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Trust for America's Health Testifies before Congress on Building Prevention into Health Reform

WASHINGTON, March 31 /PRNewswire-USNewswire/ -- Jeffrey Levi, Ph.D., Executive Director of Trust for America's Health (TFAH) testified today before the U.S. House Energy and Commerce Committee's Subcommittee on Health at a hearing entitled, "Making Health Care Work for American Families: Protecting the Public Health." Levi emphasized the savings that could come from investing in prevention, and the importance of incorporating public health into health reform.

The full text of Levi's oral testimony is below:

Good morning. My name is Jeffrey Levi and I am the Executive Director of Trust for America's Health (TFAH), a nonpartisan, nonprofit organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. I would like to thank the members of the Subcommittee for the opportunity to testify on the role of prevention and public health as a component of the health reform debate.

This morning I would like to emphasize two major points:

1. The critical importance of public health programs, in particular population and community-based prevention, in improving the health of Americans and making a reformed health care system more effective.

2. The need to create a reliable, stable funding stream for public health programs and services as part of health reform. Otherwise, the potential benefits of public health to the health care system will be lost.

My written testimony also addresses the need to build the evidence base for prevention programs and invest in public health systems and services research to improve the quality of public health that is delivered in the U.S. Much of what is said there has been covered by Dr. Fielding in his testimony.

Health care in the U.S. has become an expensive burden on our economy. High rates of chronic disease are among the biggest drivers of U.S. health care costs. What this means in real terms is that Americans are not as healthy as they could be or should be, and that is translating into huge growth in our health care costs. The country will never be able to contain health care costs until we do a better job of preventing people from getting sick in the first place.

That's where public health comes in. The nation's public health system is responsible for keeping Americans healthy and safe by preventing disease and promoting healthy lifestyles - including those that prevent or mitigate the chronic diseases that are driving up health care costs today.

There are proven community-based programs that promote healthy environments and behaviors, making it easier for people to make healthy choices. Shifting community norms about tobacco use through social marketing campaigns, changing the physical and social environment in which people live by making communities more walkable through better lighting and sidewalks, creating group walking or exercise programs to encourage physical activity, or improving access to healthy foods, are examples of community interventions that work to prevent or mitigate certain chronic diseases.

And, we know that investing in prevention, especially community-based programs, can have a big payoff. A study we at the Trust for America's Health issued last summer found that for an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use, the country could save more than $16 billion annually within five years. This is a return of $5.60 for every $1 spent based on an economic model developed by the Urban Institute and an extensive review of evidence-based studies by The New York Academy of Medicine.

Out of the $16 billion in savings, Medicare could save more than $5 billion, Medicaid could save more than $1.9 billion, and private payers could save more than $9 billion.

That's the good news: we have proven, community-based public health interventions that work. But to fully realize this potential return on investment in keeping Americans healthy requires a larger and sustained investment in public health. The bad news is, right now, the public health system is structurally weak in nearly every area and that the system, which ranges from federal agencies such as the CDC to nearly 3,000 state and local public health agencies to countless non-governmental organizations, does not have enough resources to adequately carry out core disease prevention functions. In collaboration with The New York Academy of Medicine, TFAH convened a panel of experts to analyze how much is currently spent on public health in the U.S. and how much more would be needed to support core public health services at a sufficient level. The panel's professional judgment was that there is currently a shortfall of $20 billion per year in spending on public health.

Therefore TFAH believes that a reformed health care financing system must include stable and dedicated funding for core public health functions and community-based prevention.

We recommend the establishment of a Public Health and Wellness Trust Fund ("Trust Fund") through a mandatory appropriation or set-aside of a portion of new revenues generated through the financing of health reform. Resources from the Trust Fund would be allocated to specific public health programs or activities as directed by the relevant appropriations committees - those public health functions and services that surround, support, and strengthen the health care delivery system. The Trust Fund would finance:

  • Core governmental public health functions.
  • Population-level non-clinical prevention and wellness programs, which can be delivered through governmental and non-governmental agencies.
  • Clinical preventive services (such as screenings and immunizations) that are not covered by third party payers.
  • Workforce training and development as well as public health research.

The Trust Fund could help make up for the country's current $20 billion annual shortfall in public health spending. Based on the current distribution of responsibility among the federal, state, and local governments, $10-12 billion of that amount should be a federal responsibility.

In short, TFAH believes that prevention and public health must be at the center of any effort to reform our health system. Public health programs are a critical and under-funded component of the nation's health system. We encourage Congress to establish a Public Health and Wellness Trust Fund to make our country healthier, our health system more cost-effective, and our economy more competitive.

Trust for America's Health (TFAH) is a nonpartisan, nonprofit organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. TFAH's "Blueprint for a Healthier America," can be found on TFAH's Web site at: or visit

SOURCE Trust for America's Health
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