The Prevention Fund

1. The Prevention Fund National Forum for Heart Disease & Stroke Prevention October 17, 2012 Richard Hamburg Deputy Director

2. Real money throughmandatory appropriations Prevention and Public Health Fund: now $12.5 billion over next 10 years (reaching full $2 billion level in FY2022) $20 billion over subsequent 10 years $2.25 billion already allocated for FY10-12, $1 billion annually for FY2013-2017.

3. Source: PEW

5. *FY 2010-2012 CDC values are supplemented by the Prevention and Public Health Fund ** FY2012 value represents the HHS spending plan numbers for FY2012 *** FY2013 is based on the President's Budget Request Updated 3/13/2012

6. Prevention Fund Preventing disease and injury by making healthy choices the easy choices is the most effective, common-sense way to improve health and reduce health costs for families and businesses. The Prevention and Public Health Fund gives us a chance to turn our sick care system into a health care system by bringing communities together on innovative projects that will help reverse the obesity epidemic and bring health costs down. The Prevention Fund is the first federal funding source dedicated to public health and prevention. The Fund is supporting new programs such as Community Transformation Grants, a National Tobacco Education Campaign, and new strategies to reduce hospital associated infections. It is also supporting grants to allow every state to begin to build core, comprehensive capacity to address common risk factors and determinants of health.

7. Selected CDC PPHF FY 2012 Investments

8. PPHF Successes • Funded 129 public health associates for two-year field assignments at state/local health departments • Helped 46 HIV surveillance jurisdictions to improve electronic lab reporting • In NYC, health tracking program is analyzing childhood asthma data and using results to develop educational messages • In Maine, a Childhood Lead Poisoning Prevention Program is targeting communities in five urban areas where 40% of childhood lead poisoning occurs. 240 rental units were tested for lead. • CDC’s Tips from Former Smokers public education campaign achieved the following results in one week: • Nationwide – 130 percent increase nationwide • California – 307 percent increase • Florida – 420 percent increase • Kentucky – 503 percent increase • Texas – 727 percent increase

9. FY11 PPHF Cooperative Agreement / Grant Awards by State (By Award Amount) $11.8M NH $3.0M $1.2M VT $4.0M $2.4M $11.6M $1.3M $5.6M $25.0M $10.7M $7.0M ME $5.8M $1.8M $1.9M MA $15.8M $5.9M $41.4M RI $2.4M $7.7M $2.3M $4.6M $11.0M $5.2M $3.5M CT $6.2M $3.4M $5.9M $6.6M $1.0M $5.6M NJ $5.3M $5.1M $3.2M $5.4M DE $1.3M $13.3M MD $9.2M $4.0M $5.4M DC $6.4M $6.8M $6.1M $4.1M $9.2M $18.5M $9.2M $4.5M $2.7M $2.9M Key: Total Award Amounts by State <$5M $5-10M $11-15M >$15M $3.5M $8.5M $4.0M Totals include awards to states, cities/counties, tribes, and partners ($358.8M). Awards to territories ($4.3M) are excluded. 1Programs 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).

11. F as in Fat Report 2012

12. Future #1. The Status Quo.

13. Future #2. Taking Action Today. If each state reduced average BMI by 5 percent by 2030 Millions of prevented obesity-related diseases including diabetes, CHD, hypertension, arthritis, and obesity-related cancers Billions in federal, state, private, and family health care costs

14. Future #2 Taking Action

15. Example: Connecticut • Obesity Health and Cost Savings

16. CTGs in practice – Community Engagement Awarded competitively, based on proposals Available to state and local health departments, nonprofits, national networks of community-based organizations and tribal organizations At least 20% of funding to go to community prevention programs in rural and frontier areas Applicants must define concrete, achievable targets for meeting prevention goals, and specific objectives to reduce health disparities Applicants must demonstrate the ability to coordinate with multiple community sectors – i.e. transportation, faith-based, businesses, education, etc. to achieve broad-based participation in community prevention activities.

