As STD Funding Stagnates, Rates Rise to All-time Highs

By Iman Karnabi, MPH, Manger, Communication, National Coalition of STD Directors


Current state of STDs
In the U.S., the STD epidemics of gonorrhea, chlamydia, and syphilis are at crisis levels.

For the fourth year in a row, STD infections reached all-time highs. In 2017, over 2 million new infections – about the population of Houston or Chicago – were reported by the Centers for Disease Control and Prevention (CDC), and early data from 2018 shows these steep increases continuing. Antibiotic-resistant gonorrhea in the U.S. has moved from a threat on the horizon to an inevitability. Newborn syphilis cases (congenital syphilis), a condition resulting in stillbirth or early infant death in up to 40 percent of cases, more than doubled in the last five years, and is now five times more than the number of cases of maternal to child HIV transmission. Young people (ages 14-25) and marginalized populations continue to bear the brunt of these epidemics.

            Turning the STD tide will require a national response. But, as presently equipped, the national network of public health STD prevention programs are understaffed and overmatched.

Importance of STD Funding
State and local STD programs and sexual health clinics are essential access points to sexual health care and STD testing. Unfortunately, the historic rise in STDs has not been mirrored by increased investment in these programs. Federal STD prevention funding at CDC has seen a 40 percent reduction in buying power since 2003.  

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In recent years, nearly half of all jurisdictions reported closing clinics or severely reducing hours or staff. STD clinics are essential access points to high quality sexual health care, and have historically acted as safety nets for those most at risk for STDs. The depletion of this network guarantees more infections and the associated adverse health consequences of undiagnosed and untreated STDs.

Funding and Policy Landscape
At the national level, a fight led by National Coalition of STD Directors (NCSD) is ongoing to raise awareness about the needs of the STD field. NCSD creates opportunities for its members, the state, local STD programs, and those working in sexual health and STD prevention to advocate for resources and policies to fight the STD epidemics. A key part of this effort is bringing the needs of the STD field directly to Congress.

In May 2019, after years of federal and state funding flat funding and cutbacks, the House Appropriations Committee passed the Fiscal Year 2020 (FY20) Labor, Health and Human Services (LHHS) appropriations bill that included a $10 million increase for STD prevention. The bill also included an increase of $16.9 million to the Division of Adolescent and School Health (DASH), and $140 million of new funding to the CDC’s National Center for HIV, Hepatitis, STD, and Tuberculosis Prevention for the Ending the HIV Epidemic initiative, in which STDs were featured prominently. The Ending the HIV Epidemic initiative proposed in the FY20 President’s budget presents an opportunity for state and local STD programs to be included in ending the epidemic due to the syndemic nature of STDs and HIV.

NCSD is pleased to see the profile of STDs raised at the national level and the passage of the Bipartisan Budget Act of 2019 that raises funding for nondefense discretionary programs by $27 billion. During the Senate appropriations process, NCSD will be working hard to ensure the Senate appropriates an increase similar to the House’s for STD prevention funding.

The administration’s recent rule changes to Title X prohibits organizations that refer patients for abortions from receiving federal funding. Many states rely solely on family planning clinics as their network of STD providers and this regulation threatens access to STD testing and treatment for more than 4 million low-income people who rely on providers receiving Title X funding. In 2017, over 6.4 million Title X-funded STD and HIV screening services were performed.

Get Involved
The U.S. is facing a public health crisis as the STD epidemics rage on. You can help spread awareness about the needs of the STD field by becoming an NCSD member, contacting your Senators and Representatives, and joining NCSD for STD Engage 2019, the annual meeting for STD programs. Everybody can play a role in the ongoing fight to end the STD epidemic and making sure the field receives the funding it needs.   

Never Too Young for Arthritis

by Anna Hyde, Vice President of Advocacy and Access, Arthritis Foundation and Board Member, Coalition for Health Funding

 Did you know that kids get arthritis too? I didn’t either. Not until I started working for the Arthritis Foundation five years ago and learned that kids can be diagnosed with arthritis as early as infancy, and it can be devastating for them and their families. I’ve been fortunate to meet and interact with many families impacted by juvenile arthritis, and I’ve come to learn how serious this disease, and how unique the health care needs are of children diagnosed with it.

July is Juvenile Arthritis Awareness Month, so I invite you to keep reading and learn about this disease through their eyes. The quick facts are that it affects 300,000 children in the United States, and while there are different types, almost all are autoimmune, meaning they affect the immune and organ systems, and can lead to co-morbidities like uveitis that can cause blindness. There are only 350 board certified pediatric rheumatologists in the United States; in fact, many families have had to move states or travel incredibly long distances just to see a pediatric rheumatologist. Perhaps most importantly, there is no cure.

