Late last week the American Public Health Association launched a campaign opposing dramatic cuts to the U.S. Department of Health and Human Services' Prevention and Public Health Fund. The cuts, passed as part of a Republican House bill to preserve the current low interest rates in federally subsidized student loans, would wipe out $6 billion in the Fund. A proposed Senate bill to be taken up next month alternatively preserves the current interest rates by closing a tax loophole "that allows wealthy individuals to avoid paying the same income taxes that middle-class Americans pay." The president has threatened a veto of the Republican-passed bill.
The Prevention and Public Health Fund was created as part of the Affordable Care Act "to provide expanded and sustained national investments in prevention and public health, to improve health outcomes, and to enhance health care quality." Since its creation in 2010, the fund has "invested in a broad range of evidence-based activities including community and clinical prevention initiatives; research, surveillance and tracking; public health infrastructure; immunizations and screenings; tobacco prevention; and public health workforce and training."
The politicization of the Fund is nothing new, and it has been targeted for cuts from both sides of the aisle. Democrats voted with Republicans last year to cut $5 billion from the fund to help pay for the payroll tax break, and the President has proposed additional cuts to help pay for other programs. Sadly, public health remains an easy target.
Republicans are leading this latest round of cuts, and I would suggest that the Fund's current crop of opponents get their facts straight. Rep. Ann Marie Buerkle (R., N.Y.), for example, criticizes it as a "slush fund" that supports "bike paths, jungle gyms, and worse yet, lobbying campaigns." Congresswoman Buerkle and others who supported the Republican bill can read about what it actually does by looking at the list of fiscal year 2012 allocation of funds.
For a short analysis of what the Fund is doing, read a piece by The Wonkblog at the Washington Post, which calls attention to the Fund's biggest commitments: "increasing the size of the health care workforce and implementing community-based, health care interventions." Wonkblog profiles one such program in Philadelphia: the development of a network of 600 healthy corner stores in low-income neighborhoods.
Other projects funded this year include Centers for Disease Control and Prevention programs to promote breastfeeding, screen for viral hepatitis, and modernize our public health immunization infrastructure, an Administration on Aging program on "Alzheimer's Disease Prevention Education and Outreach," and a Substance Abuse and Mental Health Services Administration program on suicide prevention.
Good God, Rep. Buerkle, the horror that our government should work to help improve the lives and health of its citizens!
Accolades to the American Public Health Association and other public health groups who have drawn attention this fight. Mary Pittman at the Public Health Institute rightly lambasts Congress for pitting popular programs, like the student loans, against the more politically nebulous Prevention and Public Health Fund. Because the fund helps everybody (the whole population) and thus seems directed at nobody specifically, Americans remain disconnected from the endless benefits of public health.
The public health community would do well to rethink its plan (if it even has one) for garnering grassroots support for its programs. We need our own Don Draper moment — a complete re-imagination and Madison Avenue-like makeover of strategy to capture Americans' support for the myriad programs that make up our population health and prevention successes. An essential part of such a campaign would be to convince the public that broad prevention and individual treatment go hand in hand — which, of course, they do.
As long as our health care culture continues to consider them dichotomous, instead of complementary parts of an organic health care whole, you can bet that we'll prioritize treatment every time. Wouldn't you?