17. Examples of CTG Implementation Grants • Alaska: Southeast Alaska Regional Health Consortium • California: County of San Diego Health and Human Services Agency, Los Angeles County Department of Public Health, San Francisco Department of Public Health, and Public Health Institute • Florida: Broward Regional Health Planning Council • Illinois Department of Public Health • Maryland Department of Health and Mental Hygiene • Massachusetts Department of Public Health (to serve state minus large counties) & Massachusetts Department of Public Health (to serve Middlesex County) • Michigan: Sault Ste Marie Tribe of Chippewa Indians • Missouri: Mid-America Regional Council Community Services Corporation • Health and Human Services • New York: The Fund for Public Health in New York & University of Rochester Medical Center • North Carolina Division of Public Health • Pennsylvania: Philadelphia Department of Public Health • South Carolina Department of Health and Environmental Control • South Dakota Department of Health • Washington: Tacoma-Pierce County Health Department & Washington State Department of Health • West Virginia Bureau for Public Health 17

18. Capacity-building CTG grants Alaska: Yukon-Kuskokwim Health Corporation California: County of Kern, Public Health Services Department, Fresno County Department of Public Health, Stanislaus County Health Services Agency, Toiyabe Indian Health Project, Ventura County Public Health and Sierra Health Foundation Connecticut Department of Public Health Georgia: Cobb Public Health Kentucky: Unlawful Narcotics Investigation Treatment Education, Inc. Louisiana Department of Health and Hospitals Michigan: Spectrum Health Hospitals Mississippi: My Brother's Keeper Inc. New Jersey Prevention Network New Mexico: Bernalillo County Office of Environmental Health North Dakota Department of Health Ohio: Austen BioInnovation Institute and Public Health-Dayton and Montgomery County Pennsylvania: Lancaster General Health Texas: Houston Department of Health & Human Services Utah Department of Health Virginia: Fairfax County Department of Neighborhood and Community Services Washington: Confederated Tribes of The Chehalis Reservation & Sophie Trettevick Indian Health Center Wisconsin: Great Lakes Inter-Tribal Council, Inc. Ulkerreuil A Klengar (Republic of Palau) More information is available at: http://www.cdc.gov/communitytransformation/ 18

19. Small Community Awards - 2012 Cherokee Nation (Oklahoma) Community Health Councils (California) County of Sonoma (California) St. Helena Hospital Clear Lake (California) County of Santa Clara (California) Nemours Hospital for Children (Delaware) DC Department of Health Miami-Dade County School Board (Florida) Tanner Medical Center (Georgia) Chicago Public Schools (Illinois) Quality Quest for Health of Illinois Welborn Baptist Foundation (Indiana) YMCA of Wichita (Kansas) Microclinic International (Kentucky) Linking the Parish (Louisiana) Maine General Medical Center (Maine) Maine Development Foundation Maine Health Healthy Acadia (Maine) Institute for Public Health Innovation (MD) Prince Georges County (Maryland) Pioneer Valley Planning Commission (MA) YMCA Southcoast (Massachusetts) Central Michigan District Health Department Minneapolis Heart Institute Foundation (MN) Ozarks Regional YMCA (Missouri) Clark County School District (Nevada) Health Research Inc. /NYS Dept. of Health The Lima Family YMCA (Ohio) Indian National Council of Governments (OK) Little Dixie Community Action (Oklahoma) Northeast Oregon Network (Oregon) City of Beaverton (Beaverton) YMCA of Greenville (South Carolina) Project Vida (Texas) Seattle Children’s Hospital (Washington) Inland Northwest Health Services (WA) West Virginia University Research Corporation / 19

20. Example of CTG sub-awards Broward Regional Health Planning Council (FL) Nova Southeastern University Broward County Public Schools North South Institute Farmers Market Coalition South Florida Regional Planning Council Alliance for A Healthier Generation Foundation for a Breastfeeding Culture Smart Growth partnership Fort Lauderdale Vegetables, inc. Holy Cross Hospital Broward Metropolitan Planning Organization 20

21. Groundhog Day! During the 112th Congress, the House has repeatedly (30+ times) sought to cut or eliminate the Prevention Fund. This year alone: 7/18/12 – A House Labor/HHS appropriations bill that includes the elimination of the Prevention Fund is approved in subcommittee. 7/11/12-- The House of Representatives approves the Repeal ObamaCare Act by a vote of 244-185 over the objections of a veto threat from President. 4/26/12 – The Interest Rate Reduction Act (HR 4628) would delay an increase in federal Stafford Direct Stafford Loan rates, offset by repealing the Prevention and Public Health Fund. House voted 215-195. 4/25/12 – The House Energy & Commerce Committee advanced a budget reconciliation measure which includes elimination of the Fund. 2/22/12 – The Middle Class Tax Relief and Job Creation Act (HR 3630) became law, extending the payroll tax cut, unemployment benefits, and physician payment updates (“doc fix”), offset by a $6.25 billion cut to Fund.

