Society for Medical Decision Making

March 4, 2013

The Honorable Patty Murray                                         The Honorable Jeff Sessions       
Chairman                                                                       RankingMember
Senate Committee on Budget                                      Senate Committee on Budget

The Honorable Paul Ryan                                              The Honorable Chris Van Hollen
Chairman                                                                       RankingMember
House Committee on Budget                                       House Committee on Budget

Our health is inextricably linked to our mission readiness on the battlefield, our productivity on the job, our educational attainment in the classroom, and our competitiveness around the world. Federal agencies and programs have a unique role in enhancing Americans’ health and well-being. Investment in these areas has and will continue to show returns on taxpayer dollars. Given the critical nature of these programs, the undersigned 430 national, state, and local organizations recommend funding of $65 billion for discretionary public health and health research programs (Function 550) in the FY 2014 budget resolution. In developing our recommendation, we strived to balance the need to reduce the deficit without compromising Americans’ immediate and longterm health needs.

Public health is the science and art of preventing disease, promoting physical and behavioral wellness, supporting personal responsibility, and prolonging life in communities where people live, work, and learn. The federal health agencies comprising the public health continuum—National Institutes of Health, Food and Drug Administration, Centers for Disease Control and Prevention, Health Resources and Services Administration, Agency for Healthcare Research and Quality, Substance Abuse andMental Health Services Administration, and Indian Health Service, among others—have benefited from longstanding, bipartisan support of Congress and administrations, and Americans’ lives are better because of it.

Our nation’s health has already borne responsibility for deficit reduction through cuts in the Fiscal Year 2011 Continuing Resolution, the bipartisan Budget Control Act discretionary caps, the bipartisan American Taxpayer Relief Act, and most recently sequestration. Public health and health research made up 1.6 percent of the budget in FY 2012—a small and shrinking share of all federal spending. Public health and health research are not the root cause of our fiscal crisis, and cutting them further will not bring the budget into balance. On the contrary, with greater investment, these programs are an integral part of the solution. For example:

• Spending $10 per person, per year in proven, community-based programs that help people take personal responsibility for their health—increase their physical activity, eat better, and avoid smoking and other tobacco use—could save the country more than $16 billion annually within five years. This is a return of $5.60 for every $1 invested.

• Vaccines are one of the most cost-effective public health interventions. For infants who receive the seven vaccines given as part of the routine childhood immunization schedule, society saves $9.9 million in direct health care costs; 33,000 lives are saved; and 14 million cases of disease are prevented.

• The nation’s more than 1,200 community health centers provide 22 million patients access to high-quality affordable primary and preventive care, saving $1,263 per person. Total patient care costs at health centers are 24-50 percent lower than those served in other settings, producing up to $24 billion in annual health system savings. This includes $6.7 billion in savings for the federal share of the Medicaid program, and is driven by lower utilization of costly specialty care, emergency departments, and hospitals.

• As many as 5.4 million Americans have Alzheimer’s disease. The costs to Medicare and Medicaid and out-of pocket expenses of treating the disease over the next 40 years will increase five-fold, from $172 billion annually to $1.08 trillion. The projected benefits of drugs capable of delaying the onset of Alzheimer’s disease by 5-years would amount to $3.97 trillion per year. Even a therapy that only delayed the onset of Alzheimer’s for one year would yield a benefit of $1.2 trillion annually.

Evidence abounds—from the Department of Defense to the U.S. Chamber of Commerce—that healthy Americans are stronger on the battlefield, have higher academic achievement, and are more productive in school and on the job. Healthy Americans drive our economic engine, and ultimately cost our nation less in health care spending. Our Function 550 request of $65 billion—consistent with our FY 2012 funding request— would allow us to seize new opportunities to improve our nation’s health while protecting its fiscal health. This requested funding level would bolster:

• Biomedical, Behavioral, and Health Services Research: Enhancing scientific discovery; saving lives, revitalizing local economies, and preserving our nation’s long-term competitiveness.

• Food and Drug Safety: Assuring the safety of our nation’s food and the safety and efficacy of drugs, biologics, vaccines, and medical devices.

