2012 budget proposal would mean cuts for public health: CDC programs slated for reductions
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* Teddi Dineley Johnson

Bowing to severe fiscal pressures, the 2012 budget proposal released by President Barack Obama in February would make investments in some key public health programs while putting others on the chopping block.

“What my budget does is to put forward some tough choices, some significant spending cuts, so that by the middle of this decade our annual spending will match our annual revenues,” Obama said at a White House news briefing Feb. 15. “We will not be adding more to the national debt.”

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/41/3/1.4/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/41/3/1.4/F1)

Copies of the fiscal year 2012 budget are unloaded in a Senate Budget Committee hearing room in Washington, D.C., Feb. 14.

Photo by Andrew Harrer, courtesy Bloomberg/Getty Images

Standing by his pledge to encourage medical innovation through research and development, the president’s $3.7 trillion budget boosts funding to biomedical research programs supported by the National Institutes of Health, both on the NIH campus as well as at academic and independent research institutions across the country. Overall, the proposed budget would award the National Institutes of Health a funding increase of $745 million beyond 2010 levels.

Hailing the focus on medical research, Health and Human Services Secretary Kathleen Sebelius said at a Feb. 14 news conference that such innovation will spark economic growth and development.

On a less positive note, the Centers for Disease Control and Prevention would see funding for its core programs shrink by $580 million from 2010 levels. To fill the gap and raise CDC’s funding level, the president’s budget would take funds from the Prevention and Public Health Fund created under the Affordable Care Act. Using prevention fund dollars to supplement CDC’s budget raises concerns among some public health leaders who worry that if the prevention fund were to go away, either because the Affordable Care Act is repealed or the funds are rescinded, CDC’s spending power would be sharply reduced.

“Given the tough financial situation we are all in, the president gave a valiant effort to hold harmless the CDC’s budget,” said Karl Moeller, MPA, executive director of Campaign for Public Health.

But Moeller said the prevention fund was not created to “backfill” CDC’s budget.

“That wasn’t the intent of the prevention fund,” Moeller told *The Nation’s Health.* “The prevention fund was created, as I understood it at the time, as part of health reform to go above and beyond what we are doing in terms of public health.”

One of the CDC programs that would face significant cuts under the budget proposal is the National Breast and Cervical Cancer Early Detection Program, which over two decades has provided more than 9 million screening tests to more than 3.7 million low-income, underinsured and uninsured women.

Some public health leaders expressed concerns that the budget increases investments in medical research but underfunds critical cancer prevention programs.

“The budget proposal takes important steps toward capitalizing on past investments in cancer research, but it gives short shrift to proven prevention programs that are saving lives,” said APHA member John Seffrin, PhD, chief executive officer of the American Cancer Society Cancer Action Network.

Equally troubling is a proposal that would combine two CDC programs — Healthy Homes and Childhood Lead Poisoning Prevention and Asthma — and then cut total funding to the new combined program in half.

“This sweeping measure will cut the healthy homes movement off at its knees,” said APHA member Rebecca Morley, MSPP, executive director of the National Center for Healthy Housing. “The proposed cut to the lead and asthma programs are the most devestating in the history of the two programs.”

Overall, the president’s budget would provide $79.9 billion to the Department of Health and Human Services, which is slightly above 2010 levels. The funds would support a range of programs as well as be used to implement the health reform and food safety overhauls signed into law last year. In addition to providing resources to launch key provisions of the Food Safety Modernization Act, the budget aims to strengthen the President’s Food Safety Working Group, a committee created in March 2009 to advise the president on modernizing the nation’s food safety laws.

The budget also gives the green light to HIV/AIDS prevention and treatment activities and prioritizes HIV/AIDS resources within high-burden communities and among high-risk groups. The Health Resources and Services Administration’s Ryan White program would also see a funding bump to continue its efforts to help people living with HIV/AIDS who lack sufficient health care coverage or financial resources to cope with the disease.

Also under the president’s budget proposal, the Indian Health Service would receive a funding increase to strengthen federal, tribal and urban programs that serve nearly 2 million American Indians and Alaska Natives at about 650 facilities around the nation. The funds would also expand access to health care services provided outside of the Indian health system when services are not available at IHS-funded facilities.

Other federal agencies where public health programs would be strengthened or initiated under Obama’s budget proposal include the:

*   Department of Housing and Urban Development’s Choice Neighbor- hoods initiative, which would receive funds to continue its efforts to transform high-poverty neighborhoods.

*   National Highway and Traffic Safety Administration’s campaigns against distracted driving as well as programs to promote seat belt use and get drunken drivers off the road.

*   Environmental Protection Agency’s efforts to reduce greenhouse gases. In addition, EPA would receive $16 million in new funding to support efforts to protect Americans from hazardous chemicals.

*   Department of Agriculture’s efforts to increase access to healthy foods for low-income Americans in rural and urban areas.

The budget also would provide funds to strengthen the health professions work force and Community Transformation Grants. Created under the Affordable Care Act, Community Transformation Grants help state and local public and private agencies and community-based organizations across the country create health initiatives that reduce chronic disease rates, prevent the development of secondary conditions, address health disparities and develop a stronger evidence-base of effective prevention programming.

Trust for America’s Health hailed the measure, saying the grants are “central to transforming the nation’s sick care system to a health care system by making healthy choices easier choices for more Americans.”

But the organization decried a $72 million cut to the Public Health Emergency Preparedness grants and a $35 million cut to the Academic Centers for Public Health Preparedness and Advance Practice Centers.

“We can’t afford a budget that gives with one hand what it takes away with another,” said Trust for America’s Health Executive Director Jeff Levi, PhD, an APHA member.

The budget would boost funding to some federal programs by eliminating or trimming investments in others. For example, energy assistance to low-income families would be reduced under the proposed budget. The budget also would cut by 50 percent its investment in the Community Services Block Grant, which provides states and tribes with funds to lessen poverty in communities.

Marked for elimination under the proposed budget is the Preventive Health and Health Services Block Grant. Eliminating the critical program — which states depend on to tailor prevention and promotion programs — raised concerns among some public health organizations, including the Association of State and Territorial Health Officials, which said it was “disappointed” in the decision.

“The block grant is a vital source of funding for states, allowing each state to address its most critical public health needs,” Sharon Moffatt, chief program officer for health promotion and disease prevention at the Association of State and Territorial Health Officials, told *The Nation’s Health.* “In addition, money spent on prevention provides a positive return on investment, something we should be reaching for in these tough economic times.”

The budget will now make its way through Congress, where final details will be hammered out and public health advocates will work to preserve crucial programs.

“The budget proposal is just a start,” said APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E). “It’s up to us as public health advocates to work toward ensuring the viability of our public health programs. I challenge all health workers to get involved and reach out to Congress.”

For more on the proposal, visit [www.omb.gov](http://www.omb.gov) or [www.hhs.gov/budget](http://www.hhs.gov/budget).

*   Copyright The Nation’s Health, American Public Health Association