 Bottom line: Juvenile arthritis is a serious disease that can be life-threatening, and has an enormous physical, emotional, and financial impact for entire families affected by it.

 But the real impact is best shared by these children themselves:

 ·         Eleanor from North Carolina, age 16: “I struggled a lot, especially in the beginning. It took me about 6 months to get a diagnosis, because every doctor thought it was just an injury. They thought that I had torn my ACL or something like that. I even had a doctor say that I probably had sepsis before I was even referred to a pediatric rheumatologist.”

·         Samantha from Tennessee, age 16: “Even though I’m in remission, I’m left with lifelong joint damage. I went misdiagnosed for over 3 years, and because of this, my jaw has become severely deformed, causing me to have difficulty eating, speaking, and even breathing.”

·         Sydney from Alabama, age 16: “I struggle to keep up with other people my age physically. I can’t stand as long, walk as fast or as long as they can. In the past, some of my teachers didn’t understand, no matter how many notes my parents or doctors wrote.”

·         Lorenzo of New York, age 16: “When my arthritis is bad, it’s difficult to do a lot of daily things. My parents have had to dress me – no 16 year old should have to go through that. Before taking my medicine, I’d missed months of school because I couldn’t walk or move around. I was wheelchair-bound for all of 9th grade, but now I use a cane daily and my wheelchair as needed.”

And then there are the devastating stories of children who have cycled through all the medications currently available and don’t know what to do next. They feel they have no choice but to let their health deteriorate while they wait for new drugs to be developed.

I can tell you first-hand that these children and their families are incredibly tenacious, strong, and persistent in their search for a cure. This month, we will convene our first juvenile arthritis Conference of the year in Houston, where kids will connect with kids, parents will connect with parents, and our advocacy team will help them find their voices and learn how to advocate before their elected officials. Because there is no cure and these heavy-duty drugs can have heavy-duty side effects, investment in our public health system is critical for these kids. Here are some of the essential ways public health is vital for these families:

·         Research at the National Institutes of Health is critical for helping identify the causes of JA, which can help lead to early diagnosis, and ultimately to finding a cure.

·         Workforce programs funded by the Health Resources and Services Administration (HRSA) help train providers and place them in underserved areas; With 10 states that have no pediatric rheumatologist and five states have only one, a stronger investment in HRSA can help connect children to providers closer to home.

·         The Centers for Disease Control and Prevention (CDC) collects data on arthritis prevalence and impact, which is vital to understanding the impact of the disease and where to place resources. The CDC Arthritis Program also helps connect people with arthritis to evidence-based self-management programs.

And that barely scratches the surface. There are also the many issues that impact kids with arthritis that you wouldn’t normally think about, like vaccine distribution. Kids with arthritis have compromised immune systems and many rely on herd immunity to stay free of diseases that vaccines protect against.

Now that you have a better understanding of what arthritis is like in children and why the public health system is so important to meeting their needs, I hope you will join me in recognizing Juvenile Arthritis Awareness Month. Connect with us on social media through #AdvocateforArthritis. Let your Members of Congress know a public health investment for children is essential. And visit the Arthritis Foundation’s blog to keep reading about the amazing children like Maya Miserlian that we interact with every day.

The Country’s Most Critical Infrastructure Investment May Not Be What You Think It Is

by John Auerbach, President and CEO, Trust for America’s Health

The House Energy and Commerce Committee recently held a hearing on “Lift America”, its impressive proposed infrastructure bill.   While the bill includes sound investments in roads and bridges, it is particularly noteworthy that it also directs money to an often overlooked yet crucially important aspect of 21st century infrastructure, the nation’s dangerously outdated public health system.  I know about this essential sector and the harm being caused by its neglect because I’ve spent the last 30 years immersed in it at local, state and federal levels.

The Committee is considering a bill that would direct $3.5 billion to the Centers for Disease Control and Prevention (CDC) as well as state, local, tribal and territorial health departments and community partners that work on the front lines of the battles to keep us and our families safe from infectious disease, food borne illness, the impact of natural disasters and other serious health threats.   Over a hundred organizations have signed on to a letter to Committee Chairman Frank Pallone calling the bill’s adoption a critical step in ensuring the nation’s public health infrastructure.

Most Americans aren’t aware of the nation’s public health infrastructure because when public health is successful, you don’t notice its work.  That critical infrastructure includes facilities and equipment – such as governmental laboratories located at the CDC and in every state; up-to-date data and information systems including electronic disease reporting; and a highly skilled and qualified workforce.  

Over my 30-year career, I have held senior positions in public health as Boston’s health commissioner during 9/11, as the Massachusetts health commissioner during the H1N1 outbreak and at CDC during the Ebola and Zika crises.  I have led efforts to combat opioid addiction, the obesity epidemic among our children and environmental contaminants.