• Disease Prevention and Health Promotion: Strengthening capacity in states and communities to prevent and treat costly chronic and infectious diseases; protecting Americans in the event of public health threats; protecting the public from environmental hazards, and ensuring those with disabilities reach their highest potential in function and health.

• Health Professions Education: Assuring that there is a robust workforce of doctors, nurses, dentists, physician assistants, public health providers and other health professionals to care for Americans in need.

• Mental Health and Substance Abuse Services: Assuring access to vital services for hundreds of thousands in need of care, including veterans and service members suffering with the invisible wounds of war.

• Health Care for American Indians and Alaska Natives: Reversing current health disparities for a population that now suffers a life expectancy that is four years lower than the general population.

• Safety Net Health Care Services: Assuring access to quality, basic health care for medically underserved populations—children, the elderly, persons with disabilities, the uninsured, and rural populations.

Please note that our recommendation does not include and is over and above funding provided through emergency requests, user fees, and mandatory transfers.

We thank you for your ongoing support of the public health continuum, and look forward to working with you. If you have questions, please contact Emily J. Holubowich, Executive Director of the Coalition for Health Funding, at eholubowich@dc-crd.com or 202.484.1100.

This letter was organized on behalf of the community by the Coalition for Health Funding—the oldest and largest nonprofit alliance working to strengthen public health in the best interest of all Americans. The Coalition’s 80 member organizations together represent more than 100 million patients, health care providers, public health professionals, and scientists. For more information, please visit www.publichealthfunding.org or follow on Twitter @healthfunding.

