According to recent data from the Trust for America’s Health, public health funding has decreased in 21 states since 2019, highlighting critical gaps in the nation’s health infrastructure. The American Public Health Association (APHA) has established strategic advocacy priorities for 2024 to address these challenges and strengthen public health systems nationwide. These priorities encompass critical areas including health equity advancement, infrastructure development, climate change response, violence, prevention, and healthcare accessibility.
Strategic Investment in Public Health Infrastructure
The state of public health infrastructure funding represents a critical challenge for national health security and community wellbeing. Current data from the Trust for America’s Health indicates that public health spending comprises less than 3% of all health-related expenditures in the United States, despite evidence showing that every $1 invested in public health programs yields $5.60 in healthcare cost savings.
APHA urges support for efforts to strengthen the nation’s public health infrastructure and workforce, including the creation of a mandatory funding stream for core public health infrastructure activities at CDC and state, local, tribal and territorial public health departments.
Key areas requiring strategic investment to strengthen public health infrastructure:
Laboratory Capacity and Modernization
Modern public health laboratories require sophisticated equipment and skilled personnel to conduct rapid disease surveillance and response. The Association of Public Health Laboratories (APHL) emphasizes the need for advanced molecular diagnostic capabilities, automated systems, and improved biosafety facilities across the laboratory network to meet current and emerging health threats.
Workforce Development and Retention
The public health workforce faces significant challenges, as documented in the de Beaumont Foundation’s 2021 Public Health Workforce Interests and Needs Survey (PH WINS). The survey identified key areas requiring investment:
- Recruitment and retention strategies
- Professional development pathways
- Competitive compensation structures
- Training programs for emerging public health challenges
Data Systems and Technology
Infrastructure The CDC’s Public Health Data Modernization Initiative highlights critical needs for:
- Interoperable electronic systems
- Real-time data analytics platforms
- Standardized reporting mechanisms
- Improved data sharing capabilities
- Enhanced surveillance systems
Emergency Preparedness Resources
The National Health Security Preparedness Index, supported by the Robert Wood Johnson Foundation, identifies core areas requiring sustained funding:
- Emergency operations centers with modern communication systems
- Strategic stockpiles of medical supplies and equipment
- Training programs for rapid response teams
- Integrated surveillance systems
- Community resilience programs
Local Health Department Support
The National Association of County and City Health Officials (NACCHO) identifies fundamental public health services requiring consistent funding:
- Environmental health monitoring
- Communicable disease control
- Preventive health services
- Community health education
- Food safety inspections
Policy Frameworks
The Public Health Infrastructure Saves Lives Act (PHISLA) proposes establishing sustained funding streams for:
- Core public health infrastructure
- Workforce development programs
- Technology modernization
- Laboratory capacity building
- Emergency preparedness enhancement
Implementation of comprehensive funding strategies requires coordination across federal, state, and local agencies to ensure efficient resource allocation and maximum public health impact. The CDC’s Public Health Infrastructure program provides frameworks for building robust, responsive health systems capable of meeting current and future public health challenges.
Expanding Healthcare Access: Analysis of ACA Protections and Coverage Enhancement
The Affordable Care Act (ACA) continues to transform healthcare access in the United States through multiple critical pathways. The American Public Health Association (APHA) emphasizes that millions of Americans have benefited from the ACA’s core provisions, including expanded coverage options, preventative care coverage, and protections for individuals with pre-existing conditions.
Recent Legislative Enhancements
Recent legislation has strengthened the ACA’s impact on healthcare accessibility. The American Rescue Plan Act and the Inflation Reduction Act expanded access to health insurance premium tax credits, making coverage more affordable for millions of Americans. These enhancements demonstrate ongoing legislative commitment to broadening healthcare access through financial assistance mechanisms.
Insurance Market Reforms and Consumer Protections
The ACA established fundamental insurance market reforms that protect consumers and ensure meaningful coverage. Key protections include:
- Prohibition on discrimination against people with pre-existing conditions
- Extension of dependent coverage for adult children up to age 26
- Elimination of annual and lifetime coverage limits
- Comprehensive coverage requirements for essential health benefits
- Medical loss ratio standards ensuring premium value
Medicare Prescription Drug Coverage
Progress in closing the Medicare prescription drug coverage gap represents another significant achievement of the ACA. This advancement has improved medication accessibility and affordability for Medicare beneficiaries, addressing a critical need in healthcare coverage for older Americans.
