Prevention and Public Health Fund paying off in communities: Success threatened by cuts to fund
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* Teddi Dineley Johnson

In Iowa, dental practices are expanding tobacco and blood pressure screenings. In Hennepin County, Minn., a new system is linking patients with clinical and community programs. And in Wisconsin, advocates are working to implement smoke-free policies in low-income housing.

Though separated by state and county lines, each of the programs traces its funding to a common source: The Prevention and Public Health Fund. Created by the 2010 Patient Protection and Affordable Care Act, the fund is the nation’s first mandatory funding stream dedicated to public health and prevention activities. In addition to supporting new and existing community prevention and research activities, monies from the fund are being used to strengthen state and local public health infrastructure, bolster data collection for community- and clinical-based prevention activities and expand and improve training for the public health workforce.

“In creating the fund, the federal government made a historic investment in the future by focusing on keeping soaring health care costs under control while at the same time helping those who want to be healthy, get or stay healthy,” Jeffrey Levi, PhD, executive director of Trust for America’s Health, told *The Nation’s Health*.

The fund provides more than $13 billion of new support for disease prevention over the next 10 years, and $20 billion over the subsequent 10 years, noted Levi, an APHA member who serves as chair of the Advisory Group on Prevention, Health Promotion and Integrative and Public Health, which was also created under the health reform law.

Just two years after its creation, the Prevention and Public Health Fund has already directed $1.25 billion to fuel critical programs aimed at preventing tobacco use, halting the spread of HIV, increasing physical activity and stepping up immunization rates, according to an APHA report on the fund released in June. Plans call for funds to be used for Alzheimer’s education, viral hepatitis screening, workforce training and breastfeeding promotion, among many other activities.

“Already, we’ve seen so much good work come out of the fund,” said APHA Policy Analyst Vanessa Forsberg, MPP, the report’s lead author. “All of the funding in the prevention fund is going toward community-based prevention activities, bolstering our public health infrastructure, helping public health departments build their capacity to address communities’ needs, addressing health disparities and addressing the issues that are at the core of the problems we are facing.”

Hailed by public health leaders as a historic investment in turning the nation’s sick care system into one focused on prevention and wellness, the fund was designed to gradually build from $500 million in 2010 to $2 billion per year by 2015. Despite a recent reduction of $6.25 billion to postpone a cut in payments to Medicare physicians — which cut the fund by a third — “the fund is still an investment in public health and prevention like we’ve never seen before,” Forsberg said.

Already, the fund’s return on investment is dramatic, advocates say. For example, just 12 weeks after the launch of a federal tobacco cessation ad campaign, calls to tobacco cessation quit lines around the country increased by 200,000, and visits to [www.smokefree.gov](http://www.smokefree.gov), a federal website designed to help people quit smoking, were up by more than 400,000. The campaign, developed by the Centers for Disease Control and Prevention and funded by the Prevention and Public Health Fund, features a diverse set of ads profiling people living with the effects of smoking-related diseases.

“The CDC’s use of the prevention fund demonstrates that targeted prevention efforts can have a dramatic and measurable impact on our nation’s health,” Matthew Myers, president of the Campaign for Tobacco-Free Kids, told *The Nation’s Health*. “It is an extraordinarily efficient use of federal dollars — far cheaper than the millions of dollars being spent treating Medicaid and Medicare patients suffering from tobacco-related diseases.”

According to Myers, if CDC had enough funding to run the campaign for a year, more than 2 million smokers might seek cessation support.

“It would have paid back the value of the prevention fund multiple times over,” said Myers, who is an APHA member.

Despite the fund’s many success stories, public health leaders agree that it will remain a political hot potato. Republican policymakers have repeatedly targeted the fund for cuts or elimination, asserting that it is wasteful or that it would accomplish little beyond existing federally funded disease prevention and health promotion programs. As recently as late May, the fund escaped a proposal that would have used its dollars to offset a student loan interest rate hike. Such attacks are likely to continue, according to Laura Hanen, MPP, chief of government and public affairs at the National Association of County and City Health Officials.

“The Prevention and Public Health Fund is a target first and foremost because it is part of the Affordable Care Act,” Hanen told *The Nation’s Health*. “It is also a large chunk of money that is hanging out there that is very desirable when wanting to find an offset for other spending priorities. The fund was mischaracterized as jungle gyms and bike paths when it was being marked up in the Senate…so it’s had its critics from before the time the Affordable Care Act became law, but it has continued henceforth.”

To protect the fund from further attacks, Hanen urges public health leaders and advocates to continue to educate Congress, their staff and the public about the fund’s importance to creating a healthier world.

With the Supreme Court deciding not to eliminate the fund as part of its decision on the Affordable Care Act, public health leaders are looking at the fund’s future with renewed optimism.

“For public health, for people who support prevention, the fund is a critical investment to really change our health care system to a health system, so that the focus is not just on making people who are sick better,” Hanen said. “It’s about preventing them from getting sick in the first place or creating conditions that prevent them from getting sick in the first place.”

To download APHA’s brief, “The Prevention and Public Health Fund: A Critical Investment in Our Nation’s Physical and Fiscal Health,” visit [www.apha.org/advocacy/reports](http://www.apha.org/advocacy/reports). For more information on the Prevention and Public Health Fund, visit [www.healthcare.gov](http://www.healthcare.gov).

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