I have observed the ways that public health prevents disease and injury and saves lives during emergencies and outbreaks.  But all too often, I have also observed the missed opportunities and delays that result when health departments are under-resourced and under-staffed and inhibited by a crumbling infrastructure.

The public health system faces unprecedented 21st century challenges, ranging from the opioid crisis to extreme weather to emerging infectious diseases, and is doing so with, in many cases, 20th century infrastructure.  Simply put, an investment in core public health infrastructure gives the public health system the foundation needed to reduce preventable deaths.  

My organization recently released a report, The Impact of Chronic Underfunding on America’s Public Health System, where we found that outdated and underfunded resources are preventing the public health system from adequately tackling leading health threats and contributing to the starting fact that U.S. life expectancy has declined for the third year in a row.   Let me offer some examples:

As public health departments are on the ground working across sectors to prevent and respond to health threats such as food contaminated with salmonella, Zika, Ebola and – right now - measles, there are sometimes dangerous delays in responding due to the limitations of laboratory capacity.   During the Zika outbreak, health departments in most states were not able to conduct a confirmatory laboratory test, so the samples would have to be flown by commercial airlines to the CDC in Atlanta. And even CDC lacked the resources to respond immediately to the volume of requests. As a local and state health commissioner I sometimes waited days for a crucial test result due to lack of capacity.  Diagnostic technology is constantly improving and offering state-of-the art potential approaches such as Advanced Molecular Detection. But without continued investment, we can’t fully access these breakthroughs.

 The success of public health relies upon accurate and timely data, but it is shocking to continue to hear stories of reports of disease that are filled out by hand and faxed only when access to a fax machine was possible – rather than real time electronic reporting.  There are parts of the country that are still communicating such time-sensitive information the way they did a half century ago.

Americans want to turn around the latest statistics that show declining life expectancy from preventable deaths.  They want us to quickly diagnose and treat an infectious disease outbreak before it spreads. And they want us to respond quickly and effectively when a major emergency occurs.  Yet these goals remain aspirational without a major investment in the public health infrastructure. The House Committee deserves praise and support for its attention to this need.  It is well worth the investment not only in terms of lives saved and illness, injuries and expensive health care costs averted: it literally is an investment in our future.


Big City Health Officials Outline their Top Priorities for a Healthier America in 2020

By Chrissie Juliano, Executive Director of the Big Cities Health Coalition

 Local health departments carry out life saving work every day.  They are the first line of defense against threats to the public’s health, leading the response to infectious disease outbreaks, disasters both natural and man-made, and chronic conditions.  They help to prevent disease before it strikes by helping to create healthier communities, and advocate for policies that help make the healthy choice the easy choice.  

To achieve greater equity and better health for present and future generations, local leaders must work together to ensure communities can learn from one another.  The Big Cities Health Coalition (BCHC) is a forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of their residents. Collectively, BCHC’s 30 member jurisdictions directly impact nearly 62 million people, or one in five Americans. Members work together to realize BCHC’s vision of healthy, more equitable communities through big city innovation and leadership across a spectrum of activities that includes advocacy/communication, practice, policy, and data.

Resources, even among large urban health departments, are sorely needed to address the most critical public health issues of today, almost all of which are tackled at the community level. Gun violence, the opioid epidemic, and the rise of vaping take up much time at our member health departments. Coupled with the challenges of chronic disease like asthma, obesity, and diabetes, and both emerging and returning infectious disease outbreaks, like Ebola or measles, these pressing public health concerns must be confronted if more Americans are to live longer, healthier lives. U.S. life expectancy has fallen for three years in a row, the longest sustained decline in expected life span since 1918. In order to reverse this trend, big city health departments need sustained and predictable funding.

BCHC recently identified the top areas where resources are most urgently needed for FY2020 and beyond. First and foremost, Congress must #RaiseTheCaps, lifting discretionary funding caps to create room for key investments in public health and other domestic funding. It’s also important to continue to increase dollars that flow to the Centers for Disease Control and Prevention (CDC), in part because this is a key funding stream to local and state public health. As such, BCHC supports the 22 by 22 campaign led by the Association of State and Territorial Health Officials.

Additional asks track with our policy priorities and our belief in the importance of a strong public health infrastructure at all levels of government that can prevent and address health challenges and prepare and respond to emergencies as they emerge.

·         Epidemiology and Laboratory Capacity is a key funding stream that supports six big cities and states to support disease detection in communities across the country. Recently BCHC partnered with the Council of State and Territorial Epidemiologists to assess Epidemiology Capacity at the local level. One key finding of that is that while state epidemiologists are largely funded by federal dollars, local epidemiologists are more often than not funded by local dollars.

