Posts Tagged ‘funding’

Teen Pregnancy Prevention Program Defunded in Baltimore…and Beyond

August 20, 2017

The teen pregnancy rate in Baltimore is 2-3 times the national average, with rates reaching upwards of 64 pregnant teens for every 1,000 female adolescents in 2009. According to the Center for Disease Control, teen pregnancy costs taxpayers $10 billion annually in health care and foster care costs. On the personal level, unplanned pregnancies significantly reduce life opportunities for teen moms, with the CDC finding that only 50% of teen moms graduating from high school by age 22. This lack of education causes a ripple effect, and teen moms have more chronic health problems and higher rates of incarceration.

Courtesy of the Baltimore Sun

Courtesy of Baltimore Sun

Teen pregnancy in Baltimore has seen a steady decline over the last decade, joining a national downward trend. This comes in no small part to programs such as the Health and Human Services’s Teen Pregnancy Prevention Program (TPPP). With funding from the TPPP, 80 city health departments have been empowered to create science-based prevention programs for teens to understand contraception and sexuality.

Unfortunately, the TPPP was abruptly defunded last week. The Trump administration offered little explanation, leaving pro-abstinence groups such as The Abstinence and Marriage Education Partnership to justify such cuts with claims that abstinence is correlated to lower rates of teen drug abuse.

Here in Maryland, the Baltimore City Health Department expressed frustration at losing $3.5 million out of the $214 milling being cut. Health Commissioner Leana Wen called the cuts “shocking.” The Health Department has joined the Big Cities Health Coalition, comprised of the 80 beneficiary cities of TPPP funds, in decrying the budget cuts. Even the American Academy of Pediatrics has joined the plea, adding a link to its website for pediatricians to contact their congressmen in protest.

There’s good news. The National Campaign to Prevent Teen and Unplanned Pregnancy found that 83% of adults support teen pregnancy prevention programs. Now is the time to tell Congress that the constituency wants the TPPP funded. Call your congressman today!


The Global Gag Rule, a harmful human rights violation

March 12, 2017

The Global Gag Rule (GGR) is harmful to women and families and violates human rights. Originally known as the “Mexico City Policy” because it was enacted by Ronald Reagan in 1984 at a conference in Mexico City, the policy is more commonly known as the Global Gag Rule because of how it silences NGOs and health care workers. Specifically, the original policy dictated that no USAID family planning funds could be awarded to organizations that performed or promoted abortion and therefore prohibited them from even speaking about abortion.

The GGR is highly partisan- every Democrat president since Reagan has rescinded the policy and every Republican has reinstated it. The current administration, however, has not only reinstated the GGR but has dramatically expanded the funds that are affected.

Reagan’s version applied to USAID family planning funds; G.W. Bush’s version limited the GGR by exempting USAID HIV/AIDs related work. The latest iteration, however, greatly expands the affected funds to cover all foreign aid arising from any agency or department. The current version restricts up to $9.5 billion in aid, or 16x the amount of funds that would have been affected by previous versions.

Worse yet, beyond being a clear example of religious overreach in US politics and a violation of human rights, evidence suggests that the policy reduces sex education and contraception use while increasing both abortions and the proportion of abortions that result in health complications- maternal, family, and child health all suffer. There is a large coalition of organizations that oppose the GGR. You can take action today by learning more information about the GGR and volunteering or donating to organizations like IPPF, PAI, and the Bill and Melinda Gates Foundation who, together with UN member countries, are attempting to counteract the extreme funding deficit.

Opioid Overdose Deaths: Time for Federal Action

March 4, 2016

imagesPrescription opioid abuse and overdose has emerged as a serious public health problem in the United States in recent decades. Drug overdose rates have been steadily increasing and is now one of leading causes of accidental death nationwide. According the CDC 44 people are dying in the United States every day from drug overdose. Naloxone is a medication that can be easily administered intramuscularly or through a nasal spray, and can rapidly reverse the effects of opioid overdose, making it widely recognized as an important tool in saving lives.


There is widespread agreement that this is an urgent problem and many states have taken policy actions to combat the overdose problem, but there has not been a unified federal effort to date. Currently there is a bill in the house called the Stop Overdose Stat Act and a companion bill in the senate known at the Overdose Prevention Act that would support community training in naloxone administration and provide federal funding for the purchasing and distribution of naloxone.

images (1)Unfortunately, despite bipartisan support for this issue, these bills are being held up in the house’s Energy and Commerce Committee and the senate’s Committee on Health, Education, Labor, and Pensions.  You can help by contacting your representatives in the responsible house and senate committees to voice your support for moving these important bills forward.

