, 2008) http://www.who.int/whr/2002/en/index.html. 12 U.S. Centers for Disease Control and Prevention. (accessed February 15, 2008). Sustaining State Programs for Tobacco Control: Data 3 U.S. Centers for Disease Control and Prevention. “Annual Highlights 2006. http://www.cdc.gov/tobacco/data_ Smoking Attributable Mortality, Years of Potential Life statistics/state_data_highlights/2006/index.htm Lost, and Productivity Losses -- United States, 1997-2001.” (accessed February 15, 2008). And, U.S. Centers for Morbidity and Mortality Weekly Report 54 (2005): 625-628. Disease Control and Prevention. “Annual Smoking- http://www.cdc.gov/mmwr/preview/mmwrhtml/ Attributable Mortality, Years of Potential Life Lost and mm5425a1.htm (accessed February 15, 2008). Economic Costs -- United States, 1997-2001.” Morbidity 4 California EPA, Proposed Identification of Environmental and Mortality Weekly Report 54 (2005): 625-628. Tobacco Smoke as a Toxic Air Contaminant, June 24, 2005, http://www.cdc.gov/mmwr/preview/mmwrhtml/ http://repositories.cdlib.org/tc/surveys/CALEPA2005C mm5425al.htm (accessed February 15, 2008). /. See also, CDC, “Factsheet: Secondhand Smoke,” 13 D.F. Behan, et al. Economic Effects of Environmental Toba- September 2006, http://www.cdc.gov/tobacco/data_sta- cco Smoke Report. Schaumburg, IL: Society of Actuaries, tistics/Factsheets/SecondhandSmoke.htm 2005. http://www.soa.org/files/pdf/ETSReportFinal 5 National Center for Health Statistics, 2006 National Health Draft(Final%203).pdf (accessed February 15, 2008). Interview Survey. 2005 National Youth Risk Behavior Survey. 14 Substance Abuse and Mental Health Services 6 Office of the Surgeon General. The Health Consequences Administration. Results from the 2006 National Survey on of Smoking: A Report of the Surgeon General. Washington, Drug Use and Health: National Findings. Rockville, MD: D.C.: U.S. Department of Health and Human Services, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National 2007. http://www.oas.samhsa.gov/nsduh/2k6nsduh/ Center for Chronic Disease Prevention and Health 2k6Results.cfm (accessed February 15, 2008) Promotion, Office on Smoking and Health, 2004. 15 National Health Interview Survey. National Youth Risk http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2 Behavior Survey, 1997, 2003 and 2005. 004/index.htm#full (accessed February 15, 2008). 16 U.S. Federal Trade Commission. Cigarette Report for 7 American Cancer Society. Cancer Facts & Figures, 2008. 2004 and 2005. Washington, DC: U.S. Federal Trade http://www.cancer.org/downloads/STT/ Commission, 2007. http://www.ftc.gov/reports/ tobac- 2008CAFFfinalsecured.pdf (accessed February 22, co/2007cigarette2004-2005.pdf (accessed February 15, 2008). J. Mackay, et al. The Cancer Atlas. Atlanta, GA.: 2008). And U.S. Federal Trade Commission. Smokeless American Cancer Society, 2006. Tobacco Report for the Years 2004 and 2005. Washington, 8 Office of the Surgeon General. The Health Consequences DC: U.S. Federal Trade Commission, 2007. of Smoking: A Report of the Surgeon General. Washington, http://www.ftc.gov/reports/ tobacco/0205smoke- D.C.: U.S. Department of Health and Human Services, less0623105.pdf (accessed February 15, 2008). Centers for Disease Control and Prevention, National 17 Campaign for Tobacco Free Kids. A Broken Promise to Center for Chronic Disease Prevention and Health Our Children: The 1998 State Tobacco Settlement Nine Years Promotion, Office on Smoking and Health, 2004. Later. Washington, D.C.: Campaign for Tobacco Free http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2 Kids; 2007. http://tobaccofreekids.org/reports/settle- 004/index.htm#full (accessed February 15, 2008). ments/2007/fullreport.pdf. (accessed February 15, 9 U.S. Centers for Disease Control and Prevention. “Cigar- 2008). Centers for Disease Control and Prevention ette smoking-attributable mortality and years of life lost -- (CDC), Best Practices for Comprehensive Tobacco United States, 1990.” Morbidity and Mortality Weekly Report Control Programs, Atlanta, GA: U.S. Department of Health and Human Services (HHS), October 2007. A H E A LT H I E R A M E R I C A : 10 TOP PRIORITIES FOR PREVENTION Preventing and Controlling Pandemic Flu and Other Infectious Diseases WHY ARE INFECTIOUS DISEASES A THREAT TO OUR NATION’S HEALTH? “I WOULD LIKE TO Infectious Diseases Are Spreading: million deaths, and the second worst U.S. EMPHASIZE THAT I Thirty-nine new infectious diseases have economic recession since World War II.8 ALTHOUGH WE CANNOT been identified over the past 40 years, I Since 2003, there have been more than 352 BE CERTAIN EXACTLY including HIV/AIDS, Ebola, and Severe humans infected with H5N1, the avian flu Acute Respiratory Syndrome (SARS).2 WHEN THE NEXT virus that scientists fear could become the next pandemic for humans (As of January INFLUENZA PANDEMIC I Older infectious diseases, including malaria and tuberculosis, have mutated 2008). Of the 348 humans infected, 219, or WILL OCCUR, WE CAN BE and developed increased drug resistance, 62 percent, have died worldwide.9 VIRTUALLY CERTAIN THAT making them harder to treat.3 I Children and teens are particularly vul- ONE WILL OCCUR AND I Airlines now carry more than 2 billion pas- nerable -- nearly 46 percent of H5N1 THAT THE RESULTING sengers a year, making it possible for any “bird” flu deaths have been individuals diseases they may have to pass from one between the ages of 0-19.10 MORBIDITY, MORTALITY, country to another in a matter of hours.4 AND ECONOMIC Measures for Preventing and Controlling I The regular seasonal flu kills 36,000 Infectious Disease Are Antiquated and DISRUPTION WOULD Americans and hospitalizes 200,000 yearly.5 Inadequate: PRESENT EXTRAORDINARY I More than one million Americans are living I The Institute of Medicine (IOM), Govern- CHALLENGES TO PUBLIC with HIV/AIDS, with an estimated 40,000 ment Accountability Office (GAO), and U.S. HEALTH AUTHORITIES new cases each year.6 Centers for Disease Control and Prevention (CDC) have found America’s public health AROUND THE WORLD.”I I An estimated 4.1 million Americans have been system to be fundamentally unprepared to infected with the hepatitis C virus (HCV), of respond to major modern health threats.11,12,13 — DR. ANTHONY S. FAUCI, whom 3.2 million are chronically infected.7 I The federal and state governments have DIRECTOR, NATIONAL Pandemic Flu Poses A Particularly failed to provide public evaluation of pre- INSTITUTE OF ALLERGY Ominous Threat: paredness and pandemic planning on a AND INFECTIOUS DISEASES, I A severe pandemic flu outbreak could result state-by-state basis, limiting the ability to NATIONAL INSTITUTES OF in 90 million Americans becoming sick, 2.2 gauge progress and identify vulnerabilities. HEALTH, DEPARTMENT OF HEALTH AND HUMAN SERVICES WHAT CAN BE DONE TO BETTER PREVENT AND CONTROL INFECTIOUS DISEASES? I Increase and Better Coordinate Federal- Government at all levels should work to State-Local Government and Private engage the private health care system and Planning and Preparedness. The govern- communities in their plans and efforts. ment should take the lead on preventing Sufficient resources must be devoted to disease, and all jurisdictions should work preparing for possible disease threats and together to create policies that follow best the government should be transparent MARCH 2008 infection-control