·         Likewise, it is critical to support surveillance systems, particularly at the local level, investing in 21st century data systems that allow real time measurement of not just death rates, but also key indicators related to violence, substance misuse, and, more broadly, the social determinants of health.

·         A key part of stemming the tide of Substance Abuse Disorder (SUD) – opioids and otherwise – is to increase resources at not just the state, but also the community level to advance interventions for preventing overdoses in this present crisis, and overall SUD.

·         As we work to implement a public health approach to violence, additional research is needed into violence prevention, firearms in particular, to know more about long term effects and what works best to prevent unnecessary death. Currently, the Core State Violence and Injury Prevention Program (CORE SVIP) is the only program in the nation that implements, evaluates, and expands strategies to reduce pressing injury and violence challenges at the state level and increased funding is needed to expand CORE SVIP from 23 states to all 50 states, U.S. territories, and D.C. Increased levels would also allow for additional dollars to trickle down to the local level.

·         Finally, BCHC supports increases for CDC’s Office of Smoking and Health to stem the tide of e-cigarette use among youth, and also the agency’s immunization programs that support health department infrastructure to provide vaccines for those most in need and address vaccine hesitancy.

Funding these, and other initiatives, such as Public Health Emergency Preparedness (PHEP) Cooperative agreements, as well as filling critical workforce gaps, are essential if we want to improve the lives of millions of Americans.  In addition, it is also crucial to consider how best these dollars can get to the people who need them most.  At a minimum, federal dollars should flow through the states to the community level, and in some cases, funds should be directly allocated to cities that are most in need.

The expertise, dedication and innovation within local health departments is doing so much across the country to help and support local communities.  We must ensure those on the front line are supported with the resources they need to continue their life changing work.

 

The Hot Zone Meets the Genome: Staying Ahead of the Next Outbreak through Advanced Molecular Detection

By Allen D. Segal, Director, Public Policy and Advocacy, American Society for Microbiology

When diseases and disasters strike, a federal response is critical to mitigating the crisis. When it comes to protecting public health, the Centers for Disease Control and Prevention (CDC) plays an indispensable role in the rapid detection and containment of diseases, outbreaks, biosecurity threats and environmental hazards. For the past 20 years, the CDC has relied heavily on the growing Laboratory Response Network (LRN) for Biological Threats when an infectious disease or high-consequence pathogen emerges. A critical component of CDC’s response to biological threats is the Advanced Molecular Detection (AMD) program. These partnerships between federal agencies and state governments exemplify how federal investments in “basic” or “fundamental” research are translated into practical “real world” applications in public health, and then deployed across the country when a crisis hits.

AMD is part of CDC’s National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). When an infectious disease or food-borne illness outbreak occurs, AMD partners across the LRN, including at state public health labs or at CDC headquarters, are able to genetically sequence the pathogens involved. The technological advances in sequencing, even during the last five years, have greatly enhanced our ability to track down the sources of outbreaks, enabling officials to take action before they become more widespread.

Before the AMD program was authorized and funded by Congress in 2014, it was becoming painfully clear that the technology “gap” between research and medicine, and public health, was widening. The U.S. public health system was not realizing the potential of advances in pathogen genomics.  With middle eastern respiratory syndrome (MERS) and Ebola raging in areas around the world, and avian flu striking the U.S., CDC needed more rapid and accurate means to prevent and address these serious outbreaks.

Since 2014, the AMD program has received annual funding level of $30 million. This has allowed the agency to rapidly incorporate next-generation sequencing (NGS), a novel and versatile technology developed with funding from NIH, into CDC operations and bring it to the front lines of public health.

AMD has broad and important implications for U.S. health and security, such as food safety, tracking emerging infections, improving vaccines, and combatting antimicrobial resistance. 

Consider the following:

·         State-of-the-art AMD methods help solve infectious disease outbreaks from foodborne pathogens faster by linking food sources to clusters of illness.

·         Studying the genetic makeup of micro-organisms helps identify and track rare and deadly pathogens such as Ebola and Zika viruses, and AMD has uncovered previously unknown threats such as the Bourbon virus.

·         Applying AMD methods to vaccine-preventable diseases, such as whooping cough and flu, helps CDC monitor genetic changes and understand why vaccine effectiveness may decrease.

·         AMD methods lead to more rapid and accurate tests to detect antimicrobial resistance.

Thanks to the effectiveness of the AMD program, today the U.S. public health system has closed the technology gap when it comes to addressing infectious disease outbreaks. But now, AMD’s decreasing ability to support innovation is threatening to open it up again. To maximize its potential, this $30 million program needs a significant increase in funding to support current operations and expand the scope of innovation to ensure cutting edge technology is working to protect Americans from disease.  