Medicaid Expansion and Coverage Gaps
CMS data indicates that Medicaid expansion has significantly reduced uninsured rates in participating states. States that have expanded Medicaid provide coverage for adults with incomes up to 138% of the federal poverty level, creating a crucial safety net for low-income individuals. Supporting remaining states in implementing expansion through enhanced federal matching rates and technical assistance could further reduce coverage gaps.
Streamlined enrollment processes and improved coordination between Medicaid and marketplace coverage help prevent individuals from losing coverage during income fluctuations. Enhanced provider participation rates through adequate reimbursement and reduced administrative burdens ensure meaningful access to care for Medicaid beneficiaries.
Healthcare Workforce Development and Access
HRSA identifies healthcare workforce development as crucial for translating coverage into meaningful care access. Expanding primary care provider capacity through training programs and loan repayment incentives helps address provider shortages. Mental health professional training programs address critical behavioral health needs, particularly in underserved areas.
Rural healthcare access initiatives, including telehealth expansion and provider recruitment programs, help address geographic disparities in care availability. Cultural competency training and provider diversity initiatives improve care quality for underserved populations and reduce health disparities.
Future Directions
APHA has committed to collaborating with Congress and the Biden administration to further expand health insurance coverage for the millions of Americans who still lack access to critical health services. This commitment includes:
- Supporting policies that enhance coverage affordability
- Protecting existing ACA provisions and the prevention fund
- Expanding access to essential health services
- Addressing remaining coverage gaps
- Strengthening public health infrastructure
Health Impacts of Climate Change
Climate change represents a significant public health challenge that disproportionately affects vulnerable populations. Current evidence demonstrates that extreme weather events and environmental changes directly impact community health outcomes, requiring immediate action through policy initiatives and public health system preparedness.
Vulnerable Population Impact Assessment
Vulnerable populations face multifaceted health risks from climate change impacts. Communities of color often reside in areas with higher exposure to environmental hazards and limited access to adaptive resources. The elderly demonstrate increased susceptibility to extreme heat events and weather-related emergencies, while their potential mobility limitations can complicate emergency response. Young children face developmental risks from air pollution and extreme weather exposure, with potential long-term health consequences.
Individuals with existing health conditions experience exacerbated symptoms during extreme weather events and poor air quality conditions. Economically disadvantaged communities often lack resources for climate adaptation measures, such as adequate cooling systems or flood protection. These populations frequently reside in areas with limited green space and higher urban heat island effects.
Inflation Reduction Act Implementation in Energy and Transportation
The $370 billion climate investment through the Inflation Reduction Act represents the largest federal commitment to addressing climate change in U.S. history. The long-term tax credits for renewable energy development provide market stability for clean energy expansion, encouraging private sector investment and innovation. Home energy efficiency improvements target residential energy consumption, a significant source of greenhouse gas emissions.
Clean transportation incentives focus on reducing emissions from the transportation sector through both individual and systemic changes. The extension of electric vehicle tax credits makes sustainable transportation options more accessible to middle-income households. Support for clean energy manufacturing helps develop domestic supply chains for renewable energy technologies, creating economic opportunities while reducing emissions.
Methane Emission Control Measures
The Act’s methane provisions address a particularly potent greenhouse gas through comprehensive regulatory and monitoring frameworks. New fees on oil and gas sector emissions create financial incentives for improved infrastructure maintenance and leak prevention. Enhanced methane monitoring systems enable more accurate emissions tracking and faster response to leaks.
Resources allocated for affected communities support public health monitoring and environmental remediation in areas impacted by methane pollution. Regulatory enforcement mechanisms ensure industry compliance with emissions standards, while providing clear guidelines for implementation. Industry compliance standards establish benchmarks for emissions reduction and technological upgrades.
Public Health Infrastructure Response
The CDC’s Climate and Health Program requires substantial enhancement to address emerging challenges. Climate-related health surveillance systems need expansion to track changing disease patterns and environmental health impacts. Community resilience building involves developing local capacity for climate adaptation and emergency response.
Emergency response preparation must account for increasing frequency and severity of extreme weather events. Research on health impacts helps identify vulnerable populations and effective intervention strategies. Intervention strategy development requires coordination across multiple sectors and jurisdictions.
Multi-Sector Approach
Power sector initiatives focus on transitioning to clean energy while maintaining grid reliability. Emissions reduction requirements establish clear targets for power plants, while clean energy transition support helps utilities adapt operations. Grid modernization initiatives enable greater integration of renewable energy sources and improve system resilience.
Transportation sector measures address both individual and system-wide emissions sources. Vehicle emission standards drive technological innovation in the automotive industry, while electric vehicle infrastructure development supports transition to clean transportation. Public transportation enhancement reduces individual vehicle dependence while improving mobility options for vulnerable populations.
