500 researchers, physicians protest elimination of public health provisions from recovery package

To: Interested Parties,

The American Recovery and Reinvestment Act (ARRA) provides needed economic stimulus while laying the groundwork for many investments important to our nation’s future. The House of Representatives has passed its version, HR-1. The Senate is now debating its own bill.

We, the undersigned group of 500 practitioners, analysts, and scholars come from virtually every state. We reflect many disciplines within public health, medical care, and policy research. We hold diverse political views, and have diverse ideas about how best to enact healthcare reform. We are united, however, in the belief that the public health provisions included in HR-1 provide a feasible, timely, and cost-effective approach to improving America’s health.

We are thus disturbed by reports of deep proposed cuts to prevention and wellness programs (as well as by proposed cuts to in other areas such as education and disability assistance) rumored to be under consideration.

Evolving press reports indicate that the current Senate bill would cut or eliminate several billion dollars in health prevention funds allocated in the House bill. Areas of proposed cuts apparently include comparative medical research, smoking cessation, HIV prevention and testing, diabetes screening and detection, pandemic flu preparedness, health information technology, and other key public health items. Whether one evaluates these expenditures as short-term economic stimulus or in broader public health terms, each of these proposed expenditures represents sound public policy.

During 2008 campaign, Democrats and Republicans supported increased investment in comparative medical research to improve the quality and cost-effectiveness of American medical care. As Dr. Ezekiel Emanuel noted in his book Healthcare, Guaranteed: “The United States spends over $2 trillion on healthcare, about $200 billion on prescription drugs, and nearly $100 billion on medical research and development, but only a paltry $1 billion to evaluate the comparative costs and effectiveness of medical interventions and their influence on health outcomes.”

The agencies that support this research employ rigorous scientific peer-review to allocate available funds. Many high-quality projects are ready for immediate implementation in hospitals, medical practices, and universities across the United States.

Health information technology is equally central. Electronic medical record systems improve continuity of care and can improve cost-effectiveness by reducing medical errors and by preventing duplicative diagnostic procedures and tests.

The broader array of prevention and wellness measures are equally essential to health and well-being. By some measures, diabetes is America’s most costly and prevalent major chronic illness. Prevalence is increasing due to increased prevalence of adult-onset disorders. Modest proposed expenditures for diabetes screening and management are therefore especially valuable.

HR-1 also includes funds for the prevention of HIV, sexually-transmitted infection, and tuberculosis. Federal expenditures in these critical areas has lagged in recent years. A variety of evidence-based interventions could be quickly implemented to address these public health challenges within the range appropriated in the House bill.

We are especially surprised by proposals to eliminate funds for smoking cessation services. Smoking remains America’s most prevalent and avoidable cause of premature illness and death. Smoking cessation services rank among the most cost-effective interventions in all of medicine and public health. The proposed $75 million would create roughly 1,500 jobs. Moreover, it would help roughly 45,000 people quit smoking, preventing many thousands of smoking-related deaths and serious illnesses.

In the 2008 campaign, candidates across the political spectrum demanded that our health system place greater weight on prevention to reduce avoidable deaths, injury, and illness, and to improve cost-effectiveness. Unfortunately, many prevention measures are politically vulnerable because they improve health among diffuse, disorganized, sometimes politically marginal constituencies.

The hope for such measures often rests with leaders who set aside momentary political pressures to ask what is really needed to promote a healthier America. If the Senate does this, it will retain the modest but crucial public health expenditures contained in the House bill.