Why?

·         Next generation sequencing technologies continue to advance at an astounding pace, giving us new and expanded tools to detect disease faster, identify outbreaks sooner, and protect people from emerging and evolving disease threats.

·         More funding would allow previously unimaginable techniques to be deployed, such as the sequencing of pathogens directly from specimens without a need for culture, critical to addressing bacterial foodborne illness, or developing more effective vaccines by targeting evolving pathogens.

·         Additional funding would allow CDC to better assist the LRN, develop and improve diagnostics, and ensure molecular tests can be deployed rapidly when needed and where they will have the greatest impact.  

In its first five years, the AMD program has transformed many areas of public health, and its success has demonstrated the critical importance to the nation’s health security of staying abreast of technologies that are both cutting edge and relevant. But it is important to understand this role in the context of the larger picture. The AMD program exemplifies one of the many ways that CDC supports the work of critical partner agencies at the state and local level and with the LRN’s nonprofit partners like the American Society for Microbiology and the Association of Public Health Laboratories.

In short, CDC puts science into action for the benefit of public health, and funding for this agency must keep pace. To carry out its mission, CDC requires an unwavering commitment from Congress to provide significant funding increases so that we can keep public health on the cutting edge of science and medicine.

 

 

Why Climate Change Is a Health Priority

by Laura Kate Bender, American Lung Association and Don Hoppert, American Public Health Association 

More and more Americans are realizing that climate change is a health emergency, in part because they have experienced its impacts personally.

Warmer temperatures are taking a toll on Americans’ health across the country and the links are clearer than ever. Hazardous air quality from wildfire smoke in the West; Lyme and other diseases spreading into new parts of the country; high ozone levels on more summer days; and the massive burden of extreme weather events, including life threatening disruptions in health care, are no longer hypothetical for too many American families.

But the bad news – that more and more Americans are realizing that climate change is a health emergency – is also the good news.

That’s because awareness of these impacts is also rising among the health and medical community leadership, who are stepping up their efforts to promote science-based solutions. And more people caring about climate and health means more people ready to find solutions.

Urgent action is needed to dramatically reduce the pollution that causes climate change to stave off the worst health impacts. What’s more, we also have to help communities deal with the impacts that are already here.

Enter Centers for Disease Control and Prevention’s (CDC) Climate and Health Program, located in the National Center for Environmental Health. It’s the only federal program helping states, cities and tribes adapt specifically to the health impacts of climate change. It provides funding and expertise to help health departments use science to predict local health impacts, and then prepare programs to protect the health of those most at risk.

When people think of measures to adapt to climate change, they often think of physical infrastructure, like sea walls and storm-resistant housing. But there are additional, health-specific adaptation measures that communities can consider, too – such as heat wave warning systems, cooling centers, surveillance of climate-related diseases, monitoring to identify water contaminants, and physician education on how to identify emerging vector-borne diseases.

The Climate and Health Program currently funds 16 states, two cities, three tribes and three territories (covering 50 percent of the U.S. population). With this funding, Massachusetts has developed a vulnerability mapping tool; Maryland put together a climate change and healthy homes curriculum for community health workers; and New Hampshire educated day camp counselors and rural seniors on tick exposures. See more examples in APHA’s “Adaptation In Action II” report.

The work is critical, but communities’ need for assistance in adapting to climate change far exceeds the available funding. Thankfully, in response to a request from health and medical organizations, including several Coalition for Health Funding members, and with the support of many Members of Congress, House Appropriations Chair Nita Lowey and Labor, Health and Human Services, Education and Related Agencies Appropriations Subcommittee Chair Rosa DeLauro included a 50 percent increase for the Climate and Health Program in the fiscal year 2020 “Labor-HHS” appropriations bill. The $15 million in programmatic funding is small in the context of the $4 trillion federal budget, but the increase is an improvement from recent years, when some members in the House actually attempted to terminate the program.

If agreed to by the Senate, the extra funding will serve two important purposes. First, it will allow CDC to fund additional cities and states. Second, it will allow CDC to better evaluate the existing grantees’ work to share best practices with communities nationwide.

However, none of this will be possible without a broader budget deal to increase federal spending. If Congress does not come together with a bipartisan agreement to #RaiseTheCaps, this and other programs will be subject to an across-the-board spending cut that would slash funds for climate and health work at exactly the time when increased investment is most critical.

Please join the call to #RaiseTheCaps and join the growing ranks of health and medical professionals calling to protect our health from climate change. We need to invest in protecting our neighbors—especially those most at-risk—from these harmful impacts.