22. Protecting the Prevention Fund - overview • Important victory in student loan rate increase debate. • Activated base, strong showing of support with every Senate Democrat voting against repealing the Fund to pay for student loans. • Opportunity to better educate Members who will have to defend this vote. • Continuing outreach to broaden base of support – including faith, education and disability communities. • CEO level visits with key supporters in Congress • AMA House of Delegates resolution

23. Appropriations riders • “Section 220” - HHS to post information on publicly accessible website on use of PPHF funds – including funding opportunity announcements (FOAs), listings of all grants, reports detailing use of funds, semi-annual reports from all grantees, and summaries of subgrants and subcontracts • “Section 503” – expanded restrictions on use of federal funds for lobbying • HHS General Counsel is reviewing and may need to generate additional guidance to grantees • Already a whole host of similar provisions in U.S. Code and in previous appropriations bills • Legislative oversight already underway on programs like Communities Putting Prevention to Work (CPPW)

24. But the Tide is Turning with Strong Congressional Support! Senate Majority Leader Harry Reid -- We “are opposed to shortchanging an important program that supports crucial efforts to prevent disease and protect against public health emergencies.” President Obama veto message – “Women, in particular, will benefit from this Prevention Fund, which would provide for hundreds of thousands of screenings for breast and cervical cancer. This is a politically-motivated proposal and not the serious response that the problem facing America’s college students deserves. If the President is presented with H.R. 4628, his senior advisors would recommend that he veto the bill.” House Minority Leader Nancy Pelosi – “Not only are they suggesting that we take the money from the prevention fund, the immunization and screening for breast cancer, and cervical cancer, and other women’s health issues, not only are they saying we should take the five or six billion dollars from there, they’re saying we should take the additional $5 billion that would be left in the account and repeal it – repeal it. “

25. Building Broad Support From Multiple Sectors 770 local, state and national organizations, including hundreds of traditional public health groups, but also: Unions – AFT, SEIU, AFSCME Medical providers – American Academy of Pediatrics, American College of Cardiology, American Nurses Association National advocacy groups – AARP, USPIRG, Families USA Business groups – National Business Group on Health, Small Business Majority, Pacific Business Group on Health Policymakers – US Conference of Mayors, National Association of Counties Faith-based groups – National Council of Jewish Women, United Church of Christ, Ascension Health, Justice and Witness Ministries

26. Identifying New Champions • Organizing partner organizations for CEO-level meetings with Senate/House public health supporters in effort to elevate their level of engagement to Prevention Fund “champions” – • Participants include: TFAH, American Heart Association, American Cancer Association Action Network, American Diabetes Association, ASTHO, NACCHO, American Public Health Association, Nemours, Campaign for Tobacco Free Kids, National Business Coalition on Health • Meetings have been held with Senators Brown (OH), Blumenthal (CT), Cardin (MD), Carper (DE), Coons (DE), Hagan (NC), Rockefeller (WV), Menendez (NJ); Bennet (CO) and Udall (CO), and Representatives Capps (CA), Delauro (CT), Roybal-Allard (CA), Pallone (PA), Van Hollen (MD), Matsui (CA) and Levin (MI), • Members of Congress considering letters to White House, colloquys on House and Senate floors, op eds, dear colleague opportunities, “ribbon-cutting” opportunities back home.

27. What can you do? • Public believes in prevention • Consistent polling data shows public believes prevention saves money and worth the investment even if it doesn’t save money • Show members of Congress where the money is going – need for transparency on use of funding, and relationship-building by grantees with elected officials • Create relationships with elected officials • Give visibility to success stories in local media Take at least one action; • Join the supporters list for the PPHF &/or recruit other organizations • Schedule in-district meetings with Members of Congress • Take action online • Send a letter • Blog or write an op-ed/Letter-to-the-Editor • Report back!

28. For more information Please visit www.healthyamericans.org to view the full range of Trust for America’s health policy reports. Or www.healthyamericans.org/health-reform for health reform implementation information. Can also contact rhamburg@tfah.org to sign up for our Digest on Wellness and Prevention in Health Reform Thank you!