AB 2424: Community-based Health Improvement and Innovation Fund.
- Session Year: 2015-2016
- House: Assembly
- Latest Version Date: 2016-08-02
Existing law establishes the State Department of Public Health, within the California Health and Human Services Agency, vested with certain duties, powers, functions, jurisdiction, and responsibilities over specified public health programs.
This bill, among other things, would create the Community-based Health Improvement and Innovation Fund in the State Treasury, and the moneys in the fund would be available, upon appropriation by the Legislature, for certain purposes, including, but not limited to, reducing health inequity and disparities in the rates and outcomes of priority chronic health conditions, as defined, preventing the onset of priority chronic health conditions using community-based strategies in communities statewide and with particular focus on health equity priority populations, as defined, and strengthening local, regional, and state level collaborations between public health jurisdictions and health care providers, and across government agencies and community partners to create healthier communities, using a health-in-all-policies approach. The department would be required to use a specified percentage of moneys from the fund for certain public health and administrative activities and would be required to award a specified percentage of moneys from the fund to local health jurisdictions and as competitive grants to eligible applicants to be used to improve health and health equity, as provided.
This bill would create the 13-member Community-based Health Improvement and Innovation Fund Advisory Committee to, among other things, advise the department with respect to policy development, integration, and evaluation of community-based chronic disease and injury prevention activities funded under these provisions, and for development of a master plan of recommendations and proposed strategies for the future implementation of those activities. The bill would require the advisory committee, based on the results of programs supported by these provisions, to produce a comprehensive set of recommendations and proposed strategies for advancing chronic disease and injury prevention throughout the state, to include implementation strategies in the recommendations for each priority chronic health condition throughout the state and identification of areas where innovative solutions are especially needed, and to submit the recommendations and proposed strategies to the Legislature triennially.
Existing law establishes the State Department of Public Health, within the California Health and Human Services Agency, vested with certain duties, powers, functions, jurisdiction, and responsibilities over specified public health programs.
This bill, among other things, would create the Community-based Health Improvement and Innovation Fund in the State Treasury, and the moneys in the fund would be available, upon appropriation by the Legislature, for certain purposes, including, but not limited to, reducing health inequity and disparities in the rates and outcomes of priority chronic health conditions, as defined, preventing the onset of priority chronic health conditions using community-based strategies in communities statewide and with particular focus on health equity priority populations, as defined, and strengthening local and regional local, regional, and state level collaborations between local public health jurisdictions and health care providers, and across government agencies and community partners to create healthier communities, using a health-in-all-policies approach. The department would be required to use a specified percentage of moneys from the fund for certain public health and administrative activities and would be required to award a specified percentage of moneys from the fund to local health jurisdictions and as competitive grants to eligible applicants to be used to improve health and health equity, as provided.
This bill would create an advisory committee, with the members serving terms not to exceed 4 years, and would require the advisory committee to provide expert input and offer guidance to the department on the development, implementation, and evaluation of the fund. The bill would require the department to develop an evaluation framework, as specified, for all activities funded through the fund. The bill would require the advisory committee to produce, and periodically revise, a comprehensive master plan for advancing chronic disease and injury prevention throughout the state and would require the advisory committee to submit the master plan and its revisions to the Legislature triennially.
This bill would create the 13-member Community-based Health Improvement and Innovation Fund Advisory Committee to, among other things, advise the department with respect to policy development, integration, and evaluation of community-based chronic disease and injury prevention activities funded under these provisions, and for development of a master plan of recommendations and proposed strategies for the future implementation of those activities. The bill would require the advisory committee, based on the results of programs supported by these provisions, to produce a comprehensive set of recommendations and proposed strategies for advancing chronic disease and injury prevention throughout the state, to include implementation strategies in the recommendations for each priority chronic health condition throughout the state and identification of areas where innovative solutions are especially needed, and to submit the recommendations and proposed strategies to the Legislature triennially.
Existing law establishes the State Department of Public Health, within the California Health and Human Services Agency, vested with certain duties, powers, functions, jurisdiction, and responsibilities over specified public health programs.
This bill, among other things, would create the Community-based Health Improvement and Innovation Fund in the State Treasury Treasury, and the moneys in the fund would be available, upon appropriation by the Legislature, for certain purposes, including, but not limited to, reducing health inequity and disparities in the rates and outcomes of priority chronic health conditions, as defined, preventing the onset of priority chronic health conditions using community-based strategies in communities statewide and with particular focus on health equity priority populations, as defined, and strengthening local and regional collaborations between local public health jurisdictions and health care providers, and across government agencies and community partners to create healthier communities, using a health in all policies health-in-all-policies approach. The department would be required to use a specified percentage of moneys from the fund for certain public health and administrative activities and would be required to award a specified percentage of moneys from the fund to eligible applicants to be used to improve health and health equity, as provided.
This bill would create an advisory committee, with the members serving terms not to exceed 4 years, and would require the advisory committee to provide expert input and offer guidance to the department on the development, implementation, and evaluation of the fund. The bill would require the department to develop an evaluation framework, as specified, for all activities funded through the fund. The bill would require the advisory committee to produce, and periodically revise, a comprehensive master plan for advancing chronic disease and injury prevention throughout the state and would require the advisory committee to submit the master plan and its revisions to the Legislature triennially.