 

#LoveAnotherMother this Mother’s Day

By Katie Schubert

Board, Coalition for Health Funding

Chief Advocacy Officer, Society for Maternal Fetal Medicine

Serena Williams. Kelly Clarkson. Beyonce. Kim Kardashian. Amy Schumer. These famous new moms had complicated  pregnancies and/or births. Serena Williams is likely the most “famous” case of a woman advocating for her own health yet not totally being heard until it was almost too late. Kim Kardashian had severe preeclampsia. Amy Schumer recently took to Instagram, saying “Amy is still pregnant and puking because money rarely goes to medical studies for women such as hyperemesis or endometriosis. . .” The rest of this quote is not entirely appropriate for print, but suffice to say, she describes her strong feelings about the prioritization of other types of research. Schumer has suffered from hyperemesis (severe nausea and vomiting) her entire pregnancy, a condition that made headlines due to Duchess Catherine Middleton’s struggle with it through her pregnancies.

Although six million women in the United States get pregnant each year, there is so much we do not know about pregnancy and birth. Research on pregnant women was long thought to be unethical and as a result, there is very little knowledge about what medications and therapies are safe during pregnancy.  In the past few years, medical ethicists have made a 180-degree change and researchers are encouraged to include pregnant women, as possible, in their work.

Even more troubling is that the United States has the highest rate of maternal death among industrialized countries. For women of color, the likelihood of pregnancy complications or death is even higher. The CDC this week released a report that provided some sobering statistics: about 700 women die from pregnancy-related complications in the U.S. annually; about 3 in 5 pregnancy-related deaths could be prevented; about 1 in 3 pregnancy-related deaths occur 1 week to 1 year after delivery; and that Black and American Indian/Alaska Native women were about 3 times as likely to die from a pregnancy-related cause as White women.  We can do better, and our nation’s moms and their families deserve better.

Once a woman delivers her bundle of joy, the focus is often on the health of the baby first, and the health of the mother comes second.  Unfortunately, there are far too many American mothers dying due to pregnancy-related complications following childbirth because we, as a nation, have not always prioritized maternal health. But that is beginning to change.  Last year, Congress passed the Preventing Maternal Deaths Act into law. This legislation is critical to tackling our rising maternal death rates. Congress paired that legislative win with $12 million for maternal mortality review committees – almost double what the community was asking for. This support for maternal health has been reinforced just this week when the fiscal year 2020 House Labor-HHS report included an additional $12 million for that work, plus increases for the Alliance for Innovation on Maternal Health and the Safe Motherhood Initiative.

There are also several proposals in the 116th Congress aimed at authorizing public health programs to address maternal health and progress is being made at the state level, as well. SMFM has created a map that includes state-level fact sheets on the public health initiatives that are critical to reducing maternal mortality.

Still, far too little has been done on the research side. Relative to investments in research for other specific diseases and populations, investments for research in pregnant women and breastfeeding women are small. Unlike other medical fields such as oncology, cardiology, and psychiatry, which rely heavily on industry for research and clinical trials, much of the evidence that guides obstetric and postpartum practice is generated from studies that are funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) at the National Institutes for Health (NIH). In fact, the NIH acknowledged this during the Task Force Specific to Pregnant Women and Lactating Women (PRGLAC) meetings in 2017 and 2018, finding that “many of the clinical practice guidelines of the American College of Obstetricians and Gynecologists are rooted in NIH-funded studies.”

Some of the most impactful NICHD-supported research related to pregnancy in the last decades has originated within research networks supported by NICHD, such as the Stillbirth Collaborative Research Network, the Obstetric-Fetal Pharmacology Research Unit Network, and the Maternal- Fetal Medicine Units Network (MFMU). The MFMU specifically has been conducting critical research in the field of obstetrics since 1986. Studies out of the MFMU directly impact the clinical practice of obstetrics – they have actively reduced the pre-term birth rates in the U.S., improved outcomes in both mothers and their babies, and have reduced health care waste. There is no better investment that can be made than in clinical trials related to obstetrics – for healthy moms bring healthy babies, improving the health of our nation.

SMFM is calling on Congress to prioritize research in pregnant and breastfeeding women. This imperative is particularly important given the continued rise in maternal mortality and severe morbidity. Evidence from clinical studies is desperately needed to guide prediction, prevention and management of the various pregnancy complications that lead to these dire outcomes.

This Mother’s Day, SMFM is calling on YOU to help us honor mothers and their role in society. While the support for public health programs related to maternal health is long overdue, we can educate policy makers to prioritize investments in research in pregnant and breastfeeding women. Let’s work together to make it happen.

