What a year 2019 was! At times it seemed like a non-stop roller coaster with plenty of hills and valleys for public health along the way. NACCHO’s government affairs team was there at every turn, advocating for public health and local health departments.
Here is a recap to take a look at where we have been and where we are headed in 2020.
Public Health Funding
As always, one of NACCHO’s top priorities is to advocate for funding for local health departments to do their work.
The year started in the midst of a 35-day partial government shutdown, which ended when Congress and the White House came to agreement on funding for FY2019. Quickly, they had to shift to FY2020 funding obstacles, including a projected equivalent of ~12% across the board funding slash, if a budgeting agreement was not agreed to. This happened in August, through the Bipartisan Budget Act, but disagreement over top-line funding levels for each appropriation bill and controversial policy disagreements led to two continuing resolutions before a bipartisan, bicameral deal was finally reached just before the winter holiday break. The final FY2020 LHHS appropriations agreement included slight increases to many public health programs at CDC and HRSA, including new money for data modernization at CDC, as well as local and state health departments. Some existing priority areas also received significant increases, including HIV prevention, tobacco, and hospital preparedness. Read NACCHO’s press statement.
Beyond Congress, this year saw several advances in availability of funds for local health departments:
In February, HHS announced its Ending the Epidemic (EtE) initiative, aimed at ending the HIV epidemic in the U.S. within 10 years. The first year of EtE will focus on the 48 counties, Washington, D.C., and San Juan, Puerto Rico where more than half of new HIV diagnoses occur, as well as the 7 states with a substantial rural burden of HIV. NACCHO has been working with the Health Resources and Services Administration (HRSA) and Centers for Disease Control and Prevention (CDC) on this initiative to ensure that the funding reaches the targeted counties quickly., while continuing to support HIV work in all communities.
In September, the Centers for Disease Control and Prevention (CDC) allocated the first ever direct funding to local communities for prevention of opioid misuse and overdose, a result of NACCHO’s advocacy in the FY19 appropriations bill. Seventeen local jurisdictions received three-year funding that focuses on the need for an interdisciplinary, comprehensive, and cohesive public health approach to the opioid misuse epidemic. State grants also required a 20% pass through to local communities. In addition, NACCHO received funds to launch a new Overdose Prevention and Response Mentorship Program to further expand the reach of these dollars to LHDs.
Input on Authorizing Legislation
Along with legislation to fund government programs, Congress was busy this year with authorizing legislation, bills that direct the activities of the various agencies and programs that are part of the federal government. A major win for NACCHO this year was enactment of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI), a years-long advocacy effort.
PAHPAI recognizes the paramount importance of emergency preparedness for the safety of the public and makes important changes to improve the flexibility and effectiveness of emergency preparedness programs. NACCHO provided feedback to policymakers informed by local health department experiences that led to improvements in the laws governing federal public health preparedness programs.
NACCHO is constantly working with Congressional offices on their legislation to improve various aspects of public health and the health care system, broadly. Some of the bills NACCHO endorsed this year include the following:
- Vaccine Awareness Campaign to Champion Immunization Nationally and Enhance Safety (VACCINES) Act of 2019 (HR 2862)
- Reversing the Youth Tobacco Epidemic Act of 2019 (HR 2339)
- Climate Change Health Protection and Promotion Act of 2019 (S 523/HR 1243)
- Strengthening Our Rural Health Workforce Act of 2019 (S 2902)
We are happy to report that two of these initiatives were passed by Congress as part o the FY 2020 full year spending package:
- The Tobacco 21 provision in the bill will raise the tobacco purchasing age to 21, nationally. The federal government is directed to produce regulations within 180 days and then states would have an additional 90 days to enforce the change, bringing the change to communities early in the fall. NACCHO supports the T21 policy change, but continues to focus on additional measures to keep kids safe from tobacco products, especially full ban on flavored tobacco products to move the needle on youth vaping.
Authorization of the Kay Hagan TICK Act, endorsed by NACCHO, which calls for a national strategy on addressing vector-borne diseases, reauthorization for Regional Centers of Excellence in Vector-Borne Disease, and new grants to states and localities to improve data collection and analysis, support early detection and diagnosis, improve treatment, and raise awareness. . NACCHO worked with the bill sponsors to ensure that local health departments are included in this important initiative.
Comments on Proposed Regulations
NACCHO regularly comments on proposed regulations related to specific areas of public health, including infectious disease, preparedness, environmental health, and chronic disease. (See NACCHO’s letters to the Administration on our website.)