U.S. Government: Invest in health systems

August 14, 2014

Health Center in Tigray, Ethiopia (taken by Anne Batchelder)

Health Center in Tigray, Ethiopia (taken by Anne Batchelder)

In Fiscal Year (FY) 2001, the United States Government (USG) contributed $1.7 billion in global health funding.  By FY 2010, global health funding had ballooned to five times the FY01 investment, while the funding has remained nearly constant for the last four years, as shown in Figure 1.  Global health spending, appropriated by Congress, is designated by health element.  Over 50% of funding is earmarked for HIV/AIDS, as shown in Figure 2.  (Both of these figure are from the Kaiser Family Foundation).  Over the years, Congress has passed many bills, from authorizing the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 to the President’s Malaria Initiative (PMI) in 2005, and increased the money appropriated for particular elements.

Global Health Funding, FY 2001 – FY 2014

Global Health Budget Request by Sector, FY2014

As shown above, HIV/AIDS funding is the majority of health funding. In 2014, the President’s budget request represented a 3% decrease in HIV funding and HIV Advocates at the AIDS Healthcare Foundation, claimed that “Never before has a President sought to actually reduce America’s commitment to fighting the AIDS epidemic globally.” On the other hand, the ONE Campaign applauded Obama’s budget proposal, “for keeping America at the forefront of the global fight against HIV/AIDS and other preventable diseases. We applaud his 2014 budget request for $1.65 billion for the Global Fund to Fight AIDS, TB and Malaria.”

While increases in health funding have enabled government agencies like USAID, USG partners, and their implementing partners to increase the impact of their health investments, many organizations are advocating for more strategic investment in global health.  Organizations like NEPAD, IHP+, and the Center for Global Development have advocated for investments in health systems.  USG investments that incorporate health systems will ensure that HIV/AIDS spending makes each dollar invested reaches more people infected or impacted by HIV/AIDS.

As the Washington Post reported, the recent African Leaders Summit in Washington, DC demonstrated that budgets will not continue to grow at the rate that they have in the past.  Therefore, investments in health need to be more strategic and focus on sustainable investments in health systems.

Revoke CABS foreign aid suspension in Malawi

March 10, 2014

Approximately $150 million (USD) in direct foreign aid committed to Malawi has been suspended in reaction to the country’s ‘cashgate’ scandal, where in late 2013, government officials were caught looting public funds estimated to be worth $32 million (USD).

The locked aid comes from the Common Approach to Budget Support (CABS) in Malawi, whose members include the European Commission, the Norwegian Embassy of Malawi, the African Development Bank, and the United Kingdom’s Department of International Development (DFID).  CABS decided that dispensing funds into a dysfunctional financial management system would be irresponsible until it could be proven that the resources would be used for their intended purposes.  Additionally, whereas the majority of the deferred funds were to go to the Malawian government under general budget support, DFID also halted sector budget support contributions of approximately $28 million (USD).  Said one expert, “… DFID’s actions may have huge adverse impacts on the health and education sectors…”


(Residents of Lilongwe gather and wait for maize from foreign donors. Source: Author)

To make matters worse, a March 11, 2014 meeting between CABS and the Malawian government regarding the possible release of aid was recently postponed.  And while the Malawian government took necessary austerity measures in response to CABS’ action, the truth remains that foreign aid represents 40% of the country’s national budget.  In fact, the last time DFID cut funding in 2011, it directly impacted the public health sector by leading to drug shortages and stock-outs, demoralized doctors, and major lapses in the medicinal supply chain.

Unquestionably, CABS (DFID included) should follow the lead of the International Monetary Fund (IMF), who had also been withholding aid but recently decided to release their funds totaling $20 million (USD).  In doing so, CABS might avoid negatively affecting innocent people (and a public health sector), who should not suffer as a result of their government’s recklessness.

Building community one small, independent business at a time.

March 10, 2013
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Street Mural in the heart of Hamilton planned and painted by HLMS volunteers. Street murals are successfully used to slow traffic, especially at busy intersections.

When neighborhood retailers and small businesses succeed, so does the neighborhood. In  recent years, “buy local” or “source independent” have become universal slogans to encourage consumers to purchase from independent retailers and service providers.  The push may be losing its original intention.  For instance American Express, which earned a staggering $1.25 billion in the last quarter of 2012, latched onto the trend by promoting annually “Small Business Saturday” to some business owner’s chagrin.  In spite of the push for small business customers, a report shows that small business owners are concerned about their future and of their economic well being.  To help business owner, more innovative and less opportunistic approaches are needed for their sustainable growth.

Community-based business development initiatives such as the Main Streets program are an  effective method supporting  independent, local business owners.  Once designated as Main Street organization,  non-profits are given seed funding  by their local governments to start their Main Street program.  Baltimore has 10 designated Main Streets throughout the city, and they are coordinated by the city’s Development Corp (BDC).   Hamilton-Lauraville Main Street (HLMS) receives praise from community business owners regarding HLMS’s assistance to them, especially with guidance through city regulations and promotions and events.