Existing law establishes the State Department of Public Health, within the California Health and Human Services Agency, vested with certain duties, powers, functions, jurisdiction, and responsibilities over specified public health programs.
This bill bill, among other things, would create the Community-based Health Improvement and Innovation Fund in the State Treasury and the moneys in the fund would be available, upon appropriation by the Legislature, for certain purposes, including, but not limited to, reducing the rates of preventable health conditions and addressing health disparities. health inequity and disparities in the rates and outcomes of priority chronic health conditions, as defined, preventing the onset of priority chronic health conditions using community-based strategies in communities statewide and with particular focus on health equity priority populations, as defined, and strengthening local and regional collaborations between local public health jurisdictions and health care providers, and across government agencies and community partners to create healthier communities, using a health in all policies approach. The department would be required to use a specified percentage of moneys from the fund for certain public health and administrative activities and would be required to award a specified percentage of moneys from the fund to eligible applicants, as described. applicants to be used to improve health and health equity, as provided.
This bill would create an advisory committee, with the members serving terms not to exceed 4 years, and would require the advisory committee to provide expert input and offer guidance to the department on the development, implementation, and evaluation of the fund. The bill would require the advisory committee to produce, and periodically revise, a comprehensive master plan for advancing chronic disease and injury prevention throughout the state and would require the advisory committee to submit the master plan and its revisions to the Legislature triennially.
Existing law establishes the State Department of Public Health, within the California Health and Human Services Agency, vested with certain duties, powers, functions, jurisdiction, and responsibilities over specified public health programs.
This bill would create the Health Improvement and Innovation Fund in the State Treasury and the moneys in the fund would be available, upon appropriation by the Legislature, for certain purposes, including, but not limited to, reducing the rates of preventable health conditions and addressing health disparities. The department would be required to award moneys from the fund to eligible applicants, as described.
The Legislature finds and declares all of the following:
(a)Over the past century, chronic diseases have emerged as a predominant challenge to public health. Chronic disease and injury account for eight of every 10 deaths and affects affect the quality of life of 14 million Californians.
(b)Obesity and diabetes in particular have grown rapidly, posing a grave threat to health. Today over one-half of California adults are estimated to have either diabetes or prediabetes. Thirteen million adults in California, 46 percent of the adult population, are estimated to have prediabetes or undiagnosed diabetes, while another 2.5 million adults, 9 percent of the adult population, have already been diagnosed with diabetes.
(c)The health inequities in this state are stark:
(1)Ethnic minorities and individuals who have low incomes have higher rates of diabetes. Nearly one-in-five 1 in 5 African Americans and Latinos in California have diabetes, more than double the rate of Whites.
(2)Nearly 12 years of life separate the life expectancy at the top and at the bottom of neighborhood clusters in California, from a life expectancy of 87 years in parts of northwest Santa Clara County to 75.3 years in the City of Twentynine Palms and the City of Barstow in the County of San Bernardino.
(3)Economically disadvantaged children are far less likely to complete the fitness requirements of the physical fitness test offered to students in grade school.
(4)Adolescents covered by Medi-Cal reported significantly higher rates of drinking sugar-sweetened beverages and less daily consumption of vegetables than the general California adolescent population and were significantly more likely to be obese.
(d)The following short list of risk factors is responsible for much of the burden of chronic disease: tobacco use, physical inactivity, unhealthful diet, excessive consumption of alcohol, hyperlipidemia, and uncontrolled high blood pressure. These risk factors and chronic conditions are largely preventable, inequitably distributed, and significantly influenced by the social determinants of health.
(e)The State Department of Public Health estimates that as much as 80 percent of heart disease, stroke, and type II diabetes and more than 30 percent of cancers can be prevented by eliminating the underlying risk factors.
(f)The economic burden of chronic disease in California weighs heavily on families, employers, and all levels of government. Approximately $98 billion, or 42 percent of all health care expenditures in the state, was spent on treating just six common chronic health conditions (arthritis, asthma, cardiovascular disease, diabetes, cancer, and depression) in 2010.
(g)The indirect costs associated with chronic disease in California are also high. According to the Economic Burden of Chronic Disease (EBCD) Index, the projected impact of lower productivity and lost workdays for individuals with chronic conditions and their caregiving family members in California was estimated to be $51 billion in 2010.
(h)The cost of health care continues to surpass the rate of inflation, causing increasing strain on the budgets of families, employers, and the government. Yet the ability of healthcare health care alone to solve health problems that arise in the community is limited.
(i)Despite the fact that chronic disease results in decreased quality of life, premature death, and exorbitant medical costs, investments in measures that prevent chronic disease have been minimal.
(j)The United States spends only 2.6 percent of health care dollars on all public health, yet 75 percent of health care costs are attributable to preventable health conditions.
(k)Paying for prevention works and upstream strategies have a remarkable history of success, measured in both cost avoidance and health improvement. In the County of Los Angeles, smoking amongst among high school students fell from 27 percent to 7 percent between 1997 and 2013, thanks to investment in policy and environmental changes as well as education.
