Among the Affordable Care Act’s more familiar components — prompting uninsured individuals to purchase coverage on the exchanges, allowing young adults to stay on their parents’ health insurance plan until age 26, or the provision of coverage for people with pre-existing conditions — is a lesser known provision that established the Prevention and Public Health Fund.
Upon its inception, the fund, whose mission is to improve health outcomes and enhance quality in health care, was meant to expand and sustain national investment in prevention and public health.
Repeal of the ACA would most certainly affect this fund and its outcomes, as well as its continued potential to improve health care quality and the nation’s health itself.
Investments from the fund to date have focused on a range of science-based actions, including strengthening public health infrastructure; providing immunizations and screenings; preventing tobacco use; strengthening the public health workforce and related training; enhancing research and strengthening the surveillance and tracking of communicable disease; and implementing a variety of community and clinical prevention initiatives.
Since Federal Fiscal Year 2012, the fund has provided investment in Montana to support personnel navigating people to the federal health exchanges; to the University of Montana for funding professional training to improve detection of and early intervention into Alzheimer’s disease and other related dementias; to UM to develop and implement a tribal suicide prevention and early intervention strategy; and to Montana State University to develop a comprehensive approach to prevent suicide within Montana University System units.
Other funding established throughout the country has gone toward implementing chronic disease self-management programs and programs designed to prevent falls among the elderly; programs that enhance hospitals’ ability to promote breastfeeding; diabetes and heart disease programs; investment to improve public health surveillance and laboratory capacity; programs that allow public health entities to better respond to events such as foodborne infections and waterborne diseases; efforts to increase vaccine coverage; programs to enhance capacity at state and city levels to prevent and eliminate childhood lead poisoning; and programs that improve physical activity and nutrition in early childhood educating settings.
President Donald J. Trump’s new Health and Human Services secretary, Tom Price, has advocated for specific repeal of the Public Health and Prevention Fund, calling it a “slush fund.” In November, Georges Benjamin, executive director of the American Public Health Association, told the online science journal Nature that if Price was confirmed as HHS secretary, “… We’d be working very hard to try and change his mind to convince him that prevention is an important issue he should champion.”
Ah, prevention. Even at the local level, here in Butte-Silver Bow, it is sometimes difficult to portray the value of prevention. Much work occurs at the Butte-Silver Bow Health Department to prevent something from happening, such as an outbreak of whooping cough. I have often said to my staff that if we’re truly competing for the county budgetary dollar, the guy filling the pothole — a pothole that you can see visibly as something that can damage your vehicle — may take funding priority over the public health nurse who works to prevent disease. If this nurse is going a great job, disease will not occur. You’ll never see, feel or be harmed by it.
Prevention is hard to explain, so policy-makers, at the local, state and federal levels, will often opt for more tangible, “see-able” items.
When I speak to people about prevention, or about funding prevention efforts, I like to bring up cancer. Because prevention has had a lot to do over the years with decreasing cancer rates.
The first anti-smoking campaign was established in 1964, when the U.S. populace began receiving education about the fact that smoking causes lung cancer, which can cause death. Since 1971, when the last television advertisement promoting cigarettes appeared, smoking has declined by half, and the rate of lung cancer has also declined.
That first anti-smoking campaign, and all of the tobacco campaigns that followed, are prevention efforts that have saved people's lives.
The Prevention and Public Health Fund, a gem embedded in the Affordable Care Act, is not a slush fund. Rather — like uninsured people obtaining coverage, like young adults remaining insured, like people with pre-existing conditions protecting their health — it is a valued part of our society.