However, lack of foundation and private funding is threatening programs like HLMS.  Baltimore, through BDC, should increase funding of Main Street activities, and include salary for current volunteers, who are commonly experts in the fields of city planning, marketing, communications and design.  If no funding is received, HLMS will surely close, and the businesses owners within the Main Street district will be without advocates and the neighborhood will suffer.


Don’t Low-Income Young Women Deserve the Right to Choose?

August 13, 2011

According to the Guttmacher Institute’s State Data Center, in Florida in 2005, approximately 847 adolescent females became pregnant in Florida every week.  Of those, 264 females terminated their pregnancies each week of that same year.  For those young women in Florida whose families depend upon Medicaid public insurance to cover the costs of ending an unwanted pregnancy, unless there are extreme circumstances surrounding the situation, such as rape, incest or being life-threatening to the woman, they will need to find alternate resources to cover the costs of salvaging their future. Florida is one of thirty-three (33) states in the US that permits abortions to be paid for with public funds only in those extreme situations, under the Hyde Amendment, which was first passed and implemented over thirty years ago.

Since then, the National Organization for Women (NOW) has been involved in the fight to remove what is viewed as a barrier to access to abortion services and forces women of all ages, not just minors, to either carry unwanted pregnancies to term or pursue potentially dangerous illegal abortions without proper medical oversight, simply because they are low-income. NOW has focused its attention on politicians that have targeted further restrictions in state funding for abortions, beyond the terms of the Hyde Amendment. In time for the congressional votes on the 2012 budget, NOW coordinated a protest of Senator Marco Rubio’s office in Tampa, Florida.

Rubio’s proposals to enact legislation targeting female adolescents with the Child Interstate Abortion Notification Act greatly restricts the rights of adolescents to obtain abortions across state lines and imposes great penalties for the abortion providers who may attempt to treat them.

The number of Medicaid-eligible women that have had limited choice but to give birth into circumstances under which they would have otherwise chosen termination, has increased over time. What has not been fully studied or well-publicized are the exponentially greater costs incurred by taxpayers to feed and provide medical coverage for the mother throughout the pregnancy and delivery, adding a dependent to the Medicaid rolls, when compared to the costs of exercising choice in an unwanted pregnancy for an adolescent already in need of public assistance.

States such as Florida should supplement federal funding to cover a young woman’s decision in this situation, so that she can create full opportunity to become a contributing member of her community.

We need increased federal and state funds to reduce racial/ethnic disparities in healthcare

August 18, 2010

The state of racial and ethnic disparities in health care continues to be problem for the U.S., and as such, federal and state funding is needed for targeted education, outreach, prevention and testing campaigns, and getting patients into treatment in a timely manner.

In 2000, Healthy People 2010 was published to provide a health prevention framework for the U.S., as a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. Addressing health disparities was the 2nd overarching goal of the report. But sadly, here in August 2010, we have fallen short of the goal, as Healthy People is being updated for 2020.

Today, minority populations are still disproportionately affected by many diseases including:

• Cancer – 50-200% greater mortality for “treatable” cancers if not detected early
• Chronic Kidney Disease – 200-400% greater prevalence
• Diabetes
• Heart Disease
• HIV/AIDS – 200-400% greater mortality rates
• Immunization gaps
• Mental health issues
• Obesity

(according to the Alliance of Minority Medical Associations)

According to the 2009 Congress-mandated annual quality and disparities reports issued by the Agency for Healthcare Research and Quality , “…we are not achieving the more substantial strides that are needed to address persistent gaps in quality and access.”

The drivers behind racial and ethnic disparities in health care and outcomes are varied, stemming from long-term socioeconomic disparities, access to care and language and cultural barriers. There are even environmental pollution/contamination effects that have been noted, as many landfills and other contaminating sites tend to be concentrated in areas populated by the poor and disenfranchised. An overview of the drivers and impact of disparities can be reviewed via a brief video from Kaiser Permanente.

Many believe that access to health care is the primary determinant of disparities. However, I believe that with increased access to care for all U.S. citizens, there is the possibility that with more Americans participating in the system and a predicted shortage in primary care physicians, there may actually be an decrease in the available health care for minorities. Given the expected growth in minority populations over the coming years, disparities will become a more critical issue. As such, federal and state funding should be increased to support & expand initiatives specifically targeted at reducing disparities.

The Congressional Black Caucus Health Braintrust posits that increased expenditures to achieve health equity represent “good” debt, in that it adds value for individuals, communities, the U.S. workforce, defense and the nation as a whole. Especially as compared to the “bad” debt of the current Iraq war investment (of $9 million/month).

Even a small percentage of the funds spent on the war overseas could have an impact on health disparities. The U.S. needs to wage battle on the variety of chronic and acute conditions that affect everyday Americans, but especially minority groups that suffer disproportionately. So all people are encouraged to contact their state and federal legislators regarding policies and state budgetary items that can reduce disparities, and call for increased investment in this area that will affect all Americans in the years to come.