For the last decade, psychologists and other health professionals have touted the benefits of prevention when it comes to health issues such as obesity, diabetes and heart disease. Though such efforts raised interest in Congress, they traditionally haven't garnered much in the way of federal funding.
But times may be changing. With the 2005 Omnibus Appropriations Bill, Congress appears to be putting its money where its mouth is when it comes to disease prevention. The bill gives several prevention efforts increased funding, including obesity, diabetes and other chronic-disease prevention programs at the Centers for Disease Control and Prevention (CDC), as well as some demonstration projects in various states.
The funding is perhaps in response to stark health statistics that undeniably mark the growing financial impact of treating conditions that behavioral interventions can help prevent, says former APA President Patrick H. DeLeon, PhD, JD, chief of staff for Sen. Daniel Inouye (D-Hawaii).
According to the CDC, chronic diseases such as obesity, diabetes and asthma cause seven out of 10 U.S. deaths and account for more than 75 percent of the total U.S. health-care budget. Obesity rates have increased by more than 60 percent among adults in the last 10 years, doubled among children in that time and tripled among adolescents since 1980.
"You hear people say that from a cost standpoint if we put money into prevention, we'd save money as a result and people's health would be better. But there haven't been any real resources dedicated to this area," says Russ Newman, PhD, JD, APA's executive director for professional practice. And, he adds, for the most part the country still views only individual cure or improvement from illness as effective health delivery.
"So the combination of no metric to measure prevention and no money to invest has made it more of an illusion," he says.
Now, the country is beginning to recognize the impact of lifestyle and behavior on health, and Congress is following suit by dedicating more money to study prevention efforts, says Newman. DeLeon believes that recognition may be the start of a prevention evolution in health care one that psychologists will very much be a part of.
Boosts for CDC efforts
Indeed, although the 2005 appropriations bill didn't necessarily create new programs, many prevention efforts received funding increases. That's noteworthy, says Doug Walter, JD, counsel for legislative and regulatory affairs in APA's Practice Directorate, because Congress actually spent fewer discretionary funds than in previous years.
In particular, the CDC saw a spike in prevention funding this year. Appropriations to the CDC for chronic-disease prevention increased by approximately $55 million over 2004 funding. Specifically:
Diabetes-prevention activities received an increase of $4 million, tobacco-prevention activities grew by $15 million and prevention centers gained $5 million.
The CDC childhood obesity prevention program VERB earned approximately $60 million in funding. VERB is a national, multicultural marketing campaign to fight childhood obesity and related health problems. It encourages kids to become physically active every day through paid advertising, partnerships with community agencies and special events.
The STEPS to a Healthier U.S. Program gained $6 million. Through the program, the CDC helps states, cities and tribal entities launch chronic-disease prevention efforts that reduce the burdens of diabetes, obesity and asthma and address three related risk factors physical inactivity, poor nutrition and tobacco use.
Specific psychology mentions
Not only did Congress give a financial boost to such prevention efforts, but some 2005 appropriations seem to support the idea that psychologists are an integral part of this trend.
Indeed, says DeLeon, "The omnibus appropriations bill suggests a very bright future for an expanded vision of health psychology." A couple of appropriations illustrate his point:
The appropriations bill's conference report expressed concern about the absence of mechanisms to deliver necessary psychosocial care to individuals with cancer and their family members. In response, the bill provided $1 million for the Department of Health and Human Services to work in collaboration with the Institute of Medicine and relevant agencies to study how community agencies can better provide cancer patients and their families with psychosocial services.
The conferences specifically requested that the analysis determine the capacity of the current system to deliver such care and the resources mental health and oncology providers need to do so. The report also calls for the agencies to examine training programs for professionals providing psychosocial and mental health services for cancer patients to ensure that professionals are gaining experience in relevant community settings.
A collaborative-care demonstration project proposed by APA for the Geisinger Medical Center in Danville, Pa., received seed money in the 2005 appropriations bill. The funding will support the integration of mental health screening and treatment with primary care for older adults at Geisinger Medical Center or one of its 20 rural primary-care clinics. The Pennsylvania Psychological Association also collaborated with APA to obtain funding, and psychologists at Geisinger will be involved in the project.
Any of the prevention demonstration projects included in the appropriations bill can incorporate psychological services, says Newman.
Though most of the money appropriated by Congress is targeted to research that demonstrates the impact of prevention and not necessarily the delivery of those services, the funding trend is a good development for the country and for psychology, notes DeLeon.
More funds are being designated "for the questions that are relevant to psychology, and...to do research on these questions," DeLeon says.Jennifer Daw Holloway is a writer in Washington, D.C.