Academic Pediatric Association
Academy of Nutrition and Dietetics
Academy of Radiology Research
AcademyHealth
ActionAIDS, Philadelphia, PA
Ad Hoc Group for Medical Research
ADAP Advocacy Association
Adult Congenital Heart Association
Advocates for Better Children's Diets
AHEPA Cooley’s Anemia Foundation
AIDS Action Baltimore
AIDS Alliance for Women, Infants, Children, Youth and Families
AIDS Community Research Initiative of America
AIDS Foundation of Chicago
AIDS Project Los Angeles
AIDS Resource Center of Wisconsin
AIDS United
AIDS/HIV Services Group, Charlottesville, VA
Alaska Public Health Association
Alliance for a Stronger FDA
Alliance for Aging Research
Alliance for Integrative Health Care
Alpha-1 Association
Alpha-1 Foundation
Alstrom Syndrome International
Alzheimer's Association
Alzheimer's Drug Discovery Foundation
American Academy of Allergy, Asthma, and Immunology
American Academy of Child and Adolescent Psychiatry
American Academy of Family Physicians
American Academy of HIV Medicine
American Academy of Neurology
American Academy of Oral and Maxillofacial Pathology
American Academy of Pediatric Dentistry
American Academy of Pediatrics
American Academy of Periodontology
American Academy of Physician Assistants
American Alliance for Health, Physical Education, Recreation, and Dance
American Art Therapy Association
American Association for Cancer Research
American Association for Dental Research
American Association for Geriatric Psychiatry
American Association for Health Education
American Association for Marriage and Family Therapy
American Association for Respiratory Care
American Association for the Study of Liver Diseases
American Association of Colleges of Nursing
American Association of Colleges of Osteopathic Medicine
American Association of Colleges of Pharmacy
American Association of Colleges of Podiatric Medicine
American Association of Immunologists
American Association of Oral and Maxillofacial Surgeons
American Association of Public Health Dentistry
American Association on Health and Disability
American Cancer Society Cancer Action Network
American College of Cardiology
American College of Clinical Pharmacy
American College of Physicians
American College of Preventive Medicine
American College of Sports Medicine
American Congress of Obstetricians and Gynecologists
American Counseling Association
American Dance Therapy Association
American Dental Association
American Dental Education Association
American Dental Hygienists' Association
American Diabetes Association
American Epilepsy Society
American Geriatrics Society
American Hellenic Educational Progressive Association
American Institute for Cancer Research
American Lung Association
American Medical Informatics Association
American Medical Student Association
American Medical Women's Association
American Mental Health Counselors Association
American Music Therapy Association
American Nephrology Nurses Association
American Nurses Association
American Occupational Therapy Association
American Organization of Nurse Executives
American Orthopsychiatric Association
American Partnership for Eosinophilic Disorders
American Pediatric Society
American Physiological Society
American Psychiatric Association
American Psychological Association
American Psychotherapy Association
American Public Health Association
American Sexual Health Association
American Sleep Apnea Association
American Society for Biochemistry and Molecular Biology
American Society for Clinical Laboratory Science
American Society for Clinical Pathology
American Society for Gastrointestinal Endoscopy
American Society for Microbiology
American Society for Nutrition
American Society for Pain Management Nursing
American Society for Pharmacology & Experimental Therapeutics
American Society for Reproductive Medicine
American Society of Hematology
American Society of Nephrology
American Society of Neurorehabilitation (ASNR)
American Society of Pediatric Nephrology
American Society of Transplantation
American Society of Tropical Medicine and Hygiene
American Society on Aging
American Sociological Association
American Speech-Language-Hearing Association
American Trauma Society
amfAR - The Foundation for AIDS Research
Anxiety and Depression Association of America
Arizona Public Health Association
Arkansas Public Health Association
Arthritis Foundation
Asian & Pacific Islander American Health Forum
Asian Human Services
Association for Clinical Research Training
Association for Patient-Oriented Research
Association for Prevention Teaching and Research
Association for Professionals in Infection Control and Epidemiology (APIC)
Association for Psychological Science
Association for Radiologic and Imaging Nursing
Association for Research in Vision and Ophthalmology
Association of Academic Health Centers
Association of Academic Health Sciences Libraries
Association of Accredited Public Health Programs
Association of American Cancer Institutes
Association of American Veterinary Medical Colleges
Association of Clinicians for the Underserved
Association of Departments of Family Medicine
Association of Family Medicine Residency Directors
Association of Maternal & Child Health Programs
Association of Medical School Pediatric Department Chairs
Association of Minority Health Professions Schools
Association of Montana Public Health Officials
Association of Organ Procurement Organizations (AOPO)