(l)Childhood obesity amongst among Los Angeles Unified School District 5th graders decreased by 10.6 percent (from 31.2 percent to 27.9 percent) between 2010 and 2013, and leveled off among 7th and 9th graders, after nine years of steady increases, reflecting investments to reduce the consumption of sugar-sweetened beverages, promote healthier eating, and increase physical activity.
(m)The California Health and Human Services Agency, in partnership with the State Department of Public Health, has defined ambitious health improvement goals for the state through the Lets Get Healthy California initiative, including making California the healthiest state in the nation by 2022, reducing health disparities, and achieving better health at lower cost. These goals cannot be met by improvements in health care or on an individual basis alone. Meeting these goals requires urgent and substantial investment in community-based prevention of chronic disease and injuries.
(n)The Health in All Policies Task Force was established by Executive Order No. S-04-10 on February 23, 2010, under the auspices of the Strategic Growth Council (SGC), in order to foster multi-agency multiagency collaboration to identify priority programs, policies, and strategies to improve the health of Californians while advancing the SGCs goals of improving air and water quality, protecting natural resources and agricultural lands, increasing the availability of affordable housing, improving infrastructure systems, promoting public health, planning sustainable communities, and meeting the states climate change goals.
(o)Senate Concurrent Resolution No. 47 (Resolution Chapter 56 of the Statutes of 2012) affirms the work of the Health in All Policies Task Force by encouraging public officials in all sectors and levels of government to recognize that health is influenced by policies related to air and water quality, natural resources and agricultural land, affordable housing, infrastructure systems, public health, sustainable communities, and climate change, and to consider health when formulating policy, and by encouraging interdepartmental collaboration with an emphasis on the complex environmental factors that contribute to poor health and inequities when developing policies in a wide variety of areas, including, but not limited to, housing, transportation, education, air quality, parks, criminal justice, and employment.
(p)The Office of Health Equity was established in Section 131019.5 of the Health and Safety Code in order to achieve the highest level of health and mental health for all people, with special attention focused on those who have experienced socioeconomic disadvantage and historical injustice, and it directs the Office of Health Equity to work collaboratively with the Health in All Policies Task Force to promote work to prevent injury and illness through improved social and environmental factors that promote health and mental health.
(q)The existing limited resources of funding for chronic disease prevention are threatened, declining from past levels, and subject to significant restrictions.
(r)Strategic investment in upstream prevention will protect, not deplete, the coffers of government. Investment in prevention has a strong evidence base of positive return on investment through reducing health care costs on a long-term basis.
106051.For purposes of this part, the following terms have the following definitions:
(a)Community food projects means those established in the federal Food and Nutrition Act of 2008 (7 U.S.C. Sec. 2011 et seq.) and the federal Food, Conservation, and Energy Act of 2008 (7 U.S.C. Sec. 8701 et seq.) that are designed to increase food security, including access to a healthy diet in communities. They may bring representatives from the community, food, and public health systems together to assess strengths, establish linkages, and create projects, non-profit nonprofit enterprises, or both, that improve access and self-reliance of community members over their food needs. These may also include urban or peri-urban farms and gardens that dedicate production to low-income communities, food hubs, farm stands, farmers markets, mobile vendors, and community-supported agriculture projects that provide distribution systems, and community-owned and managed enterprises that make healthy food more accessible to low-income families.
(b)Department means the State Department of Public Health.
(c)Fund means the Community-based Health Improvement and Innovation Fund.
(d)Health equity means efforts to ensure that all people have full and equal access to opportunities that enable them to lead healthy lives.
(e)Health equity priority population means, for each condition, populations that exhibit significant disparities with respect to prevalence of a priority chronic health condition or injury or worse outcomes outcomes, such as higher hospitalization or death rates. Priority populations may be defined based on race, ethnicity, geography, socioeconomic status, including income or education, other factors as defined by the department, or current findings and recommendations of research, including assessments of innovations funded by the fund.
(f)Local health jurisdiction means a county health department or a combined health department in the case of counties acting jointly or a city health department within the meaning of Section 101185.
(g)Priority chronic health conditions means asthma, type II diabetes, cardiovascular and cerebrovascular disease, cancer, dental disease, obesity, and other chronic conditions and injuries that are prevalent, largely preventable, and associated with high health care costs, as defined by the department. High-burden conditions whose prevention is not adequately supported by other funding streams shall be prioritized.
106052.(a)(1)There is hereby created in the State Treasury the Community-based Health Improvement and Innovation Fund. The fund shall consist of any revenues deposited therein, including any fine or penalty revenue allocated to the fund, any revenue from appropriations specifically designated to be credited to the fund, any funds from public or private gifts, grants, or donations, any interest earned on that revenue, and any funds provided from any other source.
(2)A target level of annual statewide investment from the fund shall be established as a set dollar amount per capita, to be allocated for the purposes described in subdivision (b) and as described in Section 106053.
(b)(1)Moneys in the fund shall be available, upon appropriation by the Legislature, for any of the following purposes:
(A)Reducing health inequity and disparities in the rates and outcomes of priority chronic health conditions and injuries.
(B)Preventing the onset of priority chronic health conditions using community-based strategies in communities statewide and with particular focus on health equity priority populations.
(C)Strengthening local, regional, and state level collaborations between public health jurisdictions and health care providers, and across government agencies and community partners to create healthier communities, using a health-in-all-policies approach.