Public health sector responses require coordinated action across jurisdictions. Health department capacity building ensures adequate resources for climate-related health challenges. Environmental health monitoring systems track both acute and chronic impacts of climate change. Community health protection measures focus on preventive strategies and emergency response capabilities.
Reproductive Healthcare Access
Legislative Landscape After Roe v. Wade Reversal
The reversal of Roe v. Wade in 2022 initiated unprecedented restrictions on reproductive healthcare access across the United States. In 2023, state legislatures introduced approximately 700 bills restricting abortion access, with 80 successfully enacted into law. These legislative efforts encompassed various restrictions including pre-viability abortion bans, crisis pregnancy center funding measures, and limitations on medication-assisted abortion.
Geographic Access Disparities
Current data demonstrates severe geographic disparities in reproductive healthcare access:
- 14 states have implemented complete abortion bans
- 7 additional states impose strict gestational limits
- 8 states activated pre-existing trigger bans following Roe’s reversal
Interstate Movement Restrictions
New legislative developments include unprecedented restrictions on interstate travel:
- Idaho enacted the first ban on interstate travel for abortion services
- Texas proposed legislation restricting travel across county lines These movement restrictions represent a significant expansion of state-level control over healthcare access.
Health Impact Evidence
Research demonstrates critical connections between reproductive healthcare access and health outcomes:
- Direct relationship between safe abortion access and prevention of pregnancy-related mortality
- Increased health disparities across racial and ethnic groups
- Geographic and income-based inequities in healthcare access
- Economic impact of restricted healthcare availability
Policy Recommendations
The Women’s Health Protection Act proposes crucial federal protections:
- Establishment of statutory rights for abortion providers and patients
- Federal preemption of state-level restrictions
- Uniform standards for reproductive healthcare access
Funding Requirements
APHA advocates for strengthened funding support:
- Enhanced allocation for FY 2024 and FY 2025
- Support for community-level reproductive health services
- Sustained funding for Title X family planning program
This advocacy emphasizes the urgent need for federal legislative action and sustained funding support to address growing disparities in reproductive healthcare access. Current state-level restrictions create significant barriers to essential healthcare services, with disproportionate impacts on vulnerable populations.
long-term Farm Bill to Protect Nutrition Security
SNAP’s Impact on Population Health
The Supplemental Nutrition Access Program (SNAP) serves as a fundamental component of national health improvement, particularly for vulnerable populations. Evidence demonstrates SNAP’s effectiveness in:
- Reducing negative health outcomes in children
- Enhancing economic self-sufficiency among women
- Supporting overall community health outcomes
Current Food Insecurity Statistics
2022 data reveals significant nutrition challenges:
- Over 44 million Americans experienced household food insecurity
- One in five children faced food insecurity These statistics underscore the continuing need for robust nutrition support programs.
Farm Bill Priority Areas
Key components requiring protection and enhancement include:
SNAP Access Enhancement
- Strengthening program benefit levels
- Reducing eligibility barriers
- Improving equitable access
- Streamlining application processes
Nutrition Research and Education
- Investment in evidence-based programs
- Development of nutrition education initiatives
- Research on program effectiveness
- Community outreach strategies
Food Environment Improvement
- Increasing access to healthy food options
- Addressing food desert challenges
- Supporting local food systems
- Enhancing retail participation
Economic and Health Benefits
Implementation of comprehensive Farm Bill measures would:
- Reduce hunger among vulnerable families
- Decrease healthcare costs for millions
- Improve long-term health outcomes
- Support community economic stability
This advocacy emphasizes the critical importance of long-term Farm Bill authorization in protecting nutrition security. SNAP’s demonstrated effectiveness in improving health outcomes, combined with current food insecurity statistics, underscores the need for program enhancement and sustained support. Comprehensive policy implementation would address both immediate nutrition needs and long-term public health objectives.
Protect Nutrition Standards for Children
School Meal Programs: Critical Nutrition Source
Research from 2021 demonstrates that school meals represent the healthiest source of daily nutrition for children. The past decade has shown significant progress in:
- Implementation of science-based nutrition standards
- Food industry adaptation to healthier requirements
- School system compliance with nutritional guidelines
- Integration of whole food options
Food Security Impact
School meal programs serve dual critical functions:
- Providing essential daily nutrition
- Addressing food insecurity
For many participating students, school breakfast and lunch constitute their only reliable daily meals, highlighting these programs’ crucial role in child nutrition security.