Association of Public Health Laboratories
Association of Public Health Nurses
Association of Schools and Colleges of Optometry
Association of Schools of Public Health
Association of State & Territorial Health Officials
Association of State & Territorial Public Health Nutrition Directors
Association of State and Territorial Dental Directors
Association of University Centers on Disabilities
Association of Women's Health, Obstetric and Neonatal Nurses
AVAC: Global Advocacy for HIV Prevention
Baltimore Black Pride, Inc.
Berkeley Faculty Association University of California
Biophysical Society
Boston Public Health Commission
CADASIL – Together We Have Hope
California Association of Alcohol and Drug Abuse Counselors
California Center for Public Health Advocacy
Campaign for Public Health Foundation
Cancer Legal Resource Center
Cascade AIDS Project
C-Change
Center for Behavioral Epidemiology and Community Health
Center for Communications, Health & the Environment
Center for Health and Learning
Center for Science in the Public Interest
Center on Halsted
Change Lab Solutions
Charles R. Drew University of Medicine and Science
Chicago House and Social Service Agency
Children’s Hospital Association
Children's Environmental Health Network
Children's Mental Health Network
Christopher & Dana Reeve Foundation
Clinical Research Forum
Clinical Social Work Association
Coalition for Health Funding
Coalition for Imaging and Bioengineering Research
Coalition for National Health Education Organizations
Coalition for the Advancement of Health Through Behavioral and
Social Sciences Research (CAHT-BSSR)
Coalition for the Life Sciences
Coalition of Heritable Disorders of Connective Tissue
Coalition of National Health Education Organizations
Coalition to End Childhood Lead Poisoning
Coalition to Promote Research (CPR)
College of American Pathologists
Columbia University Medical Center
Commissioned Officers Association of the U.S. Public Health Service
Community Access National Network
Community Servings, Inc.
Community-Campus Partnerships for Health
Complementary and Alternative Medical Association of Vermont
Connecticut Public Health Association
Consortium of Social Science Associations
COPD Foundation
Corporation for Supportive Housing
Council for Children with Behavioral Disorders
Council of State and Territorial Epidemiologists
Crohn’s and Colitis Foundation of America
Cystic Fibrosis Foundation
Daughters of Penelope
Defeat Diabetes Foundation
Delaware Ecumenical Council on Children and Families
Delaware Public Health Association
Dental Hygienists’ Association of the State of New York
Depression and Bipolar Support Alliance
Dialysis Patient Citizens
Digestive Disease National Coalition
Directors of Health Promotion and Education
Disability Rights Legal Center
Easter Seals
Eastern Shore Healthy Communities
Eat Smart, Move More South Carolina
Emergency Nurses Association
Emory Alzheimer's Disease Research Center, Emory University
Epilepsy Foundation
Eta Sigma Gamma
Every Child By Two – Carter/Bumpers Champions for Immunization
Family Voices
FasterCures
Federation of American Societies for Experimental Biology
Federation of Associations in Behavioral & Brain Sciences
Fight Colorectal Cancer
Food Allergy Research and Education
Friends of AHRQ
Friends of Indian Health
Friends of NCHS
Friends of the National Institute of Dental and Craniofacial Research
Futures Without Violence
GBS/CIDP Foundation International
Genetic Alliance
Georgia AIDS Coalition
Georgia Public Health Association
Hadassah, The Women's Zionist Organization of America, Inc.
Health Professions and Nursing Education Coalition
Health Professions Network
HealthHIV
Healthy Teen Network
Hepatitis Foundation International
Hispanic Dental Association (HDA)
HIV ACCESS
HIV Dental Alliance
HIV Medicine Association
HIV Prevention Justice Alliance
HousingWorks
Infectious Diseases Society of America
International Certification and Reciprocity Consortium
International Foundation for Functional Gastrointestinal Disorders
International Myeloma Foundation
International Nurses Society on Addictions
Interstitial Cystitis Association
Intracranial Hypertension Research Foundation
Iowa Public Health Association
Jeffrey Modell Foundation
Joint Advocacy Coalition of ACRT, APOR, CRF, & SCTS
Kids That Care Pediatric & Cancer Fund
Lakeshore Foundation
Lifelong AIDS Alliance
Lupus Foundation of America
Lupus Research Institute
Maine Public Health Association
Malecare
March of Dimes Foundation
Massachusetts Public Health Association
Medical Library Association
Meharry Medical College
Mental Health America
Mesothelioma Applied Research Foundation
Michigan Public Health Association
Minnesota AIDS Project
Mississippi Public Health Association
Missouri Association of Local Public Health Agencies
Missouri Public Health Association
Montana Public Health Association
Morehouse School of Medicine
NAADAC, The Association for Addiction Professionals
National AHEC Organization
National Alliance for Eye and Vision Research
National Alliance of State and Territorial AIDS Directors
National Alliance on Mental Illness
National Alopecia Areata Foundation
National Area Health Education Center Organization
National Assembly on School-Based Health Care
National Association for Children's Behavioral Health
National Association for Geriatric Education
National Association for Public Health Statistics and Information Systems
