The Cruelty of the OMB Budget Proposal: An Advocacy Guide for Public Health
Ignore the speeches and photo ops. If you want to understand what a government truly cares about, study its budget.
In the budget plan for HHS that leaked three weeks ago, we learned what matters to Trump’s Office of Management and Budget (OMB). My hot take was that it showed this administration doesn’t care a whit about public health.
Fortunately, as Jeremy Faust of Inside Medicine clarified, this internal '“passback” document is just a preliminary step in a multi-step budget process that is legally controlled by Congress. That process is likely to start in about three weeks. It’s sure to be tumultuous. The biggest flashpoint will be over Medicaid.
Unlike Medicaid, the work of public health does not have a natural constituency, because when it succeeds, no one notices not getting sick. That creates a risk that, in the mayhem, attacks on CDC’s funding or structure will be overlooked. Those of us who understand population-based prevention therefore have an obligation to scream bloody murder, starting now.
To help you scream to your Senator or Representative (Democrat or Republican), here are talking points on what OMB is proposing for CDC and why it’s so wrong.
CDC
CDC represents less than 1% HHS’s current $1.8 trillion-dollar budget. If you wanted to wring savings out of HHS, would you really go after CDC’s sliver?
Kennedy, among many others, has highlighted the huge disconnect between how much the U.S. spends on medical care and how unhealthy Americans are. That disconnect is indeed scandalous. And it’s a reason to increase funding for public health and prevention, not to cut it.
The OMB plan is not just a budget cut, it is also a reorganization. This reorganization would dismember CDC, folding units responsible for preventing the leading causes of death into Kennedy’s new plaything AHA, which is mainly a combination of HRSA and SAMHSA. It would bury the work of preventing diseases in agencies that instead treat them after the fact.
OMB’s proposed cuts for non-infectious diseases are savage – about 39% overall. Many crucial units would be completely eliminated.
CDC passes about ¾ of its budget to state and local health departments. The greatest suffering from cuts to CDC would be felt not in Atlanta but in states and localities across the country.
Chronic Disease Prevention and Health Promotion
OMB wants to eliminate the National Center for Chronic Disease Prevention and Health Promotion. That’s lunacy when chronic diseases cause about 2/3 of deaths in America, dominating the leading causes, shown in light blue below.
Chronic diseases are preventable, not just through individual actions like quitting smoking and eating healthier but also through government actions like smoke-free air policies and access to healthier foods.
The chronic disease center is the unit that focuses on Kennedy’s supposed priorities – nutrition, physical activity, obesity, and cancer prevention.
Funding for prevention of chronic diseases has always been disproportionately low. If we were to match the dollars spent per death from chronic diseases to what we spend on infectious diseases, we’d be increasing the funding for the chronic disease center forty-fold.
Smoking is still the #1 underlying killer in America, responsible for at least 300,000 deaths per year. It’s like a COVID-19 epidemic every year. The elimination of the Office on Smoking and Health represents “the greatest gift to the tobacco industry in the past half century.” And there is no toxin that threatens children more than second-hand tobacco smoke.
The chronic disease center also has a division that helps women have healthy pregnancies. It is cruel and stupid to eliminate that unit when maternal deaths are rising.
Environmental Health
OMB would cut CDC’s National Center for Environmental Health by a whopping 60%, leaving a tiny shell. That’s outrageous when Kennedy claims to care about the risks of a toxic environment to Americans.
This cut would eliminate the programs to track and prevent childhood lead poisoning, childhood asthma, and the health effects of climate change.
It would also eliminate the Environmental Tracking Portal, a great “transparency” tool that allows Americans (including MAHA moms) to track indicators like emergency room visits for asthma (see below) and the number of Americans exposed to pesticides.
Birth Defects
OMB proposes to cut the birth defect center’s budget by 19% and move it to AHA. This center works to prevent babies from being born with disabilities or developing them after birth.
Among the more horrifying cuts: eliminating screening of newborns for deafness and for biochemical diseases like phenylketonuria (PKU). The damage caused by these diseases is avoidable if they are caught immediately after birth, but permanent if they are discovered later. Does this administration really want to create a legacy of disabled children?
And the ultimate head-scratcher: OMB proposes to cut $5 million of the $28 million budget to track and understand rising rates of autism. Isn’t Kennedy supposed to care about preventing autism?
Injury prevention
OMB would cut funding for the injury prevention center by 28%, eliminating programs to prevent injuries from guns and falls in older adults, among others.
Even if our national conversation on background checks is frozen, research into the dozens of other ways to reduce the carnage from gun injuries should continue.
Death rates from falls in older adults have tripled in the past 30 years. Shouldn’t we have a unit that asks why and tries to reverse that trend?
Occupational safety and health
OMB would eliminate the National Institute for Occupational Safety and Health (NIOSH), cutting its budget by 98%. NIOSH is the center that does the research to protect coal miners from black lung disease and warehouse workers from low-back injuries. It’s also the center that evaluates the effectiveness of respiratory masks, like those N-95s we used during the COVID-19 pandemic.
Global health
The new administration would eliminate CDC’s Center for Global Health and cut the funding for global work by 58%. Unlike the other cuts, this one actually is consistent with this administration’s rhetoric: screw the rest of the world. When it comes to public health, though, that position is just dumb. As we all learned – very painfully, very recently – viruses don’t need visas to cross borders. The best way to prevent a global outbreak of, say, Ebola is to contain it as close to the source as possible. That requires people on the ground in foreign countries.
Put money where your mouth is
The Executive Order that established Kennedy’s Make America Healthy Again Commission includes this rallying cry:
“To fully address the growing health crisis in America, we must re-direct our national focus, in the public and private sectors, toward understanding and drastically lowering chronic disease rates and ending childhood chronic disease. This includes fresh thinking on nutrition, physical activity, healthy lifestyles, over-reliance on medication and treatments, the effects of new technological habits, environmental impacts, and food and drug quality and safety. We must restore the integrity of the scientific process by protecting expert recommendations from inappropriate influence and increasing transparency regarding existing data. We must ensure our healthcare system promotes health rather than just managing disease.”
I’d guess that every CDC employee – including all 2,400 who were summarily fired - would agree with that entire paragraph. That is exactly what CDC tries to do. But it is the opposite of what this proposed budget does.
So, Senator/Representative, please do the job that the Constitution assigned to you. Honor that call to action. Ignore OMB and draft a budget that actually promotes health.