President Trump’s 2018 budget would be a dangerous and deadly blow to public health if Congress were to pass it. This isn’t hyperbole.
The president’s latest budget request, which he sent to Congress on Tuesday, would excise $1.2 billion from the Centers for Disease Control and Prevention. That’s nearly one-fifth of the total budget for the nation’s public health authority, part of a series of non-defense cuts that are meant to balance hikes in military spending.
The ask was enough to rile former CDC Director Tom Frieden, who fired off a series of uncharacteristically charged tweets last night warning that the Trump administration’s budget “risks Americans' health and safety”:
Proposed CDC budget: unsafe at any level of enactment. Would increase illness, death, risks to Americans, and health care costs.— Dr. Tom Frieden (@DrFrieden) May 23, 2017
The bottom line, Frieden suggested, is that public health needs money to keep doing the work that prevents disease and keeps Americans safe:
Admin: cut CDC $1.2B (17%). More cancer, HIV, sr falls, infx. Defund science (prevention,injury,other ctrs->0 ). Americans wd be less safe.— Dr. Tom Frieden (@DrFrieden) May 23, 2017
When I met Frieden in January, just as he was about to leave the agency, he told me, “CDC can protect Americans depending on what our budget is.”
The budget request comes at a time when Congress, and Republicans in particular, are already gutting the CDC. It has lost more than $580 million in funding since 2010 — and the repeal of the Affordable Care Act that Republicans are pushing through Congress would also eliminate the Prevention and Public Health Fund, which accounts for 12 percent of CDC’s current budget.
The fund was established by the ACA in 2010 with an annual appropriation that began at $500 million. The goal was simple: Boost public health funding, much of it for CDC, to support activities that prevent people from getting sick. But over the years, the fund has been subjected to a slew of cuts. And if the Affordable Care Act is repealed, the fund will disappear.
“Even now, with a relatively stable FY 2017 budget,” John Auerbach, the president and CEO of the Trust for America’s Health, said in a statement, “CDC is operating with nearly 700 vacancies and will function with diminished resources once the Zika emergency supplemental funding runs out.”
“In essence,” he added, “the proposed budget would force CDC to fight epidemics and health threats with both hands tied behind their back while wearing a blindfold.”
If Congress moves ahead with Trump’s request for a smaller CDC, that’ll mean less money to respond to outbreaks, to combat obesity, to fight superbugs in hospitals, and to fund vaccination programs. It’ll also mean already cash-strapped public health offices will have to scramble even more when the next inevitable outbreak hits.
Public health already gets a tiny portion of the health funding pie
The sad reality is that this story isn’t new: Public health is often chronically underfunded. Trump’s proposal just makes that worse.
In a 2010 op-ed in the New England Journal of Medicine, Harvard’s David Hemenway explained why: Our brains are wired to focus on short-term issues, which deliver more immediate rewards, instead of long-term challenges, like public health. "Since it takes willpower to delay gratification, individually and collectively we sometimes underinvest in the future," he wrote.
Whether it’s improving road safety, preventing a pandemic, or limiting the effects of climate change — all of which fall under the remit of public health — they "incur costs today but don't provide benefits until sometime in the future." Not exactly a politically palatable option.
What’s more, when public health works, it’s often invisible. When we have mosquito control programs that prevent Zika from spreading, it’s a non-story. When we aren’t poisoned by our food, it’s a non-story. It’s also more difficult to talk about the benefits of public health: They tend to be long term and slow to show up, and affect entire populations instead of individuals. Unlike medical breakthroughs — which Congress loves to fund — public health doesn’t have a lot of news value. “Saving statistical lives doesn't make for good human-interest stories or photo ops," Hemenway writes.
Cutting the public health funding any further, Frieden told Vox in January, “would [lead to] tens of thousands of additional illnesses and more than 10,000 additional deaths.”
At a time when life expectancy in the US has declined for the first time in decades, nearly half the population is overweight or obese, and deaths from opioids have more than quadrupled in just 15 years, we could need public health more than ever. Instead, Trump is trying to move us in the opposite direction.