practices with the federal about their actions and held accountable PREVENTING EPIDEMICS. government providing strong leadership. for protecting the public. PROTECTING PEOPLE. I Prepare for Mass Emergencies. During into contact with unvaccinated individuals. mass emergencies, measures must be put in Vaccines help prevent infectious diseases and place to care for a potential surge of save lives. Vaccines are responsible for the patients, including creating alternative care control of many infectious diseases that were sites and recruiting additional health care once common in this country, including personnel. An emergency health care ben- polio, measles, and mumps.14 efit and improved sick leave policies should I Modernize Disease Surveillance Systems. be enacted to allow the uninsured, under- Every health department and health agency insured, and people without adequate sick should be part of a 21st century surveillance leave to receive care and take time off dur- system that meets national standards and is ing major infectious disease emergencies interoperable between jurisdictions and like a pandemic flu outbreak. agencies to ensure rapid information shar- I Emphasize Prevention, Care, and ing. Plans should ensure adequate laborato- Treatment for Chronic Viral Diseases, ry surveillance of influenza and other infec- Including HIV/AIDS and Hepatitis. tious diseases, as well as testing for Addressing the HIV/AIDS epidemic, hepa- pathogens such as E.Coli, Methicillin-resist- titis, and other chronic viral diseases must ant Staphylococcus Aureus (MRSA), and include increased funding for treatment extensively drug resistant Tuberculosis and care, as well investing in proven pre- (XDR-TB). The U.S. should take the lead vention methods, including clean needle on improving global disease surveillance. and needle exchange programs and other I Replenish and Augment the Strategic science-based behavioral prevention. National Stockpile (SNS). The government I Enhance Research and Development of should ensure the SNS contains enough vac- Vaccines and Public Health Technologies. cines, antiviral medications, and supplies to Basic technology and tools of public health respond to public health crises, and states must be modernized to adequately protect must be better prepared to distribute and the American people. This includes administer needed medications to the public. research and development of vaccines and I Clarify Existing State and Federal Roles in new technologies; and improved chemical Setting Quarantine and Isolation Policies. laboratory testing capabilities. The federal government, in coordination I Increase Childhood and Adult Vaccinations. with the states, must establish clear legal Vaccines prevent disease in the people who authority and emergency measures to receive them and protect those who come effectively contain the spread of disease. ENDNOTES 8 Trust for America’s Health. Pandemic Fu and the Potential for U.S. Economic Recession: A State-by-State 1 A.S. Fauci. The Role of NIH Biomedical Research in Pandemic Influenza Preparedness. Testimony Before the Analysis. Washington, D.C.: Trust for America’s House Committee on Appropriations Subcommittee Health, 2007. <http://healthyamericans.org/ on Labor, HHS, and Education, United States House reports/flurecession/> of Representatives. Washington, D.C.: U.S. 9 World Health Organization. “Cumulative Number of Department of Health and Human Services, National Confirmed Human Cases of Avian Influenza Institutes of Health, 2005. <http://appropriations. A/(H5N1) Reported to WHO,” Updated January 3, house.gov/_files/AnthonyFauciTestimony.pdf> 2008, http://www.who.int/csr/disease/avian_influen- (accessed May 18, 2005). za/country/cases_table_2008_01_03/en/index.html 2 World Health Organization. News Release: (accessed January 9, 2008). International Spread of Disease Threatens Public Health 10 Trust for America’s Health and the American Academy Security. Geneva: WHO, August 23, 2007. of Pediatrics. Pandemic Influenza: Warning, Children At- <http://www.who.int/mediacentre/news/releas- Risk. Washington, D.C.: TFAH, October 2007. es/2007/pr44/en/index.html> 11 Institute of Medicine. The Future of the Public’s Health 3 Ibid. in the 21st Century. Washington, D.C.: National 4 Ibid. Academies Press for the Institute of Medicine, 2003. 5 U.S. Centers for Disease Control and Prevention. “Key 12 U.S. Government Accountability Office. HHS Facts about Seasonal Influenza (Flu).” U.S. Bioterrorism Preparedness Programs: States Reported Progress Department of Health and Human Services. But Fell Short of Program Goals in 2002. Washington, http://www.cdc.gov/flu/keyfacts.htm (accessed D.C., Government Accountability Office, 2004. October 12, 2007). 13 U.S. Centers for Disease Control and Prevention. 6 U.S. Centers for Disease Control and Prevention. “A Public Health Infrastructure -- A Status Report. Atlanta, Glance at the HIV/AIDS Epidemic.” U.S. Department GA: U.S. Department of Health and Human Services, of Health and Human Services. http://www.cdc.gov/ Centers for Disease Control and Prevention, 2001. hiv/resources/factsheets/At-A-Glance.htm (accessed 14 U.S. Centers for Disease Control and Prevention. January 28, 2008). “The Importance of Childhood Immunizations.” U.S. 7 U.S. Centers for Disease Control and Prevention. Department of Health and Human Services, Centers “Hepatitis C Fact Sheet.” U.S. Department of Health for Disease Control and Prevention, 2006. and Human Services. http://www.cdc.gov/ncidod/ dis- http://www.cdc.gov/vaccines/vac-gen/ eases/hepatitis/c/cfact.pdf (accessed January 28, 2008). importance.htm (accessed January 23, 2008) A H E A LT H I E R A M E R I C A : 10 TOP PRIORITIES FOR PREVENTION Preparing for Potential Health Emergencies and Bioterrorism Attacks WHY ARE HEALTH EMERGENCIES AND BIOTERRORISM A THREAT “THE ASSUMPTION THAT TO OUR NATION’S HEALTH? CONVENTIONAL PUBLIC The Nation Remains Inadequately tion system, however it still “lacks real- HEALTH AND MEDICAL Prepared: time capability and has issued a stream of SYSTEMS CAN FUNCTION I Despite a federal investment of more false alarms that would be comical were EFFECTIVELY IN than $6 billion to improve public health the stakes not so high.”7 CATASTROPHIC HEALTH emergency preparedness after September 11, 2001, analyses find critical areas of the The Impact of Health Emergencies Can EVENTS HAS, HOWEVER, nation’s emergency preparedness effort Take Enormous Human and Financial Tolls: PROVED TO BE INCORRECT still require attention.2 I The September 11, 2001 tragedies resulted IN REAL-WORLD in the loss of approximately 3,000 lives and L The federal government has yet to SITUATIONS. THEREFORE, an estimated $80 billion in direct costs.8, 9 establish clear performance measures and data collection methods to assess I An anthrax attack in New York City could IT IS NECESSARY TO the effectiveness of the investments. lead to $90 billion in workers’ compensa- TRANSFORM THE tion losses, 3 times more than the entire I Only 10 labs in the U.S. are equipped to NATIONAL APPROACH $30 billion workers’ compensation indus- test for mustard agents, nerve agents, and TO HEALTH CARE IN try, according to a study by a major finan- other toxic chemicals that could be used cial institution.10 THE CONTEXT OF A in a chemical terrorist attack. I According to a U.S. Centers