(D)Supporting collaboration between public health entities and nonhealth organizations and agencies in fields such as, but not limited to, housing, transportation, land use planning, natural resources, parks, food access, education, economic development, community development, and employment, to promote community environments that support healthy communities and families, and that reduce inequities in disease and injury using a health-in-all-policies approach.
(E)Contributing to a stronger evidence base of effective community-based prevention strategies for priority chronic health conditions.
(F)Evaluating the effectiveness and cost-effectiveness of innovative community-based prevention strategies for priority chronic health conditions, as a basis for future decisions about investment in those strategies in order to reduce the costs of providing health care services and to improve population health status.
(2)Moneys in the fund shall be used to address social, environmental, and behavioral determinants of chronic disease and injury at any phase of the life cycle, including, but not limited to, all of the following:
(A)Promotion of healthy diets, improved access to healthy foods, and healthy food environments.
(B)Promotion of physical activity and of a safe, physical activity-promoting environment.
(C)Prevention of unintentional and intentional injury.
(D)Building partnerships to address social determinants of chronic disease.
(3)In expending moneys from the fund, policy, systems, and environmental change approaches are to be emphasized, although funds can support implementation of community-based programs.
(4)Moneys in the fund shall not be used for clinical services.
(5)Revenues deposited in the fund that are unexpended at the end of a fiscal year shall remain in the fund and not revert to the General Fund.
(6)The award of contracts, grants, or funding allocations provided through this part shall be exempt from Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code.
106053.(a)The department shall be allocated an amount not greater than 20 percent of the annual appropriation from the fund for all of the following activities:
(1)Mandatory activities for which the funds shall be used are as follows:
(A)Statewide media and communications campaigns, which shall be allocated 9 percent of total funds.
(B)Evaluation of all program activities supported through the fund, including the creation of a robust evaluation framework, which shall be allocated at least 5 percent of those funds. This evaluation framework shall include all of the following:
(i)Regular monitoring of local health jurisdiction awards to ensure activities are conducted pursuant to approved plans and consistent with all requirements of this part.
(ii)Measures to ensure funding provided pursuant to this part supplements and does not supplant existing funding or efforts.
(iii)Data collection and reporting requirements for grant awardees sufficient to assess impact and monitor compliance with this part.
(iv)A plan to analyze the impact of this part on process measures relevant to community health promotion and, if practicable, on outcome measures.
(C)Other activities, which shall be allocated no more than 6 percent of total funds, as follows:
(i)Overall program implementation and oversight, including review and approval of local health improvement plans, and granting of and monitoring the implementation of local health jurisdiction awards and competitive grant awards.
(ii)The definition of criteria for evidence-based and innovative approaches to improving health and health equity, with evaluation criteria appropriate to each type of approach. Criteria for evidence-based projects shall include cost-effectiveness or projections of return on investment to the state.
(iii)The definition of priority chronic health conditions and health equity priority populations based on public health data.
(iv)The definition of criteria for participation of community partners in local health jurisdiction funding.
(v)The development of tools that can be used by the state and by grantees to monitor progress towards improving health and health equity, including establishment of a health equity index and progress towards Lets Get Healthy California goals.
(2)Discretionary activities, as may be appropriate to support community-based prevention of priority chronic health conditions throughout the state, for which the funds may be used, include, but are not limited to, any of the following:
(A)Research, development, and dissemination of best practices, including training and technical assistance for grantees.
(B)Development of infrastructure, including, but not limited to, data resources or information technology resources to be shared statewide.
(C)Coordination of local efforts.
(D)Development and promotion of statewide initiatives.
(E)Grants or contracts to nonprofit organizations at the state level to provide technical assistance, resource development, or other support to the department, local health jurisdictions, and other grantees directly serving communities.
(3)The department, in consultation with the advisory committee established pursuant to Section 106054, may define state priorities and require activities supported by the fund to align with those priorities in a manner that is consistent with the intent of this part. The department may narrow the list of priority chronic health conditions, if necessary, to ensure an effective program.
(4)The department shall require activities pursuant to this part to be conducted in a manner consistent with principles of effectiveness, cost efficiency, relevance to community needs, maximal impact to improve community health, and sustainability of impact over time.
(b)The department shall award at least 80 percent of total moneys made available in the annual appropriation from the fund to eligible applicants to be used consistent with the purposes described in subdivision (b) of Section 106052. Moneys from the fund shall be distributed and awarded according to the following criteria:
(1)(A)At least 47 percent of total funds shall be awarded to local health jurisdictions and shall be allocated on a formula basis to local health jurisdictions, or their nonprofit designee, with approved applications for three-year funding cycles.
(B)Each local health jurisdiction shall submit an application for a three-year funding cycle, to be reviewed and approved by the department, that includes all of the following information:
(i)A detailed assessment of community health needs and factors contributing to those conditions within the local health jurisdiction with respect to priority chronic health conditions and health equity priority populations.
(ii)A health improvement and evaluation plan that includes initiatives focused on health equity priority populations.
(iii)The level of local funds, including in-kind resources, for community-based prevention activities that was provided in the most recently completed fiscal year.
