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  • ACOEM Joins Organizations to Express Support of Prevention and Public Health Fund

    April 20, 2010

    The Honorable Kathleen Sebelius
    Secretary, U.S. Department of Health and Human Services
    Hubert H. Humphrey Building
    200 Independence Avenue, SW – Room 120F
    Washington, DC 20201

    Dear Secretary Sebelius:

    On behalf of the 90 undersigned organizations, we thank you for your leadership in helping to make comprehensive health reform a reality, which we believe lays out a vision for a modernized healthcare and public health system. Together, our organizations advocated for meaningful, sustainable public health, wellness, and prevention provisions, which we feel will be the cornerstone in transforming our health system into one that truly promotes health, not just disease treatment. As you begin to work on implementation of the law, we would like to share our vision for ensuring the prevention provisions achieve the largest possible impact on disease prevention and health.

    The Prevention and Public Health Fund is central to supporting the long-term transformation of the nation’s public health system. The Fund alone cannot achieve this transformation, thus investments from the Fund should be used in a manner that leverages change throughout the public health system – with a move away from a stove-piped, disease-by-disease approach to one that addresses the determinants of health in a cross-cutting manner. If these grants merely supplant existing funding, no net benefit will be achieved. These funds should be used for transformational investments, helping lead the nation into a more community-oriented, accountable approach to public health. There should be flexibility built into the Fund to ensure a focus on the determinants of health in a cross-cutting manner in all places where people live, learn, work and play.

    The overarching goal should be to optimize the health of everyone by creating healthier, safer, and more resilient communities through policy, systems, organizational, and environmental change. Investments from the Fund should be science-informed or evidence-based, have measurable health outcomes and policy goals, promote innovation, focus on the determinants of health and health equity, and have a significant level of accountability. In addition, funding prevention strategies may yield significant returns on investment. These savings can then be reinvested into communities and support the ongoing transformation of the public health system and community health.

    The National Prevention Strategy contained in the statute should become the basis for defining the goals of a transformed public health system, identifying gaps in the current system, and how the Fund can be used to help close these gaps. The Strategy should have a particular focus on how public health investments can work synergistically with the reforming health care system so that health departments have greater capacity in areas relevant to the reform process. Additionally, there are key areas where non-governmental public health entities, including a broad range of community groups and schools can play vital roles in helping to transform the nation’s health and the broader public health system. Indeed, in a transformed system governmental public health may lead, but implementation will be across all sectors of society.

    In the short term, as the National Prevention Strategy is developed over the next year, expenditures under the Fund for FY 2010 and FY 2011 should be consistent with the categories of expenditure identified by both the House and Senate. These are:

    Community Prevention: A focus on community prevention is the centerpiece of a transformed public health system. The focus should be on cross-cutting approaches to reducing the risks that affect health and safety. Funds should not be limited categorically, and instead considered for clear and focused priorities and opportunities across the range of public health programs, which would include chronic disease prevention, injury and violence prevention, reproductive health, infectious diseases, emergency preparedness, mental and behavioral health, birth defects and developmental disabilities, and environmental health. In addition, while state and local health departments must be central players in community prevention, grant funding is also needed to support the work of non-governmental organizations committed to community prevention. Such efforts need to be promoted in communities of all sizes, particularly those with high need, using creative governmental and non-governmental partnerships.

    Core Capacity (for both state and local health departments and others doing community prevention): All health departments should be supported in their efforts to expand the role of community prevention in addressing the health needs of their populations, but particular effort should be made to close the geographic gap in capacity to build healthier, safer, and more resilient communities. Investment in capacity building will require both steady support for fundamental functions such as epidemiology, laboratory, informatics and communication as well as flexibility so that one-time, non-recurring projects can improve the most important and most underdeveloped current capacities. This can be done through support in part of the accreditation process developed by the Public Health Accreditation Board, which is focused on building these capacities and thresholds.

    Research, Development, and Dissemination of Best Practices: There is a continuing need to expand the science base of prevention, with particular emphasis on translation into practice and data to do appropriate program evaluation. In a strengthened, transformed public health system, state and local health departments will routinely be able to collect and assess sufficient data to evaluate programs as they are implemented. It also requires ramping up the capacity of the task forces on community and clinical prevention, creating the research and technical support for innovation in community prevention, and establishing the newly authorized program in public health services and systems research, with a particular emphasis on data collection and analysis.

