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State of Obesity 2023: Better Policies for a Healthier America

September 21, 2023

This 2023 version is the 20th annual report on the antecedents and rates of obesity in the U.S. as well as policy solutions. Since TFAH first published the State of Obesity report in 2004, rates of adult and child and adolescent obesity are up sharply, particularly in communities experiencing barriers to healthy eating and few opportunities for physical activity.

The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations - 2023

June 14, 2023

Decades of underfunding have left the nation's public health system ill-equipped to protect the health of Americans. The COVID-19 crisis illuminated weaknesses in the nation's public health infrastructure, including antiquated data systems, insufficient public health laboratory capacity, an under-resourced public health workforce, and the need for improved public health communications. These foundational public health capacities require increased, flexible, and sustained funding.The U.S. Centers for Disease Control and Prevention (CDC), the primary source of public health funding for state, local, tribal, and territorial health departments, is itself reliant on the annual federal appropriations process. Over the past two decades (FY 2014 – 2023), the CDC's budget has increased by just 6 percent after adjusting for inflation, leading to insufficient funding in key program areas such as emergency preparedness and chronic disease prevention.In addition to the risks associated with health emergencies, the country faces a growing number of people living with chronic diseases and the associated healthcare costs. While evidence-based public health programs that help prevent chronic disease are doing important work, insufficient funding has limited their accessibility and impact in many communities.TFAH is calling for annual funding for CDC of at least $11.581 billion in FY 2024, the level requested in the President's FY 24 budget (FY 2023 CDC funding is $9.2 billion).Other policy recommendations within the report include:Increase and sustain disease-agnostic funding to strengthen public health infrastructure. Public health experts estimate an annual shortfall of $4.5 billion in necessary funding for state and local health departments to provide comprehensive public health services in their communities.Strengthen public health emergency preparedness, including within the healthcare system. Investments should include the restoration of funding to the Public Health Emergency Preparedness Cooperative Agreement, the Healthcare Readiness and Recovery Program, and programs designed to support vaccine infrastructure as well as prevent, detect, and contain antimicrobial-resistant infections.Modernize the public health data system to ensure comprehensive and real-time data sharing during public health emergencies. Public health experts estimate that at least $7.84 billion is needed over the next five years for CDC's Data Modernization Initiative to strengthen public health data collection and reporting at the state and local levels. Congress should also provide sustained funding for CDC's new Center for Forecasting and Outbreak Analytics.Bolster the recruitment and retention of the public health workforce. In 2021, it was estimated that state and local public health departments needed to hire an additional 80,000 employees to be able to deliver a minimum set of public health services. The one-time nature of short-term emergency funding means that health departments will continue to experience understaffing.Address health disparities and the root causes of disease by addressing the social determinants of health and investing in chronic disease prevention.Invest in programs to prepare for and mitigate the impacts of climate change.

The State of Obesity: Better Policies for a Better America (2022) - Special Feature: Food and Nutrition Insecurity Among Youth and Families

September 27, 2022

Obesity rates have been rising for decades across states, ages, sexes, and racial/ethnic groups, with continued increases during the COVID-19 pandemic. These long-term, cross-population trends underscore the nature of the crisis as a population-level problem tied to social, economic, and environmental factors in the United States, most of which are outside of an individual's control. Some of these factors affect available choices and habits directly related to diet, nutrition, and physical activity—for example, the availability, cost, marketing, taste, and accessibility of nutrient-rich foods like fruits and vegetables versus calorie-rich foods like junk food and soda, and the availability, safety, and convenience of active transportation, parks, playgrounds, and facilities for exercise and physical activity. It is also important to consider the role other factors—like stress, discrimination, poverty, economic opportunity, and food insecurity— play in determining the health and well-being of every AmericanThis is the 19th annual report by Trust for America's Health on the obesity crisis in the United States. This year, our special feature highlights food and nutrition insecurity among youth and families. This report, as in previous years, also includes a section that reviews the latest data available on adult and childhood obesity rates, a section that examines key current and emerging policies, and, finally, a section that outlines recommended policy actions.

Pain in the Nation: The Epidemics of Alcohol, Drug, and Suicide Deaths 2022

May 24, 2022

COVID-19 has intensified the nation's troubling long-term trends for alcohol, drug, and suicide deaths. Between 2019 and 2020, these deaths increased a stunning 20 percent, driven by a 27 percent increase in the rate of alcohol-induced deaths and a 30 percent increase in drug-induced deaths. Increases were particularly large among communities of color and young adults. The rise in deaths occurred across all states and the District of Columbia, except for New Hampshire. And for the first time, two states--West Virginia and New Mexico--surpassed 100 deaths from alcohol, drugs, and suicide per 100,000 people. 

Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism

March 10, 2022

This report measures states' degree of preparedness to respond to a wide spectrum of health emergencies and to provide ongoing public health services, including disease surveillance, seasonal flu vaccination, safe water, and expanded healthcare services during emergencies. It includes policy recommendations for strengthening the nation's health security.

State of Obesity 2021: Better Policies for a Healthier America

September 15, 2021

In 2020, 16 states had adult obesity rates at or above 35 percent, up from 12 states the previous year. These and other emerging data show that the COVID-19 pandemic changed eating habits, worsened levels of food insecurity, created obstacles to physical activity, and heightened stress, all exacerbating the decades long pattern of obesity in America.This report is based in part on newly released 2020 data from the CDC's Behavioral Risk Factors Surveillance System and analysis by Trust for America's Health (TFAH). It provides an annual snapshot of rates of overweight and obesity by age, race/ethnicity and state of residence for U.S. adults. In the report, TFAH calls for addressing the social determinants of obesity, for example, by ensuring access to no cost healthy school meals for all students, a program started during the pandemic.

Aligning Public Health Interventions with Older Adult Housing Needs and Challenges

August 1, 2021

This brief outlines current housing challenges faced by older adults and potential areas for public health intervention. It summarizes existing programs that offer housing support for older adults and offers recommendations in each of the five key roles for public health.

A Blueprint for the 2021 Administration and Congress The Promise of Good Health for All: Transforming Public Health in America

October 16, 2020

The nation's public health system is dangerously inadequate and needs sustained attention and investment. This report provides an action plan for the administration and Congress taking office in 2021.

A Funding Crisis for Public Health and Safety: State-by-State and Federal Public Health Funding Facts and Recommendations 2018

March 1, 2018

A healthy United States is a strong United States. A prepared nation is a safe nation. But persistent underfunding of the country's public health system has left the nation vulnerable.

Racial Healing and Achieving Health Equity in the United States

January 1, 2018

This issue brief was developed to help identify and acknowledge health inequities, influencing factors and policy recommendations that can help the nation achieve health equity.

Ready or Not? Protecting the Public From Diseases, Disasters, and Bioterrorism 2017

December 1, 2017

In the 16 years since the 9/11 and anthrax tragedies, the country has had countless reminders demonstrating the need for a sufficient response to the public's health needs during major incidents—be they caused by extreme weather events, disease outbreaks or a contaminated food supply.The 2017 Atlantic Hurricane Season was particularly historic. After Hurricane Harvey made landfall in Texas, it hovered over Houston for days—dropping several feet of rain that caused unprecedented flooding and sank the Earth's crust around Houston two centimeters. Harvey was followed by two Category 5 storms–Hurricanes Irma and Maria, which had a profound impact on many Caribbean nations, Puerto Rico, the Florida Keys and other areas in the region. Out West, rain was scarce as communities were ravaged by one of the worst wildfire seasons ever.The fast-moving blaze in California's wine country killed 43 people, scorched 250,000 square miles and destroyed 8,900 structures.Despite the frequency of health threats, often the country is not adequately prepared to address them, even with all the prior lessons about what is needed for an effective response. Emergencies are a matter of when, not if; there is no reason to continue to be caught off guard when a new threat arises.The good news is that considerable progress has been made to effectively prepare for and respond to public health emergencies of all types and sizes,and much of what it takes to prepare for bioterrorism, major disease threats or major disasters is also essential to respond to ongoing health threats. The bad news is that the accomplishments achieved to improve public health and preparedness for all hazards are being undermined due to severe budget cuts and lack of prioritization.

A Funding Crisis for Public Health and Safety: State-by-State Public Health Funding and Key Health Facts 2017

April 1, 2017

A Funding Crisis for Public Health and Safety: State-by-State Public Health Funding and Key Health Facts, 2017 found that core funding for disease prevention and health promotion programs has declined by around $580 million federally and has remained flat in states since 2010 (adjusting for inflation).The annual review demonstrates that cuts to federal funds have not been offset by increases to state and local funding.  Adjusting for inflation:The Centers for Disease Control and Prevention's (CDC) core budget has decreased by more than $580 million since 2010.  In fiscal year 2016, the agency's budget was $7.17 billion ($22.26 per person).State public health spending has remained relatively level since 2010 ($11.5 billion total in 2015-2016, median spending $31.62 per capita). The President's proposed FY 2018 budget blueprint would include a nearly 18 percent cut to the U.S. Department of Health and Human Services (HHS).  The full budget detail is expected to be released later this Spring. Budget sequestration – which requires reductions in the rate of increase in federal spending – is scheduled to go back into effect in FY 2018 and would lead non-defense spending, including at CDC, to fall 16 percent below 2010 spending rates (adjusting for inflation).