(iv)Documentation of the existence and activities of a community health partnership pursuant to subparagraph (D) of paragraph (1) of subdivision (b) of Section 106052, which includes leading health care providers, local health jurisdictions, community partners, including those serving health equity priority populations, businesses, and other relevant local government agencies and community leaders and their commitments to support the efforts.
(v)How funds will be used in a manner consistent with principles of effectiveness, cost efficiency, relevance to community needs, maximal impact to improve community health, sustainability of impact over time, and projections of return on investment to the state. health, and sustainability of impact over time.
(C)Each local health jurisdiction with an approved application shall receive a base award of two hundred fifty thousand dollars ($250,000) for a three-year funding cycle. The balance of the funds shall be awarded to local health jurisdictions proportional to the number of residents living below the federal poverty level.
(D)Health improvement and evaluation plans shall emphasize sustainable policy, systems, and environmental change approaches to creating healthier communities.
(E)Local health jurisdictions may come together if they so desire to submit combined regional applications.
(F)No single recipient may receive more than 30 percent of the funding allocated to local health jurisdictions on a formula basis.
(G)Recipients of funds pursuant to this paragraph shall maintain the level of local funds, including in-kind resources, for community-based prevention activities that were provided in the most recently completed fiscal year prior to July 2016. Funds provided pursuant to this paragraph shall supplement and not supplant existing funding for community-based prevention activities of priority chronic health conditions.
(H)Local health jurisdiction investments shall prioritize communities in the third and fourth quartiles of the California Health Disadvantage Index or other criteria of health equity priority populations subsequently adopted by the department.
(I)The initial year of funding may be used for needs assessment, planning, and development.
(2)At least 33 percent of total funds shall be allocated for competitive grants as follows:
(A)(i)Competitive grants shall be awarded to local or regional level entities or statewide nonprofit organizations. Funds provided pursuant to this paragraph shall supplement and not supplant existing funding for community-based prevention activities of priority chronic health conditions.
(ii)Local, regional, and state level entities, including nonprofit and community-based organizations in partnership with other entities, including, but not limited to, other nonprofit and community-based organizations, other local public agencies, schools, religious organizations, businesses, labor unions, health care plans, hospitals, clinics, other health care providers, or other community-based entities.
(iii)Each participating health care plan or hospital shall identify monetary, in-kind, or both, contributions to projects.
(iv)Local or regional projects shall prioritize investments that serve communities in the third and fourth quartiles of the California Health Disadvantage Index or other criteria of health equity priority populations subsequently adopted by the department.
(v)At least 10 percent of the total funds shall be used for statewide nonprofit organizations to support activities conducted regionally or at the state level.
(vi)At least 5 percent of total funds shall be used for a competitive grant program administered by the department to support healthy food incentives for low-income Californians, support community food projects, as defined under Section 106051, and aid community food producers or socially disadvantaged, beginning, military veteran, or limited resource limited-resource specialty crop producers that improve the health and resilience of their communities by increasing access to any variety of fresh, canned, dried, or frozen whole or cut fruits and vegetables without added sugars, fats or oils, and salt. The department shall coordinate, as necessary, with the Department of Food and Agriculture to implement this clause.
(vii)Organizations receiving competitive grants shall coordinate efforts with the department and any local health jurisdictions where they are carrying out activities.
(B)(i)Competitive grant applicants shall identify projects as either an evidence-based or an innovative project.
(ii)Applications for evidence-based projects shall demonstrate how funds will be used in a manner consistent with principles of effectiveness, cost efficiency, relevance to community needs, maximal impact to improve community health, and sustainability of impact over time.
(iii)At least 10 percent of the funding for competitive grants shall be set aside for innovative projects that test previously untested strategies in order to improve the evidence base of effective community-based prevention strategies for priority chronic health conditions and injuries.
(iv)Applications for innovative projects shall provide a rationale for the defined approach and any evidence that suggests the innovative project will be effective, as well as a plan and resource allocation for the evaluation.
(v)Competitive grants may be used by organizations for policy systems or environmental change efforts, direct program delivery, or for technical assistance to other grantees.
106054.(a)There is hereby created the Community-based Health Improvement and Innovation Fund Advisory Committee in state government that shall advise the department with respect to policy development, integration, and evaluation of community-based chronic disease and injury prevention activities funded under this part, and for development of a master plan of recommendations and proposed strategies for the future implementation of those activities.
(b)The advisory committee shall include, at a minimum, experts on priority chronic health conditions, effective nonclinical prevention strategies, policy strategies for chronic disease prevention, and the unique needs of health equity priority populations.
(c)The advisory committee shall be composed of 13 members to be appointed as follows:
(1)One member representing voluntary health organizations dedicated to the reduction of chronic disease, injuries, or health inequities appointed by the Speaker of the Assembly.
(2)One member representing an organization that represents health care employees appointed by the Senate Rules Committee.
(3)One member representing a statewide nonprofit health organization dedicated to the improvement of public health appointed by the Governor.
(4)One member representing a community-based organization with a demonstrated track record implementing community prevention programs appointed by the Governor.
(5)One representative of a university with expertise in programs intended to reduce chronic disease appointed by the Governor.
(6)Two representatives of a population group with priority health conditions appointed by the Governor.