    Strong partnership and collaboration among local and state health departments and federal agencies will be essential to target new capacity-building funds in a manner that maximizes their impact in transforming the nation’s public health system.

    Even with accreditation, more will need to be done at the national level to build a public health workforce able to serve in health departments at varying stages of building such capacity. A number of programs targeting all levels of education and training, are authorized in the legislation that would enhance capacity at the state and local level and could be funded at least in part through this Fund.

    Finally, investments should be significant in size so that we can make a significant difference. Spreading these funds among too many programs will dilute the investment and reduce the likelihood we will see real change.

    We thank you for your leadership in a hard-fought battle to bring health reform to America. The President’s signature, however, was only one step in an ongoing fight to help Americans lead healthier lives. We look forward to working with you to ensure the objectives of this law are achieved.

    Sincerely,

    1. Alliance to Make US Healthiest
    2. All Saints Home Care And Referral Services (CA)
    3. America Walks
    4. American Academy of Physician Assistants
    5. American Association for Health Education
    6. American Association of Colleges of Osteopathic Medicine
    7. American Association of Colleges of Pharmacy
    8. American College of Clinical Pharmacy
    9. American College of Occupational and Environmental Medicine
    10. American College of Prevention Medicine
    11. American Federation of State, County and Municipal Employees
    12. American Heart Association
    13. American Medical Student Association
    14. American Nurses Association
    15. American Osteopathic Association
    16. American Psychological Association
    17. American Public Health Association
    18. American School Health Association
    19. Arthritis Foundation
    20. Asian Pacific Islander Caucus for Public Health
    21. Association for Professionals in Infection Control and Epidemiology
    22. Association of Academic Health Centers
    23. Association of Asian Pacific Community Health Organizations
    24. Association of Maternal & Child Health Programs
    25. Association of Public Health Laboratories
    26. Association of State and Territorial Directors of Nursing
    27. Association of State and Territorial Health Officials
    28. Association of University Centers on Disabilities
    29. Bay County Health Department of Bay City, MI
    30. Beach Cities Health District (L.A. County, CA)
    31. Campaign for Public Health
    32. Children's Hospital and Research Center Oakland
    33. Coalition for Health Services Research
    34. Coalition of National Health Education Organizations
    35. Coastal Health District, Georgia
    36. CommonHealth ACTION
    37. Community Action Partnership
    38. Community Health Councils
    39. Community Health Partnership: Oregon’s Public Health Institute
    40. Council of State and Territorial Epidemiologists
    41. Defeat Diabetes Foundation
    42. Faces and Voices of Recovery
    43. Family Voices
    44. Hawai‘i Public Health Association
    45. Hepatitis C Association
    46. Hepatitis Foundation International
    47. HIV Medicine Association
    48. Home Safety Council
    49. Ingham County Health Department, Lansing, Michigan
    50. Infectious Diseases Society of America
    51. Khmer Health Advocates, Inc.
    52. Michigan Association for Local Public Health
    53. Monroe County Public Health Department (MI)
    54. National Association for Public Health Statistics and Information Systems
    55. National Association for Sport and Physical Education
    56. National Association of Counties
    57. National Association of County and City Health Officials
    58. National Coalition for LGBT Health
    59. National Coalition for Promoting Physical Activity
    60. National Forum for Heart Disease and Stroke Prevention
    61. National Health Council
    62. National Health Equity Coalition
    63. National Initiative for Children’s Healthcare Quality
    64. National Network of Public Health Institutes
    65. National Nursing Centers Consortium
    66. National Psoriasis Foundation
    67. National REACH Coalition
    68. National Recreation and Park Association
    69. National Viral Hepatitis Roundtable
    70. Native Hawaiian and Pacific Islander Alliance
    71. Nemours
    72. North American Quitline Consortium
    73. Partners for a Healthy Nevada
    74. Planned Parenthood Federation of America
    75. Prevention Institute
    76. Public Health Foundation
    77. Public Health Institute
    78. Public Health-Seattle & King County
    79. REACH U.S. Charleston and Georgetown Diabetes Coalition
    80. REACH U.S. Southeastern African American CEED for Diabetes
    81. Research!America
    82. Safe States Alliance
    83. Society for Adolescent Health and Medicine
    84. Society for Public Health Education
    85. Strategic Health Policy International, Inc.
    86. The New York Academy of Medicine
    87. The Youth Becoming Healthy Project, Inc.
    88. Trust for America’s Health
    89. WalkSanDiego
    90. YMCA of the USA