Public health efforts appear headed for the chopping block under the Trump administration’s recently released budget. That’s a threat to national security.
A warning to the president and Congress: A nation cannot be great if it isn’t healthy. Public health, that often invisible science that promotes the well-being of families and communities, is a bulwark of strong defense. We need the hard power of health to keep Americans safe.
Advances in public health have helped Americans live an average of 25 years longer than they did a century ago. Widespread immunization, better control of infectious diseases, declining tobacco use, healthier foods, and road safety are among the CDC’s picks for the 10 great public health achievements of the 20th century. Such triumphs produce healthy children, strong families, and a military prepared to protect its people.
The business case for public health is also compelling. Healthy workers are the drivers of America’s economic engine. Chronically ill employees lose 450 million more work days than healthy ones, according to Gallup polling data. The Institute of Medicine estimated the indirect costs of preventable chronic illness at more than $1 trillion a year. Reducing what employers pay for health insurance makes it cheaper to produce goods and services for global markets.
Strengthening public health doesn’t require dramatic scientific breakthroughs or elegant research. What it does take is strategic thinking, long-term vision, and the political will to allocate resources today in order to reap benefits tomorrow. The math is simple. Every 10 percent increase in local public health spending reduces mortality rates by between 1.1 and 6.9 percent. Provide lead-free drinking water or pay for a lifetime of developmental delays. Support surveillance to detect early signs of flu virus mutation or confront a treatment-resistant epidemic later. Spend modestly to prepare for a natural disaster or bear the costlier burden of coping with it afterward.
The Trump administration’s proposed 19 percent reduction in the National Institutes of Health budget would undermine biomedical research, with its potential to advance knowledge of the brain, repair genetic defects, and find cures for cancer. The budget would also “reform” the CDC, the nation’s premier public health agency, apparently by diverting federal funds to the states.
And there’s more. Drastic spending cuts at the Environmental Protection Agency endanger efforts to address the increasingly apparent health consequences of climate change. Worker safety would be undermined if the Occupational Safety and Health Administration’s training grants are eliminated. And echoing presidential priorities, Congress has threatened to shut down the $1 billion-a-year Prevention and Public Health Fund, which was part of the Affordable Care Act.
Instead of making deep investments in public health, and thus public safety, we allocate pennies. Americans spend more per capita on health care than any other country in the world, but less than 3 percent of all health spending goes to public health. The CDC’s budget has declined slightly over the past decade, and funding cuts at the state and local levels have been “drastic,” says Trust for America’s Health. We have neglected our public health infrastructure just as we have neglected our transportation infrastructure. Will we let our health deteriorate as we have seen our roads and bridges crumble?
As Trump said during his campaign, we must start to build again. Now is the time for him to back those statements with action by making cost-effective investments in community health centers, water systems, public transportation, walkable cities, disease monitoring, supply chains that carry nutritious foods, safe housing, and much more.
We should commit to curbing diabetes, which afflicts 30 million Americans and consumes one out of every three Medicare dollars. Let’s lower the infant mortality rate instead of tolerating one that puts us behind 26 other wealthy countries. We need to craft innovative information systems that tell us whether our programs and practices are working and conduct timely surveillance to pinpoint looming infectious diseases.
This is the moment to give our public health agencies the resources they need to respond to imminent dangers like bioterrorism but also to perils that don’t grab headlines but do steal lives. Not having enough public health workers is a persistent problem, so directing more funding and greater respect to the field is also an essential job-creating opportunity.
The president’s current budget proposal is not altogether bleak for public health. A new Federal Emergency Response Fund would make resources immediately available when the next Zika or Ebola virus strikes, as it certainly will. The budget would also preserve a four-year, billion-dollar commitment to Gavi, the global vaccine alliance. Such inclusions suggest that some people in the Trump administration do recognize the sizable return on public health investment.
Let’s listen more closely to those voices. Public health can help Trump keep his promise to rebuild the nation’s infrastructure and make America safe. Healthy Americans create a prosperous and secure nation. Let’s give them the resources they need to get to work.
Ruth J. Katz is the executive director of the Aspen Institute Health, Medicine, and Society Program and a former dean of the George Washington University Milken Institute School of Public Health.