for Disease CATASTROPHIC HEALTH I Ten states do not have adequate plans to Control and Prevention (CDC) study, if EVENT IN ORDER TO distribute emergency vaccines, antidotes, public health officials identify an anthrax and medical supplies from the Strategic attack on a city of 100,000 persons, and ENABLE U.S. PUBLIC National Stockpile.3 HEALTH AND MEDICAL distribute antibiotics to the exposed per- I Twenty-one states do not have statutes that sons within 24 hours, the number of lost SYSTEMS TO RESPOND allow for adequate liability protection for lives could be roughly 5,000 and econom- EFFECTIVELY TO A BROAD healthcare volunteers during emergencies.4 ic losses will reach $128 million. But, if it were to take public health officials 6 days RANGE OF INCIDENTS.”1 I Seven states have not purchased any portion to identify the attack, an estimated 33,000 of their federally-subsidized or unsubsidized people could die, and economic losses -- HOMELAND SECURITY antivirals to use during a pandemic flu.5 could reach $26.2 billion.11 PRESIDENTIAL I The Homeland Security Presidential I In 2003, Severe Acute Respiratory DIRECTIVE/HSPD 21 Directive 21 identifies mass casualty care Syndrome (SARS) infected more than as a key priority, however, federal govern- 8,000 people and left 774 dead.12 Its ment funding for hospital surge capacity reach demonstrates the tremendous development is only $100,000 per year speed in which disease can spread. The per hospital, far from the level needed to economic losses, due to lives lost, quaran- adequately prepare.6 tines, and lost tourism dollars, are esti- I Some $230 million has been spent on mated to be $30 billion to $50 billion.13 MARCH 2008 BioSense, the nation’s early-event detec- PREVENTING EPIDEMICS. PROTECTING PEOPLE. HOW CAN WE IMPROVE READINESS FOR HEALTH EMEGENCIES? I Clearly Designate Strong Federal and retaining a robust volunteer health Leadership. National plans should estab- care workforce. Congress should also lish officials in charge of public health address the public health workforce preparedness and specify how various shortage crisis through legislation to departments are to collaborate in the recruit a new generation of professionals. event of a public health emergency. I Modernize Technology and Equipment. I Require Accountability and Conduct Basic technology and tools of public Meaningful Oversight. The federal health must be modernized to adequately Pandemic and All-Hazards Preparedness protect the American people. This Act, was enacted to improve our emer- includes research and development of gency preparedness response capabilities. vaccines and new technologies; improved Many deadlines for benchmarks and chemical laboratory testing capabilities; deliverables, however, have not been met. and, modernized surveillance systems to The Administration must adhere to the detect infectious disease outbreaks or a deadlines in the legislation, and Congress bioterrorist attack. must conduct ongoing oversight to I Partner with the Public. Preparedness ensure that progress is being made. plans need to consider the diverse needs I Bolster Surge Capacity and the Public of the U.S. population, in particular, vul- Health Workforce. Public health emer- nerable and ‘special needs’ populations. gency planning at the federal, state, and This includes designing culturally compe- local levels must include preparations for tent risk communication campaigns that mass emergencies, including surge capac- use respected, trusted messengers to com- ity alternative care sites and recruiting municate the message. ENDNOTES 9 H. Kunreuther and M.K. Erwann. Dealing with Extreme 1 Homeland Security Council. Homeland Security Events: New Challenges for Terrorism Risk Coverage in the Presidential Directive/HSPD 21: Public Health and Medical U.S. Philadelphia, PA: University of Pennsylvania, Preparedness. Washington, D.C.: The White House, Wharton School of Business, April 2004, 2007. http://grace.wharton.upenn.edu/risk/downloads/04- 09%20Howard%20and%20Erwann.pdf (accessed 2 Trust for America’s Health. Ready or Not? Protecting the January 10, 2008). Public’s Health from Diseases, Disasters, and Bioterrorism. Washington, D.C.: TFAH, 2007. 10 Towers Perrin. Workers’ Compensation Terrorism Reinsurance Pool Feasibility Study. Stamford, CT: Towers 3 Ibid. Perrin, March 2004. 4 Ibid. 11 A.F. Kaufmann, et al. “The Economic Impact of a 5 Ibid. Bioterrorist Attack: Are Prevention and Postattack 6 E. Toner, et al. “Meeting Report: Hospital Intervention Programs Justifiable?” Journal of Preparedness for Pandemic Influenza.” Biosecurity and Emerging Infectious Diseases 3, no. 2 (April-June 1997): Bioterrorism 4, no 2. (2006): 1-11. 83-94. 7 K. Eban. “Biosense or Biononsense? Years of 12 World Health Organization. “Summary of Probable Development and Hundreds of Millions of Dollars SARS Cases with Onset of Illness from 1 November Later, What Has the CDC’s Syndromic Surveillance 2002 to 31 July 2003.” WHO. http://www.who.int/ Program Accomplished?” The Scientist 21, no. 4 (April csr/sars/country/table2004_04_21/en/ (accessed 2007): 32, http://www.the-scientist.com/2007/ January 9, 2008). 4/1/32/1 (accessed October 22, 2007). 13 Bio Economic Research Associates. “Thinking Ahead: 8 Congressional Budget Office. “Cost Estimate: H.R. Anticipating Early Impacts of an Avian Influenza 4634: Terrorism Insurance Backstop Extension Act of Pandemic.” Bio-Era. http://www.bio-era.net/ 2004.” CBO, http://www.cbo.gov/ftpdoc.cfm?index= research/add_research_18.html (accessed January 9, 6014&type=0&sequence=0 (accessed January 10, 2008). 2008). A H E A LT H I E R A M E R I C A : 10 TOP PRIORITIES FOR PREVENTION Recognizing the Relationship Between Health and U.S. Economic Competitiveness WHY IS POOR HEALTH A THREAT TO U.S. ECONOMIC “IF WE CAN CREATE A COMPETITIVENESS? HEALTH CARE PLAN Health Care Costs Are Undermining I More than 20 percent of adult Americans THAT CONTAINS COSTS Business Profits and Successes: currently smoke. Lifetime health care costs OR DRIVES THEM DOWN, I Poor health is putting the nation’s eco- for individuals who smoke are $17,500 THAT IMPROVES THE nomic security in jeopardy. The skyrock- higher than for those who do not smoke.8 HEALTH OF THE eting costs of health care threaten to I Workplace injuries annually cost U.S. bankrupt American businesses, causing EMPLOYEE AND employers $46.8 billion — nearly $1 bil- some companies to send jobs to other lion per week -- in direct costs (medical EXTENDS THEIR LIFE, AND countries where costs are lower. and lost wage payments). When indirect AVOIDS CATASTROPHIC I U.S. health care costs exceed $2 trillion costs, such as overtime, training, lost pro- ILLNESS AND DOESN’T annually, nearly 3 times more than in ductivity, are taken into account, costs to 1990, over 8 times more than in 1980.2 employers can climb to as much as $291.6 COST THEM ANY MORE billion each year.9 MONEY, WHY WOULD I More than one-quarter of health care costs are related to obesity, overweight, and phys- ANYONE QUARREL WITH Keeping People Healthier is Crucial to ical inactivity due to associated health prob- Keeping Health Costs Down: THAT PLAN?”I lems including heart disease, hypertension, I Keeping the American workforce well diabetes, and some forms of cancer.3 helps American business remain competi- -- SAFEWAY CEO, STEVEN L Health care costs of