(7)One representative of the Health and Human Services Agency appointed by the Governor.
(8)One representative of the Department of Food and Agriculture appointed by the Governor.
(9)One representative of the Health in All Policies Task Force appointed by the Strategic Growth Council.
(10)One member representing the interests of the general public appointed by the Governor.
(11)One representative of the California Conference of Local Health Officers.
(12)One representative from the California Health Benefit Exchange appointed by the executive board of the exchange.
(d)Members of the advisory committee shall serve for a term of two years, renewable at the option of the appointing authority. The initial appointments of members shall be for two or three years, to be drawn by random lot at the first meeting. The committee shall be staffed by the departments coordinator of the program as described in paragraph (3) of subdivision (a) of Section 106053.
(e)The committee shall meet as often as it deems necessary, but shall meet not less than four times per year.
(f)The members of the committee shall serve without compensation, but shall be reimbursed for necessary travel expenses incurred in the performance of the duties of the committee.
(g)The committee shall be advisory to the department, the Department of Food and Agriculture, and the Health and Human Services Agency, for all of the following purposes:
(1)Evaluation of research on community-based policies, practices, and programs funded under this part as necessary in order to assess the overall effectiveness of efforts made by the programs to reduce the occurrence of preventable chronic disease and injuries.
(2)Facilitation of programs directed at reducing and eliminating preventable chronic disease and injury that are operated jointly by more than one agency or entity. The committee shall propose strategies for the coordination of proposed programs administered by the department, the Department of Food and Agriculture, the Health and Human Services Agency in general, and the efforts of the other members, such as the Health in All Policies Task Force, in order to maximize the public benefit of the programs.
(3)Making recommendations to the department, the Department of Food and Agriculture, and the Health and Human Services Agency regarding the most appropriate criteria for the selection of, standards of operation of, and types of activities to be funded under this part.
(4)Reporting to the Legislature on or before January 1 of each year on the number and amount of chronic disease and injury prevention activities funded by the Community-based Health Improvement and Innovation Fund, the amount of money in the fund, any moneys previously appropriated to the department, but unspent by the department, a description and assessment of all programs funded under this part, and recommendations for any necessary policy changes or improvements.
(5)Ensuring that the most current research findings regarding chronic disease and injury prevention are applied in designing the Community-based Health Improvement and Innovation Fund activities administered by the department. The department shall apply the most current findings and recommendations of research, including assessments of innovations funded by the fund.
(h)(1)Based on the results of programs supported by this part and any other proven methodologies available to the advisory committee, the advisory committee shall produce a comprehensive set of recommendations and proposed strategies for advancing chronic disease and injury prevention throughout the state.
(2)The recommendations shall include implementation strategies for each priority chronic health condition throughout the state and identification of areas where innovative solutions are especially needed.
(3)The advisory committee shall submit the recommendations and proposed strategies to the Legislature triennially.
(4)The advisory committee recommendations shall include specific goals for reduction of the burden of preventable chronic conditions and injuries by 2030, administrative arrangements, funding priorities, integration and coordination of approaches by the department, the Department of Food and Agriculture, local health jurisdictions, non-profit nonprofit and community-based organizations, the University of California, the Health in All Policies Task Force, and their support systems, and progress reports relating to each health equity priority population.
(i)A report submitted pursuant to section shall be submitted in compliance with Section 9795 of the Government Code.
106055.Implementation of this part shall be contingent on an appropriation provided for this purpose in the annual Budget Act or other measure.
The Legislature finds and declares all of the following:
(a)Over the past century, chronic diseases have emerged as a predominant challenge to public health. Chronic disease and injury account for eight of every 10 deaths and affects the quality of life of 14 million Californians.
(b)Obesity and diabetes in particular have grown rapidly, posing a grave threat to health. Today over one-half of California adults are estimated to have either diabetes or prediabetes. Thirteen million adults in California, 46 percent of the adult population, are estimated to have prediabetes or undiagnosed diabetes, while another 2.5 million adults, 9 percent of the adult population, have already been diagnosed with diabetes.
(c)The health inequities in this state are stark:
(1)Ethnic minorities and individuals who have low incomes have higher rates of diabetes. Nearly one-in-five African Americans and Latinos in California have diabetes, more than double the rate of Whites.
(2)Nearly 12 years of life separate the life expectancy at the top and at the bottom of neighborhood clusters in California, from a life expectancy of 87 years in parts of northwest Santa Clara County to 75.3 years in the City of Twentynine Palms and the City of Barstow in the County of San Bernardino.
(3)Economically disadvantaged children are far less likely to complete the fitness requirements of the physical fitness test offered to students in grade school.
(4)Adolescents covered by Medi-Cal reported significantly higher rates of drinking sugar-sweetened beverages and less daily consumption of vegetables than the general California adolescent population and were significantly more likely to be obese.
(d)The following short list of risk factors is responsible for much of the burden of chronic disease: tobacco use, physical inactivity, unhealthful diet, excessive consumption of alcohol, hyperlipidemia, and uncontrolled high blood pressure. These risk factors and chronic conditions are largely preventable and inequitably distributed. preventable, inequitably distributed, and significantly influenced by the social determinants of health.