This year NACCHO also commented on several cross-cutting proposals, many of which were of concern because of the impact on the public’s health. For example, NACCHO commented on several different attempts to limit Supplemental Nutrition Assistance Program benefits, proposed changes to the Title X family planning program, and a proposal undoing the non-discrimination requirements put forth in the Affordable Care Act. NACCHO’s comments on proposed regulations are informed by input from NACCHO members and draw on evidence from NACCHO’s policy statements.
In 2019, NACCHO members and staff continued to engage with policymakers and help them to understand the role of local health departments in keeping people healthy and safe. NACCHO’s policy statements provide the basis for advocacy. At each of their quarterly meetings, NACCHO’s Board of Directors considered and passed policy statements that serve as the official policy recommendations of the organization. All of NACCHO’s policy statements can be found on our website.
NACCHO members and staff also conducted meetings with more than 225 Members of Congress/Congressional staff. In March, NACCHO’s Board of Directors joined representatives of state associations of county and city health officials, the National Association of Local Boards of Health, Big Cities Health Coalition, and the Association of State and Territorial Health Officials (ASTHO) on Capitol Hill meeting with their Members of Congress and staff. In addition, members of the Food Safety Workgroup and the Global Climate Change Workgroup met with federal policymakers later in the year.
NACCHO also capitalized on opportunities for our members to provide information about their work in public settings. These include the following:
- Congressional hearings:
- Investing in America’s Economic and National Security, House Budget Committee, NACCHO Past President Dr. Umair Shah, Harris County Public Health (TX)
- Defending the Homeland from Bioterrorism: Are We Prepared? House Emergency, Preparedness and Response and Recovery Subcommittee, Dr. Umair Shah, Harris County Public Health (TX) and Assistant Commissioner and Dr. Jennifer Rakeman, New York City Department of Health and Mental Hygiene
- Congressional briefings:
- PFAS and Water Protection Briefing with Public Health Experts, Presenter: Karla Black, PhD, Preparedness Director, Kent Co. (MI) Health Department
- Preventing Outbreaks: Working Together to Increase Vaccine Confidence, Presenter: Jeff Duchin, MD, Health Officer, Seattle-King County Public Health
- Vaping and Electronic Nicotine Delivery Systems: A View from the Front Lines of Public Health: Telebriefing with the Association of State and Territorial Health Officials, Presenter: Susan Palchick, PhD, MPH, Public Health Director, Hennepin County (MN) Public Health
In order to make sure that NACCHO members can make their voices heard back home as well as in Washington, organizing 12 Congressional Action Network mobilizations, as well as in-person advocacy training at NACCHO Annual 2019. At the meeting in Orlando, NACCHO also held a gathering of the Congressional Action Network, a free peer sharing group that fosters skills and opportunities for effective public health advocacy. If you’re not a member of the CAN, please consider joining today.
Looking Ahead to 2020
Next year promises to be just as eventful as 2019 was for public health. NACCHO’s 2020 Federal Legislative and Policy Agenda launches a new effort to support local health departments by focusing on their workforce needs. The first step in this will be to lead a campaign to call on Congress to invest in the public health workforce, by enacting and implementing a loan repayment program for public health professionals who agree to serve two years in a local, state, or tribal health department. Such a program would help to provide health departments with appropriate staff who can tackle 21st Century challenges and increase health departments’ capacity to keep the public healthy and safe.
In 2020, NACCHO will also push for strong investments in federal public health programs—and work to ensure that those program funds get to the local level. NACCHO will continue to be an active participant in the 22×22 campaign to raise the budget of CDC 22% by 2022. A $1.5 billion total funding increase by 2022 would allow CDC to better implement effective programs to address federal, state, and local public health priorities. In addition, NACCHO will continue to advocate for strong appropriations in FY2020 and FY2021 for public health programs within the CDC, Food and Drug Administration, HRSA, and Office of the Assistant Secretary for Preparedness and Response. It is important that the continuum of governmental public health work together to support our shared mission. To do that, NACCHO will continue to advocate for public health funding to flow from the federal level to states and local communities, where appropriate, to most effectively improve the public’s health.
Finally, we will continue to work in coalition to address the many public health policy issues that local health departments work on every day.
In 2020, there will be plenty of opportunities for NACCHO members to engage in advocacy campaigns and provide input about the most pressing health challenges in their communities. As always, do not hesitate to reach out if there is anything NACCHO’s government affairs team can do to help! Please contact Eli Briggs, NACCHO Senior Government Affairs Director, at [email protected].