Updated: February 2011: In the past year, we have seen extensive federal support for community health and prevention. February marks the one-year anniversary of the First Lady's Let's Move Initiative, which supports wellness for children across the country through increased opportunities for healthy eating and physical activity. This March will also mark the one-year anniversary of the passage of 2010's Affordable Care Act (ACA), which includes substantial federal investments in community health and prevention. ACA invests in prevention via the Prevention and Public Health Fund, the first $500 million of which was allocated in 2010. On February 9, 2011, HHS announced the appropriations for the fund for 2011, which will total $750 million. While the potential repeal of health reform has been noted in the national conversation, we do not anticipate that the bill will be completely eliminated. We do, however, anticipate that there will be challenges to funding the bill's prevention components, which will probably mean that both those in favor and those in opposition to the prevention elements—and the bill itself—will be mobilizing to make their case.
Below, we detail the specific allocations for fiscal year 2011 and also provide a summary of some of the most visible and important federal activities; the list is by no means exhaustive, as there are many smaller but nonetheless important opportunities to advance community prevention throughout the ACA.
Prevention and Public Health Investment Fund, Affordable Care Act
The Affordable Care Act (ACA) allocates $15 billion over ten years to a Prevention and Public Health Investment Fund. Again, there is an emphasis on expediency, as this funding is popular with the public and able to be rolled-out quickly (unlike many of the other ACA provisions, which go into effect in 2014 or later). $500 Million was allocated in fiscal year 2010 (see Appendix A), and $750 million has been allocated this fiscal year. The amount of funding will increase each year until it levels off at $2 billion per year for 2015-2019. The Prevention and Public Health Fund is a mandatory appropriation, meaning that it does not require an act of Congress in order for the money to be available and for the Administration to choose to spend the money.
UPDATE: Appropriation of $750 million for FY 2011
Specific allocations for FY 2011 were announced on February 9, 2011. A total of $750 million will be disbursed from the fund for FY 2011. Several new initiatives were funded this year, including $145 million for Community Transformation Grants, which will support state and community efforts to reduce tobacco use, increase healthy eating and activity, and reduce inequities. It is anticipated that the Funding Opportunity Announcement for Community Transformation Grants (see below) will be released soon, though as of now there is no confirmed release date. FY 2011 also includes additional supports for the public health workforce and infrastructure, and a new investment in workplace wellness. Community health related elements and their funding levels are listed below:
- $145 million for Community Transformation Grants
- $25 million for REACH
- $60 million for tobacco control
- $52.2 million for Comprehensive Chronic Disease Prevention Program (Chronic disease state grants)
- $45 million for public health workforce and development
- $20 million for public health research
- $40.2 million for public health infrastructure
- $10 million for prevention research centers
- $10 million for workplace wellness
- $7 million for Community Preventive Services Task Force
- $35 million for environmental public health tracking
- $1 million for the National Prevention Strategy
- $100 million for Section 317 Immunization Program (immunization services for under- and uninsured children, as well as immunization infrastructure)
- $6 million for National Youth Fitness Survey
- $40 million for Epidemiology and Lab Capacity
- $7 million for Clinical Preventive Services Task Force
- $9.12 for obesity media activities
For a complete list of FY 2011 Prevention and Public Health Fund appropriations, please visit: http://www.healthcare.gov/news/factsheets/prevention02092011b.html
Community Transformation Grants
Community Transformation Grants (CTGs) will be awarded from the Prevention and Public Health Investment Fund by the CDC Director based on a competitive process. It is anticipated that the Funding Opportunity Announcement for Community Transformation Grants will be released soon, though as of now there is no confirmed date. We anticipate that Community Transformation Grants will be broader than Communities Putting Prevention to Work (CPPW, Appendix B), and will include issues such as injury and violence prevention and a more direct focus on equity. We also expect that the grants will move beyond cities to a diversity of communities, and will emphasize effective work between cities, states, and community-based organizations. Based on our experience with the CPPW process, work cosponsoring convenings with public health leaders on the CTGs, and conversations with leaders in federal agencies, we anticipate that:
- The grants will build upon the Communities Putting Prevention to Work initiative and will support policy, environmental, programmatic, and infrastructure changes to support healthy living and health equity.
- The intent of the grants is to seed truly transformational efforts that have a broad impact and not to provide replacement for current funding or the scaling up of narrowly focused projects.
- State and local jurisdictions, national networks of community-based organizations, state or local nonprofits, and Native American tribes will likely be eligible to apply for Community Transformation Grants. Partnerships between governmental and non-governmental entities may also be encouraged.
- Not less than 20% of the grants will be awarded to rural and frontier areas.
- The FOA will not require the quick turn-around time or the two-year limitation that CPPW imposed.
- These grants are intended to support the implementation and evaluation of community prevention activities that "reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective prevention programming." While all initiatives will be informed by research and best practice, there should be an effort to encourage innovation, to both be responsive to community needs and to build new evidence base as prevention strategies are implemented and expanded, particularly in communities disproportionately impacted by health inequities.