(e)The State Department of Public Health estimates that as much as 80 percent of heart disease, stroke, and type II diabetes and more than 30 percent of cancers can be prevented by eliminating the underlying risk factors.
(f)The economic burden of chronic disease in California weighs heavily on families, employers, and all levels of government. Approximately $98 billion, or 42 percent of all health care expenditures in the state, was spent on treating just six common chronic health conditions (arthritis, asthma, cardiovascular disease, diabetes, cancer, and depression) in 2010.
(g)The indirect costs associated with chronic disease in California are also high. According to the Economic Burden of Chronic Disease (EBCD) Index, the projected impact of lower productivity and lost workdays for individuals with chronic conditions and their caregiving family members in California was estimated to be $51 billion in 2010.
(h)The cost of health care continues to surpass the rate of inflation, causing increasing strain on the budgets of families, employers, and the government. Yet the ability of healthcare alone to solve health problems that arise in the community is limited.
(i)Despite the fact that chronic disease results in decreased quality of life, premature death, and exorbitant medical costs, investments in measures that prevent chronic disease have been minimal.
(j)The United States spends only 2.6 percent of health care dollars on all public health, yet 75 percent of health care costs are attributable to preventable health conditions.
(k)Paying for prevention works and upstream strategies have a remarkable history of success, measured in both cost avoidance and health improvement. In the County of Los Angeles, smoking amongst high school students fell from 27 percent to 7 percent between 1997 and 2013, thanks to investment in policy and environmental changes as well as education.
(l)Childhood obesity amongst Los Angeles Unified School District 5th graders decreased by 10.6 percent (from 31.2 percent to 27.9 percent) between 2010 and 2013, and leveled off among 7th and 9th graders, after nine years of steady increases, reflecting investments to reduce the consumption of sugarsweetened sugar-sweetened beverages, promote healthier eating, and increase physical activity.
(m)The California Health and Human Services Agency, in partnership with the State Department of Public Health, has defined ambitious health improvement goals for the state through the Lets Get Healthy California initiative, including making California the healthiest state in the nation by 2022, reducing health disparities, and achieving better health at lower cost. These goals cannot be met by improvements in health care or on an individual basis alone. Meeting these goals requires urgent and substantial investment in community-based prevention of chronic disease. disease and injuries.
(n)The Health in All Policies Task Force was established by Executive Order No. S-04-10 on February 23, 2010, under the auspices of the Strategic Growth Council (SGC), in order to foster multi-agency collaboration to identify priority programs, policies, and strategies to improve the health of Californians while advancing the SGCs goals of improving air and water quality, protecting natural resources and agricultural lands, increasing the availability of affordable housing, improving infrastructure systems, promoting public health, planning sustainable communities, and meeting the states climate change goals.
(o)Senate Concurrent Resolution No. 47 (Resolution Chapter 56 of the Statutes of 2012) affirms the work of the Health in All Policies Task Force by encouraging public officials in all sectors and levels of government to recognize that health is influenced by policies related to air and water quality, natural resources and agricultural land, affordable housing, infrastructure systems, public health, sustainable communities, and climate change, and to consider health when formulating policy, and by encouraging interdepartmental collaboration with an emphasis on the complex environmental factors that contribute to poor health and inequities when developing policies in a wide variety of areas, including, but not limited to, housing, transportation, education, air quality, parks, criminal justice, and employment.
(p)The Office of Health Equity was established in Section 131019.5 of the Health and Safety Code in order to achieve the highest level of health and mental health for all people, with special attention focused on those who have experienced socioeconomic disadvantage and historical injustice, and it directs the Office of Health Equity to work collaboratively with the Health in All Policies Task Force to promote work to prevent injury and illness through improved social and environmental factors that promote health and mental health.
(n)
(q)The existing limited resources of funding for chronic disease prevention are threatened, declining from past levels, and subject to significant restrictions.
(o)
(r)Strategic investment in upstream prevention will protect, not deplete, the coffers of government. Investment in prevention has a strong evidence base of positive return on investment through reducing health care costs on a long-term basis.
106051.For purposes of this part, the following terms have the following definitions:
(a)Community food projects means those established in the federal Food and Nutrition Act of 2008 (7 U.S.C. Sec. 2011 et seq.) and the federal Food, Conservation, and Energy Act of 2008 (7 U.S.C. Sec. 8701 et seq.) that are designed to increase food security, including access to a healthy diet in communities. They may bring representatives from the community, food, and public health systems together to assess strengths, establish linkages, and create projects, non-profit enterprises, or both, that improve access and self-reliance of community members over their food needs. These may also include urban or peri-urban farms and gardens that dedicate production to low-income communities, food hubs, farm stands, farmers markets, mobile vendors, and community-supported agriculture projects that provide distribution systems, and community-owned and managed enterprises that make healthy food more accessible to low-income families.
(a)
(b)Department means the State Department of Public Health.
(b)
(c)Fund means the Community-based Health Improvement and Innovation Fund.
(d)Health equity means efforts to ensure that all people have full and equal access to opportunities that enable them to lead healthy lives.
(c)
(e)Health equity priority population means, for each condition, populations that exhibit significant disparities with respect to prevalence of a priority chronic health condition or injury or worse outcomes such as higher hospitalization or death rates. Priority populations may be defined based on race, ethnicity, geography, socioeconomic status, including income or education, other factors as defined by the department, or current findings and recommendations of research, including assessments of innovations funded by the fund.
