post by Bill Gardner
Evidence-based strategies for preventing chronic diseases are essential for improving the health of current and future generations. So it is distressing to read Sarah Kliff's reporting on the political jeopardy of the Prevention and Health Fund:
Republicans have regularly attacked the $16 billion investment [over 10 years] in programs meant to reduce chronic diseases and improve Americans’ health. Wyoming Sen. Mike Enzi has quipped that the program was a “slush fund” for jungle gyms... “There’s certainly concern among the public health advocates,” says Jeff Levi, who chairs the new National Advisory Group on Prevention, Health Promotion and Integrative and Public Health “The concern is will it fall into a catch all category of things that can be cut, and that’s a challenge.” ...The White House proposed slashing its budget for the first time in its last deficit reduction proposal. House Republicans, meanwhile, would like to zero out the program’s funding in their budget...“The question is: are we funding the status quo, are we funding the stagnant quo, or are we getting an effort...that’s transformative?,” Maryland Sen. Barbara Mikulski vented at a Senate hearing on the fund last week.
Sadly, I think there is something to Sen. Mikulski's concerns. I looked at what the Fund is doing in the state of Ohio. The graph shows how much money will be spent on three types of activities in Ohio over 10 years (the vertical axis is in $1000s). The categories are:
- Community and Clinical Prevention: Prevention activities that have been shown to be effective in reducing health care costs and promoting health and wellness. Specific activities include: a) Assisting communities with the integration of primary care services into community-based mental & behavioral health settings, b) HIV Prevention, and c) Tobacco Cessation.
- Public Health Infrastructure: To strengthen state and local capacity to prepare health departments to meet 21st century public health challenges and support the training of existing and next generation public health professionals. The money supports information technology, laboratories, public health training, and something called 'capacity building'.
- Primary Care Training: Spending to expand the primary care workforce. These are training programs for (in order of increasing spending): State health care workers, physician assistants, advanced nurse practitioners, and primary care physicians.
There is an argument to be made for each of these categories of spending. But I'm concerned about the priority of infrastructure and training programs relative to actual community interventions. The latter appear to be getting less than $100,000 / year. The details will matter here. Are the Infrastructure and Primary Care Training funds being spent in ways that will generate a sustained increase in evidence-based preventive care by primary care practitioners? If so, the money could be well spent. If not, we will just have more doctors doing more of the same. I hope that the Senators push the Prevention Fund managers hard on this point.