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.