obese workers are tive in the global economy, for example: BURD up to 21 percent higher than non- L Caterpillar’s Healthy Balance Program obese workers.4 will save $700 million by 2015.10 L More than one quarter of U.S. health L MetLife estimates a 2.52 return on care costs are related to physical inac- investment from its fitness program, tivity, overweight, and obesity.5 which costs about $550,000 a year, a L Obese and physically inactive workers savings of about $1.38 million per year. also suffer from lower worker produc- The percentage of MetLife employees tivity, increased absenteeism, and high- who were previously considered at high er workers’ compensation claims.6 cardiovascular risk has dropped from about 35 percent of a 200 person ran- L Obese employees, on average, submit dom sample to less than 10 percent.11 twice as many workers compensation claims as normal weight employees, and L Motorola’s Wellness Program saves the these claims are far more expensive.7 company $3.93 for every $1 invested in wellness benefits.12 MARCH 2008 PREVENTING EPIDEMICS. PROTECTING PEOPLE. WHAT CAN BE DONE TO IMPROVE THE HEALTH OF THE U.S. WORKFORCE? I Encourage Every Employer to Offer a strong public health policies and services Workplace Wellness Program. Federal, that help make healthy choices easy choices. state, and local governments must work I Improve Job Safety. Federal agencies, with private employers and insurers to including the Occupational Safety and ensure that every working American has Health Administration (OSHA) and the access to a workplace wellness program National Institute for Occupational Safety and preventive care benefits. Preventive and Health (NIOSH), should receive the benefits should also be extended to funding they need to set and enforce employees’ families. workplace safety and health standards. I Promote Healthy Communities. Businesses I Support Smoke-Free Communities. should support measures to ensure the com- Businesses should adopt create smoke- munities where their employees and their free workplace policies and communities families live are healthy, through advocating should support smoke-free laws and for safe, affordable recreation spaces, side- tobacco-taxes to encourage smoking ces- walks, bike paths, healthy school policies, sation and reduce second-hand smoke. access to affordable healthy foods, and other ENDNOTES 8 Campaign for Tobacco Free Kids. “Fact Sheet: 1 V. Colliver. “Preventive Health Plan May Prevent Cost Lifetime Health Costs of Smokers vs. Former Smokers Increases: Safeway Program Includes Hot Line, vs. Nonsmokers.” Campaign for Tobacco Free Kids. Lifestyle Advice.” San Francisco Chronicle, February 11, http://www.tobaccofreekids.org/research/factsheets/p 2007. df/0277.pdf (accessed January 10, 2008). 2 KaiserEDU.org. “U.S. Health Care Costs: Background 9 The Liberty Mutual Research Institute for Safety. Brief.” Kaiser Family Foundation. http://www.kaisere- “2006 Liberty Mutual Workplace Safety Index.” Liberty du.org/topics_im.asp?imID=1&parentID=61&id=358 Mutual. http://www.wausau.com/omapps/Content (accessed January 10, 2008). Server?cid=1078452376750&pagename=wcmInter%2F Document%2FShowDoc&c=Document. (access 3 K. Thorpe, et al. “Trends: The Impact Of Obesity On January 28, 2008). Rising Medical Spending.” Health Affairs 4, (October 2004): 480-486. 10 U.S. Department of Health and Human Services. Prevention Makes Common “Cents”. Washington, D.C.: 4 E. Ostbye, et al. “Obesity and Workers’ Compensation: U.S. Department of Health and Human Services, Results from the Duke Health and Safety Surveillance 2003. System.” Archives of Internal Medicine 167, no. 8, (2004):766-773. 11 Business Roundtable. Doing Well Through Wellness: 2006-07 Survey of Wellness Programs at Business 5 L.H. Anderson, et al. “Health Care Charges Associated Roundtable Member Companies. Washington, D.C.: with Physical Inactivity, Overweight, and Obesity.” Business Roundtable, 2007. http://www.business- Preventing Chronic Disease 2, no. 4, (October 2005):1-12. roundtable.org/pdf/Health_Retirement/BR_Doing_ 6 S. Klarenbach, et al. “Population-Based Analysis of Well_through_Wellness_09192007.pdf (accessed Obesity and Workforce Participation.” Obesity 14, no. 5 October 9, 2007). (May 2006): 920-927. 12 U.S. Department of Health and Human Services. 7 Ibid. Prevention Makes Common “Cents”. Washington, D.C.: U.S. Department of Health and Human Services, 2003. A H E A LT H I E R A M E R I C A : 10 TOP PRIORITIES FOR PREVENTION Safeguarding the Nation’s Food Supply WHY ARE FOODBORNE ILLNESSES A THREAT TO OUR “OUR FRAGMENTED NATION’S HEALTH? FOOD SAFETY SYSTEM Major Cause of Sickness and Death: percent decline in beef and live cattle HAS RESULTED I Approximately 76 million cases of food- exports.10 Slaughter and disposal costs of IN INCONSISTENT borne diseases occur in the U.S. each at-risk cattle could add up to an addition- OVERSIGHT, INEFFECTIVE year, leading to an estimated 325,000 hos- al $12 billion.11 COORDINATION, AND pitalizations and 5,000 deaths.2 Virtually all of these illnesses could be prevented if Outdated Regulation and Poor Coordination INEFFICIENT USE OF the right measures are taken to improve Leave U.S. Food Supply Vulnerable: RESOURCES. WITH 15 the U.S. food safety system. I Studies from the National Academy of AGENCIES COLLECTIVELY Sciences (NAS), the Institute of Medicine I More than 200 known diseases are trans- ADMINISTERING AT LEAST (IOM), and the U.S. Government mitted through food, many through Accountability Office (GAO) have all 30 LAWS RELATED TO improper food handling techniques.3 raised serious concerns about the system FOOD SAFETY, THE I One outbreak of E. coli contamination in that is responsible for keeping the coun- spinach in 2006 caused more than 200 try’s food safe.12, 13, 14 PATCHWORK NATURE OF known illnesses and at least 3 deaths. THE FEDERAL FOOD I None of the agencies with the largest Officials believe for every E. coli case report- roles in food safety oversight has ultimate SAFETY OVERSIGHT SYSTEM ed, 20 go unreported.4, 5 authority or responsibility, and no agency CALLS INTO QUESTION takes an integrated, holistic approach to Agriculture and Food Production Are WHETHER THE FEDERAL ensuring food safety. Essential to the Economy: GOVERNMENT CAN MORE I Agriculture represents one-sixth of the L As one example: FDA regulates frozen cheese pizzas, but if the pizza is topped EFFICIENTLY AND Gross Domestic Product at more than $1 trillion a year and accounts for over $50 bil- with cooked meat or poultry, it is regu- EFFECTIVELY PROTECT OUR lion in exports annually, the largest positive lated by USDA.15 Inspections at pizza NATION’S FOOD SUPPLY.”I contribution to the national trade balance.6 production facilities must follow 2 sets of guidelines, one issued from FDA and I Agriculture and the food sector employ one from USDA. USDA already inspects -- 2007 REPORT BY one out of every 7 U.S. workers, more plants making pepperoni pizza every GOVERNMENT than any other single industry.7 day, after it has already inspected the ACCOUNTABILITY OFFICE I Over 13 percent of all jobs in metropoli- manufacture of the pepperoni on a LISTING FOOD SAFETY AS tan areas are tied to agriculture and the daily basis and the slaughter of every ONE OF THE FEDERAL food sector.8 animal used to make the pepperoni. GOVERNMENT’S “HIGH RISK” I Plant