Standards Alignment Requirements
Key recommendations for Child Nutrition Reauthorization include:
- Alignment with 2020 Dietary Guidelines for Americans
- Enhanced standards for:
- Added sugar content
- Sodium levels
- Whole grain requirements
Implementation Priorities
USDA rulemaking considerations should address:
- Updated nutrition guidelines
- Implementation timelines
- School system support
- Monitoring mechanisms
- Compliance standards
This advocacy emphasizes the critical importance of maintaining and strengthening school nutrition standards through both legislative and regulatory mechanisms. The demonstrated success of existing programs, combined with their essential role in addressing child food insecurity, underscores the need for continued program enhancement.
Uphold and Strengthen Critical Public Health Laws and Regulations and Reverse Damaging Rollbacks
The American Public Health Association (APHA) works to protect and enhance vital public health regulations, standing against attempts to weaken these established safeguards. A particular focus is preserving the integrity of the Clean Air Act and similar evidence-based regulations that protect community well-being.
Environmental regulations play a vital role in protecting vulnerable communities and advancing health equity goals. These protections address disproportionate environmental burdens often faced by disadvantaged populations and establish consistent standards for environmental quality.
Current priorities for regulatory action through the Environmental Protection Agency include:
Power Plant Emissions Control
The Biden administration faces urgent calls to finalize robust regulations reducing carbon emissions from power plants. The restoration of the “appropriate and necessary” finding for Mercury and Air Toxics standards represents positive progress, with further strengthening needed for mercury and air toxics limits from power plants.
Particulate Matter Protection
APHA emphasizes the need for strong regulations protecting public health from dangerous particulate matter pollution. These protections particularly benefit communities facing elevated exposure risks from industrial and transportation sources.
Vehicle Emissions Standards
Enhanced regulations addressing emissions from cars and trucks remain crucial for comprehensive environmental health protection. These standards help reduce mobile source pollution while supporting broader air quality objectives.
This framework of environmental regulations serves multiple critical functions:
- Protecting public health through evidence-based standards
- Advancing health equity across populations
- Safeguarding vulnerable communities
- Establishing consistent environmental quality benchmarks
- Supporting comprehensive pollution reduction goals
The integration of strong environmental protections with health equity considerations remains essential for effective public health protection. Continued regulatory development and enforcement must prioritize both environmental quality and community health outcomes while ensuring practical implementation measures.
Address the Nation’s Gun Violence Epidemic
Current State of Gun Violence
The scale of gun violence in the United States reached critical levels in 2022, with over 48,000 reported fatalities. This public health crisis requires comprehensive research and evidence-based policy solutions to address its multiple dimensions.
Research Funding Progress
Key federal funding allocations include:
- $25 million to CDC and National Institutes of Health
- $1 million to National Institute of Justice These investments support essential gun violence prevention research, with continued funding needed for fiscal years 2024 and 2025.
Public Health Research Approach
Evidence-based understanding requires:
- Scientific analysis of gun violence patterns
- Data collection and analysis systems
- Policy effectiveness evaluation
- Program impact assessment
These research initiatives provide crucial foundations for developing effective prevention strategies and policy measures.
Policy Recommendations
Universal Background Checks
- Comprehensive screening for all firearm purchases
- Standardized verification processes
- Interstate coordination mechanisms
- Enhanced monitoring systems
Extreme Risk Protection Orders
- Legal framework for firearm removal
- Risk assessment protocols
- Implementation mechanisms
- Safety measure coordination
This advocacy emphasizes the essential role of research funding in developing evidence-based approaches to gun violence prevention. The combination of sustained research support and comprehensive policy measures represents a crucial strategy for addressing this public health crisis.
Conclusion
The integration of health equity considerations across all priority areas remains crucial for addressing persistent disparities and ensuring effective public health protection for all populations. Continued advocacy, research support, and policy implementation will be essential for advancing these public health objectives in 2024 and beyond. For more information on APHA’s advocacy priorities, visit https://www.apha.org/advocacy.
References:
APHA 2024 advocacy priorities for the 118 th Congress and the Biden administration. (n.d.). https://www.apha.org/-/media/Files/PDF/advocacy/240112_APHA-advocacy_priorities_for_Congress_2024.pdf
American Public Health Association. (2024). Public Health Priorities. Apha.org. https://www.apha.org/policies-and-advocacy/advocacy-for-public-health/priorities
CDC. (2024). About CDC’s Climate and Health Program. Climate and Health. https://www.cdc.gov/climate-health/php/about/index.html
Congress.GOV (2023). Women’s Health Protection Act of 2023. (2023). Congress.gov. https://www.congress.gov/bill/118th-congress/senate-bill/701