The Prevention Dilemma: DHHS Secretary Urged To Seize Opportunity to Impact Public Health

Few would argue the importance of increasing funding for community prevention. That’s the reason prevention advocates were so delighted Congress established a Prevention and Public Health Fund to “provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs.” The fund makes available $500 million in new spending in FY2010; the fiscal year ending September 30. There is a tough decision ahead to spend a great deal of money in a short period of time.

There are many worthy ideas vying for DHHS Secretary Kathleen Sebelius’ attention. She is the official charged by the new law in allocating the funds “for prevention, wellness and public health activities…”

How should the Secretary make the initial trust fund allocation given that so many deserving programs are asking for a slice from the pie?

In an Op Ed (“The Prevention Dilemma”) written for Kaiser Health News, Partnership for Prevention CEO, Dr. Robert Gould, answers the tough question.

“There will never be enough federal money to address every prevention need. What the secretary needs to decide is whether there is sufficient political courage to concentrate early prevention funding to deliver a knockout blow to the leading cause of premature death in the country? … The criteria for prioritizing this specific funding should be simple: what are the evidence-based programs that are primed and ready to go, that are proven to work, that we know will move us toward a healthier society and that we can be sure will deliver a large, measurable return on investment? By these criteria, the top priority for prevention spending should be tobacco control.”

Gould recommends DHHS focus their resources on three well tested, evidence-based components::

1) Nationwide public education campaign modeled on the highly successful Truth® campaign that dissuades thousands of young people from initiating tobacco use and encourages smoking cessation;

2) Fully funding quit lines that provide direct cessation services and significantly improve quit rates efficiently and effectively, especially among disadvantaged populations served by Medicaid; and

3) Support for existing state and community-based tobacco control programs that reach people where they live, work, play and worship.”

The Partnership leader believes the goal of this potentially historic investment is simple and most important, achievable.. Gould concludes:

“If community-based tobacco control programs could be brought to scale nationally, we have a genuine opportunity to drive smoking rates into single digits. The rapid and enduring payoff, in lives and money saved, is there for the taking. It’s a rare opportunity. I urge Secretary Sebelius to seize it.”

Sounds like good advice. Do you agree?

Ripley Forbes
Director, Government Affairs
Partnership for Prevention

Is Prevention about to Relive the "Stimulus" Experience?

Earlier this year, Congress had proposed spending between $3 billion and $10 billion on prevention and wellness programs when it initially crafted an economic stimulus bill. But when key senators insisted the overall price tag for the legislation had to fall below $900 billion, prevention's share was zeroed out by Congress before the White House intervened to insist on $1 billion.

Fast-forward to August and remarks made by Senate Finance Committee Chair Max Baucus, D-Mont., as health reform negotiators work to achieve a bipartisan bill.

As the Washington Post explains: "Before leaving for the month-long recess, Baucus had pegged the cost of the negotiators' ideas at less than $900 billion over the next decade. Thursday's discussions focused on driving that cost lower, the sources said."

The House version of the bill contained provisions requiring first-dollar coverage for many clinical preventive services, and establishes a trust fund reserved for prevention and wellness programs. Many observers fear such programs will be deemed "expendable," particuarly in light of Congressional Budget Office statements that prevention programs do not save money for the federal government.

Is it deja vu all over again?

Raise Alcohol Tax to Finance Prevention Trust Fund, Partnership Urges Congress

Partnership for Prevention is urging chairmen of the three congressional committees crafting the House version of a health care reform bill to raise the federal excise tax on alcoholic beverages and apply those revenues to a special fund to finance prevention and wellness initiatives.

“Higher alcohol excise taxes are an important tool in reducing the public health toll of alcohol abuse, while also providing a viable and appropriate source of funding to finance reform of our nation’s health system,” Partnership President Robert J. Gould said in a letter to Reps. Charles B. Rangel (D-NY), Henry A. Waxman (D-CA), and George Miller (D-CA). Rangel, Waxman and Miller are chairmen, respectively, of the House Ways and Means Committee, the House Energy and Commerce Committee and the House Education and Labor Committee.

In his letter, Gould cited a review of scientific studies by the U.S. Task Force on Community Health Services that found increased taxes or prices on alcoholic beverages are consistently related to a reduction in motor vehicle crashes and deaths, alcohol-impaired driving and death from liver cirrhosis as well as deaths from other causes. Higher alcohol taxes were also demonstrated to reduce the incidence of violence, sexually transmitted diseases, and alcohol dependence.

He also noted that federal alcohol excise taxes were last raised in 1991 and have not kept pace with inflation. Meanwhile, the Congressional Budget Office estimates that a 20% tax hike on distilled spirits and equalizing the tax rates on other alcoholic beverages would provide $60 billion in new revenue over a decade.