Celebrating 75 Years of Protecting and Promoting America’s Health
ASTHO hosted a congressional briefing this week on Capitol Hill, convening nearly two dozen leading state and territorial health officials to educate lawmakers on the importance of public health and the impact of proposed cuts to the Prevention and Public Health Fund. Topics discussed during the briefing included state and territorial responses to Zika, the opioid epidemic, as well as the nation’s ever-changing environmental health challenges.
Brenda Fitzgerald, MD, commissioner of the Georgia Department of Public Health and ASTHO president-elect, as well as Celeste Philip, MD, surgeon general and secretary of the Florida Department of Health, began the briefing with a discussion on the Zika response in Georgia and Florida respectively.
Fitzgerald spoke about how Zika reached Georgia through its very active ports—both coastal and air. “When we had international workers coming into our ports from countries affected by Zika, we made sure port authority provided them with DEET and other strong mosquito repellents, to lessen the likelihood of insects biting and potentially transmitting the virus locally.” In addition, Fitzgerald shared the multipronged Zika-prevention approach the Georgia Department of Public Health implemented to protect travelers arriving into Hartsfield-Jackson Atlanta International airport, the busiest airport in the United States and a gateway to the world. Addressing efforts in Florida, Philip gave an update on the status of Zika, outlined current needs, and spoke about how key collaborations with CDC, mosquito control districts, as well as the American Congress of Obstetricians and Gynecologists and local OB/GYN providers helped make Florida’s urgent Zika response possible. “Collaboration, responsiveness, and transparency,” Philip emphasized, when asked to share key lessons learned from last year.
ASTHO President Jay Butler, MD, chief medical officer of the Alaska Department of Health and Social Services and director of the Division of Public Health, followed with a discussion on the role state and territorial public health agencies play in addressing the current opioid epidemic and preventing its spread. Butler began by pointing out that opioids such morphine are not new drugs—they have been around for centuries. “However, a seismic shift occurred in the late twentieth century,” Butler explained. “There were changes in how we viewed pain, and the medical practice followed with what I would say are some fallacies, such as people in pain are not at risk for addiction, or that opioids don’t really cause tolerance, all we have to do is increase the dose.”
Butler went on to describe what he considers the three waves that led to the current opioid epidemic. The first wave happened due to the abovementioned shift in perception regarding prescription painkillers. The second wave came around 2010, as “cheap and very pure heroin” began to infiltrate communities, primarily from Mexico. “And of course,” as Butler pointed out, “heroin had a very eager market, because unlike in the past, there was a large portion of the population that had become dependent or even addicted to opioids [through prescription pain medication].” The third wave occurred in the last two years, with the emergence of synthetic opioids such as fentanyl—a very powerful opioid, in some cases one-hundred times as powerful as morphine. “This wave is a little different,” Butler explained. “Many people who use fentanyl don’t realize they’re using it, and the risk of overdose is quite high.”
Butler’s 2017 ASTHO President’s Challenge is focused on public health approaches to mitigating the health impacts of substance misuse and addictions. And while the challenge’s goals are broader than just addressing opioid addiction, Butler explained that the emergence of the opioid epidemic was one of the main drivers for engaging in this conversation about substance misuse and the public health response.
Later in the afternoon, Larry Wolk, MD, executive director and chief medical officer of the Colorado Department of Public Health and Environment, and Catherine Heigel, JD, director of the South Carolina Department of Health and Environmental Control, spoke on current opportunities and future challenges faced by state and territorial public health agencies when it comes to environmental health.
Wolk described how public health and environmental health converged in Colorado two years ago during the disaster at the Gold King Mine, when toxic waste water spilled into the Animas River, turning it an orange-green color and raising concerns about water and environmental safety. Wolk also spoke about Colorado’s substantial involvement in fracking, the controversial oil and gas development process. “Environmental health and public health are intertwined,” Wolk said. “Environment affects people, we affect the environment, we try to keep the environment from harming people, and try to keep people from harming the environment. It’s all a big cycle,” he said, adding: “If you think about the ten great public health achievements of the twentieth century, at least five—safer workplaces, controlled infectious disease, safer and healthier foods, the purification of drinking water, and a reduction in childhood lead poisoning—were the result of state and federal environmental health policies and interventions.”
Heigel followed by offering a perspective on environmental challenges and preparedness activities in South Carolina. In addition to discussing issues of air and water quality, Heigel spoke passionately about the need to address not only emerging threats, like Zika, but existing threats, such as the extreme weather events that are happening with increased frequency. “Climate change is real, and it is changing our weather patterns. Major storm events have occurred in South Carolina two years in a row,” Heigel said, referring to the flood of 2015 and last year’s catastrophic Hurricane Matthew. “The number and severity of storms is increasing, and this affects everything from breaching dams, power outages, and lack of potable water, to impacts on hospitals when you can’t perform surgeries. The point was made earlier today about the importance of an emergency fund. I cannot stress this enough. We have to build capacity for what is becoming our new normal, but that plan costs money.”
With the mention of money, the briefing turned towards a summary regarding the implications of ACA repeal and replace efforts on the Prevention and Public Health Fund. Federal funding for core state prevention and public health programs and services has existed for decades. Since its creation in 2010, the Prevention and Public Health Fund, a key mechanism in ACA providing the bulk of funding for public health programs, has invested $6 billion in preventive health services and core public health programs such as childhood immunization, tobacco cessation, obesity prevention, and chronic disease prevention. In FY16, the Prevention and Public Health Fund provided $932 million to programs across multiple federal health agencies, affecting millions of Americans.
According to the American Health Care Act, the Republicans’ recently unveiled legislation to replace ACA, the Prevention and Public Health Fund could face elimination as soon as FY19. This, combined with promised federal budget cuts, would prove catastrophic for public health funding.
Rich Hamburg, executive vice president and chief operating officer at Trust for America’s Health, highlighted a few specific public health programs that would suffer as a result of cuts to the Prevention and Public Health Fund, including appropriations for healthcare-associated infections, lead poisoning, heart disease and stroke prevention, suicide prevention, as well as access to preventive clinical services, and the Centers for Medicare and Medicaid Services’s Innovation Center, where initiatives to improve health are developed. “These investments need to continue,” Hamburg stressed, adding that in the past year, 24 out of 50 states experienced decreases in their state-level public health funding. “If you take the Prevention and Public Health Fund away, and you have a 10-15 percent, across-the-board federal budget cut, we’re not in a good position. And I’m a glass-half-full kind of guy.”
ASTHO Executive Director Michael Fraser closed by thanking everyone for attending the briefing and emphasizing that prevention really should be a nonpartisan issue. “We all care about health for different reasons,” Fraser said. “But we all care about health. That’s what brings us to this work, and that’s what drives us to share our passion, as well as the actions of states and territories and all of the work they do on many urgent issues.”
Matthew Oglesby is associate editor, public relations at ASTHO.