The Fight to Keep Title X Strong

By Lauren Weiss, Director, Advocacy & Communications, National Family Planning and Reproductive Health Association and Zara Day, Pharmacy Analyst, Planned Parenthood Federation of America

 On March 4, 2019, the Trump-Pence administration finalized a regulation, sometimes referred to as the domestic gag rule, which would dramatically alter the Title X (ten) family planning program. For nearly 50 years, Title X has served as the nation’s only federal program dedicated to ensuring high-quality, affordable family planning and sexual health care for poor, low-income, and otherwise underserved people.

 For the last six years, the Department of Health and Human Services has been appropriated $286.5 million to administer the competitive grant program in communities across the country. Unfortunately, this funding level for Title X is wholly insufficient to meet the demand for the program. In fact, current funding levels are less than 40 percent of what is needed to meet the need for publicly funded family planning in this country, according to analyses published in the American Journal of Public Health. Despite reflecting a small portion of federal dollars spent on health care and the program’s statutory prohibition on using funds for abortion services, Title X has been on the receiving end of criticism and pushback in recent years from conservative lawmakers who seek to undermine the program as part of an anti-choice policy agenda.

 Title X funding goes to nonprofits and state and local public health agencies to subsidize family planning and related preventive health services, including contraceptive counseling, services, and supplies; Pap smears; cancer screenings; sexually-transmitted infection (STI) testing and treatment, HIV testing and education, and community outreach and sexual and reproductive health education. All services are provided at no cost to people who have incomes below the federal poverty line (FPL) – who make up more than two-thirds of patients served - and on a schedule of discounts to people with incomes between 101 and 250 percent FPL.

 All of these critical services are at risk under the new rule. The Trump-Pence administration’s final rule gags providers from offering patients a full range of medical options, prohibiting them from referring for abortions even if a patient requests a referral, and coercively requiring that all patients with a positive pregnancy test be referred for prenatal care regardless of the patient’s wishes. The rule also removes the term “medically approved” from a requirement that Title X projects offer a broad range of contraceptive methods, potentially opening the door for crisis pregnancy centers to receive federal funds to provide confusing, medically unsound and unethical care to patients. The rule imposes unnecessary physical and financial separation requirements between a Title X program and the provision of abortion services or any other activity the administration deems to support, promote or advocate for abortion. Additionally, the rule creates onerous reporting requirements for program participants. In the aggregate, all of these changes are targeted at penalizing the current network of highly qualified health centers, some of whom separately offer abortion care, an ethical and legal service. If the courts do not block this unlawful rule, the nation should expect decreased access to high-quality, compassionate care for low-income patients and for patients of color, who are disproportionately represented in the Title X patient population.

 So, some CHF members are fighting back. NFPRHA, jointly with one of its Washington state-based members, Cedar River Clinics, as well as PPFA, jointly with the American Medical Association, have filed lawsuits, including motions for preliminary injunctions, seeking to block the rule from taking effect. This is in addition to separate litigation filed by the Title X grantees in California and Maine and the attorneys general representing Washington, California, the city of Baltimore, and Oregon, the last of which is joined by 19 states and the District of Columbia.

 Both public health experts and the medical community are on the side of barring the Trump-Pence administration from moving forward with these egregious policies. Moreover, an array of stakeholders are working together to raise awareness about the dangers posed by this rule and to mobilize our champions in Congress to speak out against this attack and support bold policies that strengthen the network, including increased funding to meet the needs of people across the country. The response has been tremendous - in the last month, 197 members of the House of Representatives and 42 members of the Senate have signed Dear Colleague letters in support of increased funding for Title X in the FY 2020 appropriations process. Clare Coleman, NFPRHA’s President & CEO, also testified about the need to support the current network of providers in front of the Labor, Health and Human Services, and Education Subcommittee of the House Appropriations Committee. Blocking the rule and strengthening investments in Title X annually will help the program deliver on the nation’s imperative to ensure that the people are able to access affordable birth control and preventive to care, which in turn supports their ability to fulfill their goals.

 NFPRHA and PPFA urge you to join us in support of Title X and the millions of patients who rely on it. For more information about fighting the Title X rule, please contact Lauren Weiss at lweiss@nfprha.org and Jack Rayburn at jack.rayburn@ppfa.org.  

 The National Family Planning & Reproductive Health Association (NFPRHA) is a non-partisan 501(c)3 membership association that advances and elevates the importance of family planning in the nation’s health care system and promotes and supports the work of family planning providers and administrators, especially in the safety net.

 Planned Parenthood (PPFA) is the nation’s leading women’s health care provider and advocate and a trusted, nonprofit source of primary and preventive care for women, men, and young people in communities across the United States. Each year, Planned Parenthood’s more than 600 health centers provide affordable birth control, lifesaving cancer screenings, testing and treatment for sexually transmitted diseases (STDs), and other essential care to 2.4 million patients. We also provide abortion services and ensure that women have accurate information about all of their reproductive health care options.