diseases alone currently cost the I FDA is responsible for 80 percent of food PROGRAMS U.S. economy an estimated $33 billion safety oversight, but two-thirds of the food a year.9 safety budget goes to USDA.16 CDC esti- mates that 85 percent of cases of illness I If a significant outbreak of mad cow dis- reported for which there is a known food ease in the United States occurred, the source were associated with FDA-regulat- Food and Drug Administration (FDA) ed food products. estimates that there would be a loss of $15 billion, resulting from a 24 percent I The FDA’s main food safety statutes date MARCH 2008 decline in domestic beef sales and an 80 back to 1938 or earlier. PREVENTING EPIDEMICS. PROTECTING PEOPLE. HOW CAN WE KEEP OUR FOOD SUPPLY SAFER? I Unify Government Food Safety tem, and then devoting resources to Agencies. Legislation should be passed to reduce and eliminate threats as much as bring existing food safety agencies togeth- possible, where inspections and other er into a single, unified food safety agency efforts are applied in ways most likely to to carry out a prevention-focused, inte- contribute to disease reduction. grated food safety strategy. I Improve Federal-State-Local Efforts. States I Develop a Prevention- and Risk-Based should adopt the FDA’s Food Code that sets Strategy. Policies and resources should forth up-to-date, scientifically sound prac- be reevaluated to set priorities based on tices and enroll in the FDA’s Voluntary understanding where the highest and National Retail Food Regulatory Program most likely risks are in the food safety sys- for more uniform and accountable practices ENDNOTES 10 Food and Agriculture Organization of the United 1 L. Shames. Federal Oversight of Food Safety: High-Risk Nations. The State of Food and Agriculture 2001. Rome, Designation Can Bring Attention to Limitations in the Italy: Food and Agriculture Organization of the Government’s Food Recall Programs. Testimony of Lisa United Nations, 2001. Shames, Acting Director Natural Resources and 11 Ibid. Environment, Government Accountability Office 12 National Academy of Sciences. Addressing Foodborne before the Subcommittee on Oversight and Threats to Health: Policies, Practices, and Global Investigations, Committee on Energy and Commerce, Coordination, Workshop Summary. Washington, D.C.: House of Representatives. Washington, D.C.: U.S. National Academy Press, 2006. Government Accountability Office, 2007. http://www.gao.gov/new.items/d07785t.pdf. 13 Committee to Ensure Safe Food from Production to Consumption, Institute of Medicine and National 2 P.S. Mead, et al. “Food-Related Illness and Death in Research Council. Ensuring Safe Food: From Production the United States.” Emerging Infectious Diseases 5, no. 5, to Consumption. Washington, D.C.: National Academy (Sept-Oct 1999): 607-625. http://www.cdc.gov/nci- Press, 1998. dod/eid/vol5no5/mead.htm. 14 Government Accountability Office. Food Safety: USDA 3 Ibid. and FDA Need to Better Ensure Prompt and Complete 4 L. Sander. “Nebraska Woman’s Death Brings to 3 Those Recalls of Potentially Unsafe Food. Washington, D.C.: Attributed to Spinach.” New York Times, October 7, 2006. U.S. Government Accountability Office, 2004. 5 A. Shin. “E. Coli Detected Near Spinach.” Washington 15 Committee to Ensure Safe Food from Production to Post, October 13, 2006. Consumption, Institute of Medicine and National 6 H. Parker. Agricultural Bioterrorism: A Federal Strategy to Research Council. Ensuring Safe Food: From Production Meet the Threat: McNair Paper 65. Washington, D.C.: to Consumption. Washington, D.C.: National Academy National Defense University, 2002. Press, 1998. 7 Ibid. 16 M. Taylor. Improving Food Safety, Noontime Seminar at the George Washington University School of Public Health and 8 Ibid. Health Policy. Washington, D.C.: September 24, 2007. 9 D. Pimentel, et al. “Environmental and Economic Costs Associated with Non-indigenous Species in the United States.” BioScience 50, no. 1, (2000):53-65. A H E A LT H I E R A M E R I C A : 10 TOP PRIORITIES FOR PREVENTION Managing the Changing Health Care Needs of Seniors WHY ARE THE CHRONIC DISEASES OF AGING A THREAT TO OUR “CHRONIC DISEASES NATION’S HEALTH? EXACT A PARTICULARLY High Health Burden, High Financial Costs: I There is growing evidence that Alzheimer’s HEAVY HEALTH AND I By 2030, 20 percent of the U.S. population can be prevented or delayed through ECONOMIC BURDEN ON -- 71 millions Americans -- will be 65 or health lifestyles, physical activity, and “exer- older. Aging-related diseases are projected cising” the brain by reading and staying OLDER ADULTS DUE TO to increase the country’s health care costs socially active. ASSOCIATED LONG-TERM by 25 percent during this time period.2 I Seniors with the flu are at higher risk for ILLNESS, DIMINISHED I 80 percent of America’s seniors (people developing pneumonia as a complication, 65 and older) live with at least one chron- which can be lethal, particularly in older QUALITY OF LIFE, AND ic disease that could lead to premature adults. Flu and pneumonia are currently GREATLY INCREASED death or disability.3 the eighth leading cause of death in the United States. In 2004, over one million HEALTH CARE COSTS. Many Health Problems Could Be hospitalizations and 60,207 deaths were associated with people who died from pneu- ALTHOUGH THE RISK OF Prevented, Delayed, or Better Managed: monia and there were over one million hos- DISEASE AND DISABILITY I Many cases of chronic illnesses, particularly pitalizations associated pneumonia.5, 6 heart disease, stroke, diabetes, and some CLEARLY INCREASES WITH forms of cancer, could be avoided or I A recent study found that despite govern- delayed with healthy lifestyle practices, such ADVANCING AGE, POOR ment recommendations, more than one- as regular physical activity, healthy eating, third of Americans aged 65 and over did HEALTH IS NOT AN and avoiding tobacco use, and through not receive a flu shot.7 screenings for early detection of cancer and INEVITABLE CONSEQUENCE I Each year, between 360,000 and 480,000 other diseases, according to U.S. Centers OF AGING.”I older Americans sustain fall-related injuries, for Disease Control and Prevention (CDC).4 many of which could be prevented.8 -- U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) MARCH 2008 PREVENTING EPIDEMICS. PROTECTING PEOPLE. HOW CAN WE KEEP SENIORS HEALTHIER? I Promote Prevention. Health care provided, including preventive screen- providers and insurers, community organ- ings for heart disease, diabetes, and a izations, employers, and government number of other chronic diseases, and should provide seniors with increased vaccinations for flu and pneumonia. information about the importance of I Prioritize Vaccinating Seniors for Flu and lifestyle changes, such as those related to Pneumonia. Government health depart- diet and exercise, and the importance of ments should strive to achieve the nation- getting routine screenings and physicals al goals of vaccinating 90 percent or more for early diagnosis and treatment of med- of seniors for flu and pneumonia. ical conditions. Federal, state, and local governments should develop and imple- I Increase Resources for Research. The ment a national strategy for promoting federal government should increase fund- prevention activities. ing for the National Institute on Aging, and research efforts at the National I Expand Prevention Benefits Covered by Institutes of Health that investigate causes Medicare and Provide More Information and cures of aging-related chronic dis- to Seniors About Existing Prevention eases, including neurological diseases Benefits. Medicare should actively pro- such as Alzheimer’s and dementia. mote the range of prevention benefits ENDNOTES 5 A. M. Minino, et al. “Deaths: Preliminary Data for 2004.” 