Last night, Congress passed a $1.3 trillion spending bill, which President Trump has not yet signed. Here is a quick, initial overview of public health-related provisions:
- Public health and prevention: After a strong push from advocates, Racial and Ethnic Approaches to Community Health (also known as REACH) -- which had been zeroed out in the House and Senate spending proposals, and in the Trump administration’s proposed budget -- has been funded at $50.95 million. Funding for the Centers for Disease Control and Prevention -- which had faced steep cuts -- will receive a $806 million boost. The Prevention and Public Health Fund is included at $800.9 million. The CDC Office on Smoking and Health will receive a $5 million increase over last year’s funding levels, to $210 million (the original House spending proposal had cut the Office of Smoking and Health by $50 million).
- Gun violence prevention: Lawmakers agreed that the CDC “has the authority to conduct research on the causes of gun violence,” clarifying language in the Dickey Amendment that states that “none of the funds… may be used, in whole or in part, to advocate or promote gun control,” a provision that has effectively barred the CDC from researching gun violence since 1996. The Fix NICS Act would strengthen federal background checks for gun purchases by incentivizing states to update the National Instant Criminal Background Check System. The STOP School Violence Act of 2018 focuses on beefing up school security.
- Opioids: The spending bill allocates over $4.65 billion to address the opioid epidemic, with funding going to Mental Health Block Grants and State Opioid Response Grants; opioid addiction research at the National Institutes of Health; overdose prevention, surveillance, and prescription drug monitoring at the Centers for Disease Control and Prevention; access to treatment in rural and underserved communities; mental health support services at the Department of Veterans Affairs; and other programs.
- Housing: The Department of Housing and Urban Development will receive a significant one-year increase in funding for housing vouchers; the Low Income Housing Tax Credit, which incentivizes development of affordable housing units; repair and maintenance of public housing; supportive housing for veterans, people with disabilities, and the elderly; lead abatement; homeless assistance programs; reauthorization of the US Interagency Council on Homelessness; and other programs supporting affordable housing, while stabilizing rents for people living in public housing. The Community Development Block Grant -- which funds a variety of local affordable housing and anti-poverty programs, and was zeroed out in the administration’s proposed budget -- is being nearly doubled to $5.2 billion.
- Education: The spending bill more than doubles funding for Student Support and Academic Enrichment grants, which had been eliminated in the administration’s proposed budget. These grants fund trauma-informed classroom management, mental health support services, and school violence prevention.
- Immigration: The spending bill does nothing to address the status of hundreds of thousands of Dreamers, participants in the Deferred Action for Childhood Arrivals program. The Congressional Hispanic Caucus urged lawmakers to oppose the spending bill: "It is indefensible for Congress to pass a spending bill that not only leaves DREAMers without permanent protections but also funds their deportations and those of immigrants with deep ties to their communities.” The spending bill does not defund sanctuary cities, despite pressure from the Trump administration to do so.
- Environmental protection: The spending bill maintains overall funding levels for the Environmental Protection Agency and adds $753 million to fund water infrastructure improvements, accelerate clean-up activities at Superfund sites, among other activities.
- Healthcare: The final spending bill does not include funding to stabilize the Affordable Care Act marketplaces. Republican lawmakers had attached anti-abortion policy riders to ACA funding.
The Centers for Disease Control and Prevention has a new director, Robert Redfield, an HIV researcher with a controversial record and no experience leading a public health agency. Vox reports that “some in the science community are not as impressed with the 66-year-old’s track record as a researcher — and worry about the discriminatory and religious overtones of some of the policies he’s championed during his long career. In the early 1990s, Redfield faced accusations of scientific misconduct for misrepresenting data about an experimental HIV vaccine he was involved with. In a military investigation, he was eventually cleared of the misconduct charges, but data he published about the vaccine had to be corrected, according to the New York Times.”