 

 

Fighting the Funding Cliff

By Ben Corb, Board Member, Coalition for Health Funding

Co-Chair, NDD United

Director of Public Affairs, American Society of Biochemistry and Molecular Biology

There are a lot of expectations for the 116th Congress. In the public health and health research communities, many of us are advocating for more funding for programs, projects, and activities at the Department of Health and Human Services and for good reason. In recent years, many of these activities have seen cuts or watched their buying power erode as their funding failed to keep pace with inflation.

However, all of this advocacy will be for naught if Congress does not pass legislation to avoid a steep, $55 billion funding cliff for nondefense discretionary (NDD) programs scheduled to take effect at the end of this fiscal year. Without another bipartisan budget deal to #RaiseTheCaps, it will be all but impossible for the House or Senate to maintain funding for health programs, let alone provide the resources necessary to begin to make up for years of cuts.

NDD United, founded and co-led by the Coalition for Health Funding, has been successful in advocating for two other two-year deals to raise the budget caps, which means that the most extreme funding levels were only allowed to be implemented in one year since the law’s enactment. As a result that year, there were significant reductions in funding for every program, project, and activity across the discretionary landscape. For health, this meant significantly fewer grants for research, fewer patients receiving care, fewer future healthcare providers trained, fewer public health officials monitoring and responding to threats, and much more. (Learn more about the impacts of budget cuts on health here).

 It would be devastating for Congress to allow for the current cap for fiscal year 2020 to take effect. Thus, the Coalition for Health Funding has once again joined 850- national, state, and local organizations from all different sectors to call on Congress to “Raise the Caps.” The letter, with all signatures, is available here.

Last week, House Budget Chair John Yarmuth took the first steps in preventing the enactment of the 2020 cap by introducing the Investing for the People Act, which would raise nondefense discretionary caps for two years. In 2020, it would provide $34 billion over current levels and maintain the parity principle by providing comparable increases to defense and nondefense caps. It also would allow for further adjustments to the caps for the big ticket items including the 2020 Census. Despite the need for relief, however, there are inter and intra party struggles on both sides of the aisle that make the bill’s passage uncertain.

With a divided Congress and growing deficits, the path to #RaiseTheCaps this year is not clear, and advocates must realize that bipartisan budget deals don’t just happen. It will take the advocacy of people and organizations across the nation to again avoid harmful cuts. We hope you will continue to engage with us in both the #RaisetheCaps and #FUNdHealth campaigns to keep the drumbeat going.

 

We encourage groups to continue to stay engaged with NDD United throughout the year as Congress continues conversations about topline funding by following them on Twitter at @NDDUnited or signing up for the distribution list on www.nddunited.org.

2019 State of the Coalition

By Craig Kennedy, President

Next year, the Coalition for Health Funding will celebrate its 50th Anniversary marking five decades of working together to protect and promote federal investment in the public health continuum. As the new President of the Coalition, I am proud to continue the work of Donna Meltzer, Don Hoppert and all our previous Coalition presidents to work with all of you to improve the health of people across the country.

Having now served on the Board for six years and a Coalition member for 20 years now, I have seen first-hand how this Coalition continues to grow and lead the national conversation about health funding. From our humble roots at the American Association of Medical Colleges, we have grown to more than 90 members representing over 100 million patients and consumers, health providers, professionals, and researchers.

Our signature educational events, including the Public Health Fair and Public Health 101 congressional briefing, have helped to educate hundreds of lawmakers and advocates across Capitol Hill about the role the federal government funding plays in protecting and improving Americans’ health. Our leadership of the NDD United campaign resulted in THREE deals to raise the austere budget caps, and we successfully advocated for emergency supplemental funding for public health crises such as Ebola and Zika. Further, we proactively educated our members and the public through thousands of daily “Member Updates,” hundreds of statements, and more one-pagers than we could count. If you don’t believe me, check out what we did in 2018 alone in our new Annual Report!

Still, our work is not done. Already this year we have experienced the longest shutdown in American history, and we are facing the return of austere budget caps, a debt ceiling debate, and numerous other health funding cliffs. The public health community must continue to speak with one voice in order to overcome these challenges together. Thus, it is my personal goal to grow this Coalition to more than 100 organizational members in order to further strengthen the voice of the Coalition, of public health, and our entire community in the upcoming funding debates.

This Coalition leads the way on the broad funding issues that affect federal funding for health programs. As we look ahead to the remainder of the 116th Congress, I believe that, due to the strength of the alliance among our members, the Coalition will to continue to be the leading voice for public health funding and I look forward to working with all of you to ensure the best is yet to come!

Thank you very much, and I am honored to serve you and the entire Coalition during my term in office.