1 U.S. Centers for Disease Control and Prevention. National Vital Statistics Report 54, no. 19 (June 28, 2006). “Healthy Aging for Older Adults.” U.S. Department of 6 C. J. DeFrances, et al. “2004 National Hospital Health and Human Services, Centers for Disease Discharge Survey.” Advance Data from Vital and Health Control and Prevention, http://www.cdc.gov/aging/ Statistics no. 371 (May 4, 2006). (accessed January 10, 2009). 7 U.S. Centers for Disease Control and Prevention. 2 U.S. Centers for Disease Control and Prevention and Behavioral Risk Factor Surveillance System, Prevalence Data, The Merck Company Foundation. The State of Aging Nationwide (States and D.C.) - 2005 vs 2004, Immunization. and Health in America 2007. Whitehouse Station, NJ: Atlanta, GA: U.S. Department of Health and Human The Merck Company Foundation; 2007. Services, 2006. <http://apps.nccd.cdc.gov/ brfss/dis- http://www.cdc.gov/aging/pdf/saha_2007.pdf play_c.asp?yr_c=2004&yr=2005&cat=IM&state=UB&bke 3 Ibid. y=20059912&qkey=4407&qtype=C&grp=0&SUB- MIT2=Compare> (accessed October 30, 2006). 4 U.S. Centers for Disease Control and Prevention. “Healthy Aging for Older Adults.” U.S. Department of 8 U.S. Centers for Disease Control and Prevention and Health and Human Services, Centers for Disease The Merck Company Foundation. The State of Aging Control and Prevention, http://www.cdc.gov/aging/ and Health in America 2007. Whitehouse Station, NJ: (accessed January 10, 2009). The Merck Company Foundation; 2007. < http://www.cdc.gov/aging/pdf/saha_2007.pdf> A H E A LT H I E R A M E R I C A : 10 TOP PRIORITIES FOR PREVENTION Improving the Health of Low-Income and Minority Communities WHY ARE HEALTH DISPARITIES A THREAT TO OUR “OF ALL THE FORMS OF NATION’S HEALTH? INEQUALITY, INJUSTICE Racial and Ethnic Minorities Are More IN HEALTH CARE IS THE Likely to Have Less Access to Care: MOST SHOCKING AND I Thirteen percent of white Americans are INHUMANE.” uninsured, however, that figure nearly doubles to 22 percent among African- -- MARTIN LUTHER KING, JR. Americans, and nearly triples to 36 per- cent among Latinos.5 People with Lower-Incomes Have Fewer Opportunities to Make Healthy Choices: I There is limited access to nutritious, affordable foods in low-income areas. Low-income zip codes tend to have fewer and smaller grocery stores, and people in these areas often pay more for fresh fruits and vegetables when such foods are even Low-Income and Minority Communities available.6 The presence of supermarkets Systematically Have Less Access to is related to lower rates of obesity, while Health Care, Higher Exposure to Health higher rates of obesity are related to the Threats, and Worse Health Outcomes: presence of convenience stores.7 I Rates of death from heart disease were 29 I Even before Hurricane Katrina, Gulf percent higher among African-American Coast populations - many of them low- adults than among white adults in 2000, income, minorities - were among the and death rates from stroke were 40 per- most chronically ill in the nation. After cent higher.1 the hurricane, one in five survivors with chronic illness reported a disruption in I African-American males are over twice as his/her treatment, which researchers likely to die of prostate cancer.2 attribute to the loss of healthcare facilities I Cervical cancer incidence rates in and personnel in the region, as well as Vietnamese women have been found to unemployment and associated income be 5 times higher than the rate among loss among survivors.8 white American women.3 I The states with the highest rates of obesity I African-American, American Indian, and in the nation are also the poorest; these Puerto Rican infants have higher death states often have high rates of adults lack- rates than white infants. African- ing health insurance. Obesity is a risk fac- American babies are two-and-a-half times tor for more than 30 serious diseases. MARCH 2008 as likely to die in infancy as white infants, Eight of the states with the highest poverty, a statistic that has remained unchanged diabetes, and hypertension rates were also PREVENTING EPIDEMICS. for the past 2 decades.4 in the top 15 in the country for obesity.9 PROTECTING PEOPLE. HOW CAN WE ELIMINATE HEALTH DISPARITIES? I Create Strategies to Improve the are to be successful. Established proven Health of All Americans, Regardless of programs, such as REACH (Racial and Race, Ethnicity, Income, or Where They Ethnic Approaches to Community Health) Live. All Americans should have the should be fully-funded and expanded. opportunity to be as healthy as they can I Communicate Effectively with Different be. As a nation, we must invest in first Community Groups. Federal, state and understanding the systematic disparities local officials must design culturally com- that exist and the factors that contribute petent communication campaigns that to these differences, including poverty, use respected, trusted, and culturally income, racism, and environmental fac- competent messengers to communicate tors like exposure to pollution and quali- the message and appropriate channels for ty of housing. Resources must be devoted reach target audiences. to implement community-driven approaches to address factors. I Prioritize Community Resiliency in Health Emergency Preparedness I Engage Entire Communities in Planning. Federal, state, and local gov- Addressing Disparities. Efforts to elimi- ernment officials must work with commu- nate disparities in health must also include nities and make a concerted effort to addressing the range of community factors address the needs of low-income and that influence health, such as safe and minority communities during health affordable housing, safe streets and recre- emergencies. Public health training ation spaces, and affordable and accessible should be targeted to include disaster sce- nutritious foods. This will require taking a narios in at-risk populations’ neighbor- community-wide approach, involving fed- hoods. For example, planning for how eral, state, and local government, business- emergency responders would react to an es, and community groups. event in a neighborhood of primarily I Partner with a Diverse Range of Spanish-speaking residents. Community Members in Developing and I Promote Health Services, Including Implementing Health Strategies. Federal, Preventive Care Services, in Underserved state, and local governments must engage Communities. Policies must address the communities in efforts to address both ongoing gaps in services to low-income ongoing and emergency health threats. and underserved minority communities. The views, concerns, and needs of com- Inadequate preventive care means prob- munity stakeholders, such as volunteer lems are often left untreated until they organizations, religious organizations, and become higher-cost emergency care or schools and universities must be taken into serious chronic care issues. account when developing strategies if they ENDNOTES (2005).” Washington, D.C.: Kaiser Family Foundation, 1 Office of Minority Health and Health Disparities. State Health Facts. http://statehealthfacts.org/compare- “Disease Burden & Risk Factors.” U.S. Centers for bar.jsp?ind=143&cat=3 (accessed October 10, 2007). Disease Control and Prevention. http://www.cdc.gov/ 6 Trust for America’s Health. F as in Fat: How Obesity omhd/AMH/dbrf.htm (accessed October 11, 2007). Policies are Failing in America 2006. Washington, D.C.: 2 National Medical Association and Pfizer, Inc. Racial TFAH, 2006. http://healthyamericans.org/reports/ Differences in Cancer: A Comparison of Black and White obesity2006. Adults in the Unites States. New York, NY: Pfizer, Inc. and 7 K. Morland, et al. “Supermarkets, Other Food Stores National Medical Association, 2005. http://www.pfiz- and Obesity: The Atherosclerosis Risk in Communities er.com/files/products/Racial_Differences_in_Cancer.p Study.” American Journal of Preventive Medicine 30, no. 4, df (accessed January 10, 2008). (2006): 333-339. 