Sacramento police shot and killed a young, unarmed Black man, Stephon Clark, in his own backyard this week after police had been called to respond to car break-ins in his neighborhood. Clark’s grandmother, Sequita Thompson, said, ”He was at the wrong place at the wrong time in his own backyard?” His family has hired the lawyer who represented Trayvon Martin and Michael Brown’s families to represent them as they investigate their loved one’s death. Police use of force is marked by significant racial disparities. New research shows the role of housing segregation and economic inequality -- on top of systemic racism and implicit bias -- in police violence toward people of color.
Even when they’re raised in wealthy families in similar conditions, Black boys are likely to earn less than their White counterparts when they grow up, according to a major study published by The Equality Opportunity Project. The study, which analyzed census data for 20 million children born between 1978 and 1983, found that wealth gaps arise among White and Black men even when they grow up in the same neighborhoods, attend the same schools, and have similar family structures. The study did not detect similar patterns among men of other groups or between Black and White women. “While black women also face negative effects of racism, black men often experience racial discrimination differently,” a New York Times article on the study states. “As early as preschool, they are more likely to be disciplined in school. They are pulled over or detained and searched by police officers more often….Black men raised in the top 1 percent — by millionaires — were as likely to be incarcerated as white men raised in households earning about $36,000.” The study authors noted a few neighborhoods in which Black boys tended to fare well as they grew up, the Times reported: "The few neighborhoods that met this standard were in areas that showed less discrimination in surveys and tests of racial bias. They mostly had low poverty rates. And, intriguingly, these pockets — including parts of the Maryland suburbs of Washington, and corners of Queens and the Bronx — were the places where many lower-income black children had fathers at home. Poor black boys did well in such places, whether their own fathers were present or not."
Work-related stress is among the leading causes of early death in the US, according to Stanford Professor Jeffrey Pfeffer, author of the recently published book, Dying for a Paycheck. The book reveals that while deaths attributable to dangerous physical conditions at work have declined, those related to factors like lack of job control and the threat of job loss are taking a substantial toll, contributing to 120,000 excess deaths a year. In an interview with The Washington Post, Pfeffer said, “We focused on the physical environment, and we now need to focus on the social environment — the human environment.” He and fellow researchers measured the effects of 10 factors that contribute to work-related stress, including work-family conflicts, micro-managing, and losing employer-sponsored health insurance, and concluded that work-related stress is the fifth-highest cause of early deaths in the US.
President Trump rolled out a “tough on crime” plan to address the opioid epidemic with proposals for stiffer penalties for drug trafficking, including the death penalty in some cases, Vox reports, despite research that indicates that such enforcement measures are ineffective at reducing drug misuse. The plan also includes measures to reduce the use of prescription opioids and to increase access to treatment, in part by addressing shortages of providers and drugs that treat addiction, as well as access to naloxone, which reverses overdoses. TBD: how to fully fund the plan.
Almost a year after Congress approved $500 million in grants for states to address the opioid epidemic, states have spent less than a quarter of their funding, Politico reports. One challenge the states face is getting new initiatives designed and up and running; another has been determining whether to invest in establishing new programs or services without knowing if the funding commitment will continue. The grants are part of a $1 billion, two-year commitment authorized in the Cures Act under President Obama.
The Rev. Dr. Tony Minor, manager of faith-based engagement for Cleveland’s MetroHealth System, makes the case for why community trauma merits the same attention as patients in the health system’s trauma center. “Until recently, we didn't think about "community trauma" - the collective damage caused by everyday exposure to violence, crime, poverty, blight, delinquency and disinvestment,” he writes at Cleveland.com. “This trauma is insidious because it harms not only individuals, it tears apart a community's social fabric, ripping residents away from trust, hope and health. Community trauma is now not only widely recognized by medical professionals, it is an epidemic.”
Native-American communities experienced the highest increase in deaths from drug overdoses of any group between 1999 and 2015: 22 deaths for every 100,000 people in metropolitan areas and nearly 20 for every 100,000 people in non-metropolitan areas, the Associated Press reported. Dr. Michael Toedt, the Indian Health Services chief medical officer, said the rate may be a significant underestimate since Native-American men are sometimes misidentified as belonging to another race in death certificates.