- HHS and CDC indicate that a strong focus of the grants will be to increase health equity: CTGs will require, in addition to jurisdiction or population-wide changes, the reduction of health inequities for one or two particular populations within the community or state.
- Language in the Affordable Care Act specifically mentions that activities undertaken by the Community Transformation Grants can include "creating the infrastructure to support active living and access to nutritious foods in a safe environment." While these grants will be focused primarily on chronic disease prevention, this language reflects the necessity of including strategies that improve safety in order to achieve community health and equity.
- Unlike the Communities Putting Prevention to Work Grants, Community Transformation Grants will also have a capacity building component for communities that might not have the capacity or experience to undertake community policy and environmental change. The capacity building grants will provide substantial training and technical assistance to help communities get leadership and coalitions established that will enable implementing projects that achieve transformative change. As more funds become available, communities awarded the capacity building grants will be able to transition into the implementation phase. This is critical as communities with fewer resources to complete the grant process often have the greatest immediate need for change and the most significant potential for tangible, short-term impact on health outcomes.
National Prevention, Health Promotion, and Public Health Council
Additionally, ACA establishes a National Prevention, Health Promotion, and Public Health Council, chaired by the Surgeon General and comprised of high-level staff from 17 federal departments. The President signed an Executive Order in early September 2010, which added five important agencies that were not originally included: Housing and Urban Development, Office of Management and Budget (OMB), Department of Justice, Department of Defense, and Veterans Administration. This is of great significance as the Surgeon General has the opportunity to encourage health promoting practices and policies in the major sectors that impact health-from economic development to transportation, agriculture, education, etc. The President has also formed an Advisory Group on Prevention, Health Promotion, and Integrative and Public Health, made up of non-Federal members that also report to the Surgeon General. On January 26, 2011, the White House announced the 13 members of the Advisory Group. For a complete list of Advisory Group members, please visit: http://www.whitehouse.gov/the-press-office/2011/01/26/president-obama-announces-more-key-administration-posts.
The Council, with input from the Advisory Group, is tasked with developing a National Prevention and Health Promotion Strategy. The strategy will encourage work across sectors, catalyze public and private partnerships, and focus on where people live, work, and play. The Strategy is currently scheduled to be released in March of 2011; there have been multiple opportunities for stakeholder input including national conferences, outreach calls, and HHS Regional Meetings. Visit www.healthcare.gov/nationalpreventioncouncil for additional information. The Assistant Secretary for Health will coordinate with HHS agencies and other Federal departments; the CDC will conduct analysis and provide technical support in the development of the Strategy.
In addition to developing the National Prevention and Health Promotion Strategy, the Council is responsible for ongoing leadership and coordination of federal prevention activities and is to release an annual status report by July 1st of each year.
Stay Up to Date / Health Reform Advocacy
Find opportunities for action and ongoing updates at http://preventioninstitute.org/focus-areas/reforming-our-health-system/what-you-can-do-health-reform-advocacy.html. While there you can join our Health Reform Rapid Response Network, and help us keep the conversation on community prevention going. We'll keep you updated on related news and involved in opportunities to respond to the media. Every added voice is critical to ensure that these efforts are maintained and flourish.
Sign onto the Principles for Quality Prevention in Health Reform, developed by Prevention Institute, PolicyLink, Trust for America's Health, Public Health Institute, and other organizations, to ensure the highest quality in our national prevention efforts. Signatories stand for a shared voice and commitment to quality prevention on behalf of organizations across the country. http://org2.democracyinaction.org/o/5902/p/dia/action/public/?action_KEY=3735
Appendix A: Prevention and Public Health Investment Fund: $500 million for FY 2010
Of 2010's funding, a one-time allocation of $250 million was distributed for primary care workforce development. The remaining $250 million was distributed as follows (determined by the administration):
- $44 million for Community Transformation Grants for approved but unfunded CPPW applicants. These funds were distributed on September 14. See below for details.
- $16 million for tobacco cessation activities
- $20 million for primary and behavioral health integration
- $16 million for obesity prevention and fitness
- $20 million for Epi and Lab Capacity state grants
- $50 million for state public health infrastructure
- $15 million for public health training centers
- $30 million for HIV/AIDS
- $8 million for public health workforce
- $10 million for Community and clinical preventive services task forces
- $21 million for surveillance
For a complete summary of how the Prevention and Public Health Fund was used to support health and wellness in 2010, including state-specific information, please visit:
http://www.healthcare.gov/news/factsheets/prevention02092011a.html
Appendix B: Communities Putting Prevention to Work, American Recovery and Reinvestment Act
In 2009, Congress allocated $1 billion in Stimulus funding for prevention and wellness. The Stimulus funds needed to be expended quickly, and the funded two-year projects were initiated by early 2010. Ultimately, over $370 million was invested in Communities Putting Prevention Work (CPPW) grants to advance statewide and community-based policy and environmental changes in eating, physical activity, and tobacco control, with a small amount reserved from CPPW for CDC staffing, consultation contracts, and evaluation. Additional funds went toward immunizations and reducing healthcare-associated infections. The list of funded CPPW projects can be found at http://www.hhs.gov/recovery/programs/cppw/granteesbystate.html.