3 B.A. Miller, et al. Racial/Ethnic Patterns of Cancer in the 8 The Hurricane Katrina Community Advisory Group. United States 1988-1992: NIH Pub. No. 96-4104. “Hurricane Katrina’s Impact on the Care of Survivors Bethesda, MD: National Cancer Institute, 1996. with Chronic Medical Conditions.” Journal of General 4 Office of Minority Health. “Highlights in Minority Internal Medicine 22, (2007): 1225-1230. Health: April 2004.” U.S. Centers for Disease Control 9 Trust for American’s Health. F as in Fat: How Obesity and Prevention. http://www.cdc.gov/omh/Highlights/ Policies are Failing in America 2007. Washington, D.C.: 2004/HApr04.htm. (accessed October 11, 2007). TFAH, 2007. http://www.healthyamericans.org/ 5 Kaiser Family Foundation. “Uninsured Rates for the reports/obesity2007. Nonelderly by Race/Ethnicity, States (2004-2005), U.S. A H E A LT H I E R A M E R I C A : 10 TOP PRIORITIES FOR PREVENTION Reducing Environmental Threats WHY ARE ENVIRONMENTAL THREATS HARMFUL TO THE “WHEN WE IMPROVE NATION’S HEALTH? THE HEALTH OF AN The Health Impact of Environmental I Childhood asthma has more than dou- ENVIRONMENT, WHETHER Hazards is Well Documented: bled over the last 2 decades, with outdoor THAT ENVIRONMENT IS I The National Academy of Sciences esti- and indoor air quality considered to be A COMMUNITY OR A mates that 25 percent of developmental major contributing factors.5 WORKPLACE, WE diseases, such as cerebral palsy, autism, I Illnesses stemming from air pollution cost and mental retardation, are caused by IMPROVE THE HEALTH between $14 billion and $55 billion annually.6 environmental factors acting alone or OF THE PEOPLE WHO together with genetic risk factors.2 Investigating Connections Between the LIVE OR WORK IN THAT I The World Health Organization estimates Environment and Health Yields Life-Saving ENVIRONMENT.”I that 13 million deaths annually are due to Discoveries: preventable environmental causes.3 I Tracking the impact of environmental factors has led to greater understanding -- JULIE GERBERDING, I Global warming is expected to lead to DIRECTOR, U.S. CENTERS of the connections between: more extreme weather events ranging FOR DISEASE CONTROL from intense heat and drought to more L Folic acid and the reduction of neural severe storms and flooding, which have AND PREVENTION (CDC) tube birth defects; the potential to negatively affect health.4 L Tobacco and cancer; I Researchers are also exploring concerns L Childhood exposure to lead and devel- that diseases such as multiple sclerosis, opment of mental retardation and loss Parkinson’s disease, and Alzheimer’s dis- of motor skills; and ease may be linked to exposure to envi- ronmental hazards. L Early cancer screenings and better treatment outcomes. MARCH 2008 PREVENTING EPIDEMICS. PROTECTING PEOPLE. WHAT CAN BE DONE TO REDUCE ENVIRONMENTAL HEALTH HAZARDS? I Improve Coordination Among Agencies. inform communities about the health- Health departments at the federal, state, related risks of climate change and means and local levels should work with environ- to reduce them. mental agencies to undertake initiatives I Increase Funding for Research into the to reduce known health threats from Impact of Chemical Exposures on food, water, and air, and educate the pub- Human Health. CDC has conducted lim- lic about ways to avoid potential risks. ited research on how chemicals ranging I Establish a Nationwide Health Tracking from pesticides to personal care products Network. Congress should provide full impact health. CDC and state health funding for the U.S. Centers for Disease departments need greatly increased Control and Prevention’s (CDC) environ- resources for “biomonitoring” (analysis of mental public health tracking program. blood, urine, and tissues to measure The CDC should be provided with the chemical exposure in humans) to gain mandate and resources to establish a cen- more understanding of how different tralized, nationwide health tracking cen- chemicals and levels of exposures to ter, and each state should get funding to chemicals affect health. fully conduct health tracking activities, I Prioritize Childhood Lead Poisoning including tracking animal diseases; Prevention. While great progress has chronic diseases such as cancer and asth- been made nationally in reducing child- ma; events related to bioterrorism; and hood lead poisoning through efforts to environmental risks. remove older paint from homes and to I Fund Research on Global Warming- reduce lead gasoline emissions, serious Related Health Effects. Congress should problems remain. In many cities, lead is provide funding to CDC to track data on present in the water at unacceptable lev- environmental conditions, disease risks, els, while lead paint is still found in older, and disease occurrence related to climate substandard housing in many lower- change. CDC should use this data to income urban areas. ENDNOTES 4 U.S. Centers for Disease Control and Prevention. 1 U.S. Centers for Disease Control and Prevention. “CDC Policy on Climate Change and Public Health.” “News Release: Four Communities to Pilot New U.S. Department of Health and Human Services. Federal Environmental Health Partnership.” Atlanta, http://www.cdc.gov/nceh/climatechange/ (accessed GA: U.S. Centers for Disease Control and Prevention, January 28, 2008). July 18, 2007. http://www.cdc.gov/nceh/pressroom/ 5 U.S. Environmental Protection Agency. “America’s 2007/Four_Pilots.htm (accessed January 10, 2008). Children and the Environment.” U.S. Environmental 2 National Research Council. Scientific Frontiers in Protection Agency. http://www.epa.gov/envirohealth/ Developmental Toxicology and Risk Assessment Washington, children/highlights/index.htm (accessed May 11, D.C.: National Academies Press, 2000. 2007). 