National Association of Chronic Disease Directors
National Association of Clinical Nurse Specialists
National Association of Community Health Centers
National Association of Councils on Developmental Disabilities
National Association of County and City Health Officials
National Association of County Behavioral Health and Developmental Disability Directors
National Association of Geriatric Education Centers
National Association of Hispanic-Serving Health Professions Schools
National Association of Mental Health Planning & Advisory Councils
National Association of Social Workers
National Association of State Alcohol and Drug Abuse Directors
National Association of State Head Injury Administrators
National Association of State Mental Health Program Directors
National Black Nurses Association
National Business Group on Health
National Center for Healthy Housing
National Coalition of STD Directors
National Council for Community Behavioral Healthcare
National Council for Diversity in the Health Professions
National Council of Jewish Women
National Disability Rights Network
National Family Planning & Reproductive Health Association
National Federation of Families for Children's Mental Health
National Gaucher Foundation
National Health Care for the Homeless Council
National Indian Health Board
National Kidney Foundation
National League for Nursing
National LGBT Cancer Network
National Lung Cancer Partnership
National Marfan Foundation
National Minority AIDS Council
National Multiple Sclerosis Society
National Native American AIDS Prevention Center
National Network of Public Health Institutes
National Nursing Centers Consortium
National Organization for Rare Disorders (NORD)
National Pediatric AIDS Network
National Psoriasis Foundation
National Respite Coalition
National Rural Health Association
National Student Nurses' Association, Inc.
National Tay-Sachs & Allied Diseases Association, Inc.
National Violence Prevention Network
National Viral Hepatitis Roundtable
National Women's Health Network
New Mexico Public Health Association
New York State Public Health Association
New York Stem Cell Foundation
North American Primary Care Research Group
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
North Carolina Harm Reduction Coalition
Ohio Public Health Association
Okaloosa AIDS Support and Informational Services, Inc.
Oklahoma Public Health Association
Oncology Nursing Society
Open Door Clinic
Oral Health America
Oregon Health & Science University
Oregon Public Health Association
Oregon Public Health Institute
Palo Alto Medical Foundation Research Institute
Pancreatic Cancer Action Network
Pediatric Stroke Network, Inc.
PennMedicine
Physician Assistant Education Association
Planned Parenthood Federation of America
Population Association of America/Association of Population Centers
Prevent Blindness America
Preventive Cardiovascular Nurses Association
Project DOCC - Delivery of Chronic Care
Project Inform
Prostate Cancer Foundation
Public Health Association of Nebraska
Public Health Institute
Pulmonary Hypertension Association
PXE International
Racial and Ethnic Health Disparities Coalition
Red Circle Wellness
Regional AsthmaManagement & Prevention
Research!America
Rhode Island Public Health Association
RiverStone Health
RTI International
Ryan White Medical Providers Coalition
Safe States Alliance
San Francisco AIDS Foundation
Schizophrenia and Related Disorders Alliance of America
Scleroderma Foundation
Sexuality Information and Education Council of the United States (SIECUS)
Sjogren’s Syndrome Foundation
Sleep Research Society
Society for Clinical and Translational Science
Society for Healthcare Epidemiology of America
Society for Maternal-Fetal Medicine
Society for Medical Decision Making
Society for Neuroscience
Society for Nutrition Education and Behavior
Society for Pediatric Research
Society for Public Health Education
Society for Women's Health Research
Society of General Internal Medicine
Society of Heart Attack Prevention and Eradication
Society of Interventional Radiology
Society of Teachers of Family Medicine
South Dakota Public Health Association
Southern AIDS Coalition
Southern California Public Health Association
Southern HIV/AIDS Strategy Initiative
Special Olympics, Inc.
Test Positive Aware Network
Texas Health Institute
The AIDS Institute
The American Brain Coalition
The American Society for Cell Biology
The Arc of the United States
The Child and Adolescent Health Measurement Initiative
The Coalition of Urban Serving Universities
The Endocrine Society
The Gerontological Society of America
The LGBT Cancer Project - Out With Cancer
The National Campaign to Prevent Teen and Unplanned Pregnancy
The National Council of State Boards of Nursing
The NephCure Foundation
The SPARK Programs
The TMJ Association, Ltd
Trauma Center Association of America
Treatment Action Group
Treatment Communities of America
Trust for America's Health
Turner Syndrome Foundation, Inc.
Tuskegee University College of Veterinary Medicine, Nursing & Allied Health.
U.S. Hereditary Angioedema Association
Utah Public Health Association
Vermont Public Health Association
VillageCare
Voices for America’s Children
Washington State Public Health Association
Wisconsin Public Health Association
Women African Affairs
WomenHeart: The National Coalition for Women with Heart Disease
YMCA of the USA
Young People’s Healthy Heart Program at Mercy Hospital