3 World Health Organization. Preventing Disease Through 6 B. Ostro and L. Chestnut. “Assessing the Health Healthy Environments: Towards an Estimate of the Benefits of Reducing Particulate Matter Air Pollution Environmental Burden of Disease. Geneva: World Health in the United States.” Environmental Research 76, no. 2 Organization, June 2006. (1998): 94-106. A H E A LT H I E R A M E R I C A : 10 TOP PRIORITIES FOR PREVENTION Holding Government Accountable for Protecting the Health of Americans WHY IS THE LACK OF ACCOUNTABILITY A THREAT TO OUR “AMERICANS DESERVE AND NATION’S HEALTH? SHOULD EXPECT BASIC Evaluations Question Abilities of Public tematically evaluates how spending is HEALTH PROTECTIONS -- Health System, Yet No Basic Standards impacting the health of Americans.8 AND THEY ALSO DESERVE Exist for Public Health Departments: L Disease rates and public health spending TO KNOW WHAT THE I A series of assessments by the Institute of vary dramatically from state-to-state, but GOVERNMENT IS DOING Medicine (IOM), Government Account- there is no mechanism in place to deter- ability Office (GAO), U.S. Centers for TO KEEP THEM HEALTHY mine the reasons for the differences. Disease Control and Prevention (CDC), AND SAFE. RIGHT NOW, and independent research organizations L For example, rates of asthma among adults range from a low of 10.5 percent THERE IS NO SYSTEMATIC conclude that the public health system is unprepared to meet the challenges of in South Dakota to a high of 15.4 per- APPROACH FOR ENSURING today’s modern health threats.1, 2, 3, 4, 5 cent in Oregon, and adult obesity rates A MINIMUM LEVEL OF range from a low of 16.9 percent in I There are currently no basic standards, Colorado to a high of 29.5 percent in HEALTH SERVICES OR THAT performance measures, or accreditation Mississippi, but there is no evaluation MONEY SPENT ON PUBLIC programs for the more than 3,000 feder- into why these differences exist.9 al, state, and local public health agencies HEALTH PROGRAMS IS across the country. L Federal public health funding for CDC BEING USED IN THE MOST grants for states ranges from a per capi- L The IOM “called on the public health ta low of $13.89 in Indiana to a per EFFECTIVE WAY TO community to consider how accredita- capita high of $77.24 in Alaska.10 REDUCE AND PREVENT tion ultimately could prompt improve- L Each state reports its budget for public DISEASE AND INJURY.” ments in the nation’s health.”6 health in a different way. Based on an L In 2006, a model voluntary national analysis that tries to compare budgets -- LOWELL WEICKER, accreditation program by the Association in a standardized way, the median state FORMER THREE-TERM U.S. of State and Territorial Health Officials spending on public health is $31 per and the National Association of County SENATOR AND GOVERNOR person, with a range of $3.73 per per- and City Health Officials recommended OF CONNECTICUT, AND son in Nevada to $127.69 per person the development of accreditation stan- in Hawaii.11 BOARD PRESIDENT OF TRUST dards to promote quality improvement FOR AMERICA’S HEALTH and accountability for public health, I According to the Journal of Public Health including performance measures.7 Management and Practice, “Knowledge of the sources and uses of public health Limited Information Makes It Difficult to funding remains scarce. Evidence is not Set Policies or Measure the Effectiveness readily available on efficient models for of Public Health Programs: resource allocations, and metrics to measure funding outcomes have not yet I No independent source analyzes the been identified.”12 impact of public health spending or sys- MARCH 2008 PREVENTING EPIDEMICS. PROTECTING PEOPLE. WHAT CAN BE DONE TO INCREASE ACCOUNTABILITY? I Make Information About the Health of stand the health of Americans and to Americans and Spending to Improve measure the effectiveness of public health Health Easily Accessible to the Public. programs. Budget transparency would Federal, state, and local health agencies allow the public to monitor how much is should be required to collect and make being spent at the state and local levels on health data easily accessible and under- public health and to measure the effec- standable to the public at a community tiveness of these programs. Improved level. States should follow the lead of transparency would also allow the public Wisconsin’s Department of Health & and government to compare spending Family Services, which annually publishes levels and program outcomes to deter- health and demographic information mine best practices for the best prices. about each county in the state.13 I Institute Federal, State, and Local I Designate Leaders Who Are Responsible Accountability Measures. The public to the Public. Clear, strong leadership at health community must adopt accounta- the federal, state, and local must be bility and quality improvement measures, defined so Americans know who to hold including performance and accreditation accountable for improving the health of standards, based on delivery of services their communities. These leaders should and health improvement outcomes. Real- be given the authority to bring together life and table-top exercises should be used resources from across government agen- to help gauge health emergency prepared- cies that have an impact on health and ness. Measures should take into account engage businesses and community groups. the influence of other factors on health beyond those the public health communi- I Require Collection of Consistent and ty can control, such as healthcare systems Detailed Data and Budget Reporting and urban planning. Performance data Practices. Consistent and comparable must be collected and made publicly avail- information is needed to better under- able on a regular basis. ENDNOTES 7 Robert Wood Johnson Foundation. Press Release: Public 1 Institute of Medicine. The Future of the Public’s Health in Health Leaders Recommend Voluntary National Accreditation the 21st Century. Washington, D.C.: National Academies Program. Washington, D.C.: RWJF, September 21, 2006. Press for the Institute of Medicine, 2003. http://www.rwjf.org/newsroom/newsreleases- detail.jsp?id=1-433. 2 U.S. Government Accountability Office. HHS Bioterrorism Preparedness Programs: States Reported Progress 8 Trust for America’s Health. Shortchanging America’s But Fell Short of Program Goals in 2002. Washington Health 2006: A State-By-State Look at How Federal Public D.C.: Government Accountability Office, February Health Dollars Are Spent. Washington, D.C.: Trust for 2004. America’s Health, June 2006. 3 U.S. Centers for Disease Control and Prevention. 9 Trust for America’s Health. “Your State’s Health.” Trust Public Health Infrastructure --A Status Report. Atlanta, GA: for America’s Health. http://healthyamericans.org/ U.S. Department of Health and Human Services, 2001. state/. (accessed January 11, 2007). 4 Trust for America’s Health. Ready or Not? Protecting the 10 Ibid. Public’s Health from Diseases, Disasters, and Bioterrorism -- 11 Ibid. 2007. Washington, D.C.: Trust for America’s Health, 12 P.A. Honore and B.W. Amy. “Public Health Finance: 2007. Fundamental Theories, Concepts, and Definitions.” 5 C. Nelson, et al. “Assessing Public Health Emergency Journal of Public Health Management and Practice 13, no. Preparedness: Concepts, Tools, and Challenges.” 2 (March-April 2007): 89-92. Annual Review of Public Health 28, (April 2006): 1-18. 13 Department of Health and Family Services. “Public 6 Institute of Medicine. The Future of the Public’s Health in Health Profiles.” State of Wisconsin. http://dhfs.wis- the 21st Century. Washington, D.C.: National Academies consin.gov/localdata/pubhlthprofiles.htm (accessed Press for the Institute of Medicine, 2003. January 28, 2008). Ourfor a Vision Healthier 1730 M Street, NW, Suite 900 Washington, DC 20036 (t) 202-223-9870 (f) 202-223-9871