(d)
(f) Local health jurisdiction means a county health department or a combined health department in the case of counties acting jointly or a city health department within the meaning of Section 101185.
(e)
(g)Priority chronic health conditions means asthma, type II diabetes, cardiovascular and cerebrovascular disease, cancer, dental disease, obesity, and other chronic conditions and injuries that are prevalent, largely preventable, and associated with high health care costs, as defined by the department. High-burden conditions whose prevention is not adequately supported by other funding streams shall be prioritized.
106052.(a)(1)There is hereby created in the State Treasury the Community-based Health Improvement and Innovation Fund. The fund shall consist of any revenues deposited therein, including any fine or penalty revenue allocated to the fund, any revenue from appropriations specifically designated to be credited to the fund, any funds from public or private gifts, grants, or donations, any interest earned on that revenue, and any funds provided from any other source.
(2)A target level of annual statewide investment from the fund shall be established as a set dollar amount per capita, to be allocated for the purposes described in subdivision (b) and as described in Section 106053.
(b)(1)Moneys in the fund shall be available, upon appropriation by the Legislature, for any of the following purposes:
(A)Reducing health inequity and disparities in the rates and outcomes of priority chronic health conditions. conditions and injuries.
(B)Preventing the onset of priority chronic health conditions using community-based strategies in communities statewide and with particular focus on health equity priority populations.
(C)Strengthening local and regional local, regional, and state level collaborations between local public health jurisdictions and health care providers, and across government agencies and community partners to create healthier communities, using a health-in-all-policies approach.
(D)Supporting collaboration between public health entities and nonhealth organizations and agencies in fields such as, but not limited to, housing, transportation, land use planning, natural resources, parks, food access, education, economic development, community development, and employment, to promote community environments that support healthy communities and families, and that reduce inequities in disease and injury using a health-in-all-policies approach.
(D)
(E)Contributing to a stronger evidence base of effective community-based prevention strategies for priority chronic health conditions.
(E)Evaluating effectiveness
(F)Evaluating the effectiveness and cost-effectiveness of innovative community-based prevention strategies for priority chronic health conditions, as a basis for future decisions about investment in those strategies in order to reduce the costs of providing health care services and to improve population health status.
(2)Moneys in the fund shall be used to address social, environmental, and behavioral determinants of chronic disease and injury at any phase of the life cycle, including, but not limited to, all of the following:
(A)Promotion of healthy diets and diets, improved access to healthy foods, and healthy food environments.
(B)Promotion of physical activity and of a safe, physical activity-promoting environment.
(C)Prevention of unintentional and intentional injury.
(D)Building partnerships to address social determinants of chronic disease.
(3)In expending moneys from the fund, policy, systems, and environmental change approaches are to be emphasized, although funds can support implementation of community-based programs.
(4)Moneys in the fund shall not be used for clinical services.
(c)
(5)Revenues deposited in the fund that are unexpended at the end of a fiscal year shall remain in the fund and not revert to the General Fund.
(6)The award of contracts, grants, or funding allocations provided through this part shall be exempt from Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code.
106053.(a)The department shall be allocated an amount not greater than 20 percent of the annual appropriation from the fund for all of the following activities:
(1)Mandatory activities for which the funds shall be used are as follows:
(A)Statewide media and communications campaigns, which shall be allocated 9 percent of total funds.
(B)Evaluation of program activities, which shall be allocated at least 5 percent of total funds.
(B)Evaluation of all program activities supported through the fund, including the creation of a robust evaluation framework, which shall be allocated at least 5 percent of those funds. This evaluation framework shall include all of the following:
(i)Regular monitoring of local health jurisdiction awards to ensure activities are conducted pursuant to approved plans and consistent with all requirements of this part.
(ii)Measures to ensure funding provided pursuant to this part supplements and does not supplant existing funding or efforts.
(iii)Data collection and reporting requirements for grant awardees sufficient to assess impact and monitor compliance with this part.
(iv)A plan to analyze the impact of this part on process measures relevant to community health promotion and, if practicable, on outcome measures.
(C)Other activities, which shall be allocated no more than 6 percent of total funds, as follows:
(i)Overall program implementation and oversight, including review and approval of local health improvement plans, and granting of and monitoring the implementation of local health jurisdiction awards and competitive grant awards.
(ii)The definition of criteria for evidence-based and innovative approaches to improving health and health equity, with evaluation criteria appropriate to each type of approach. Criteria for evidence-based projects shall include cost-effectiveness or projections of return on investment to the state.
(iii)The definition of priority chronic health conditions and health equity priority populations based on public health data.
(iv)The definition of criteria for participation of community partners in local health jurisdiction funding.
(v)The development of tools that can be used by the state and by grantees to monitor progress towards improving health and health equity, including establishment of a health equity index. index and progress towards Lets Get Healthy California goals.
(2)Discretionary activities, as may be appropriate to support community-based prevention of priority chronic health conditions throughout the state, for which the funds may be used, include, but are not limited to, any of the following:
(A)Research, development, and dissemination of best practices, including training and technical assistance for grantees.
(B)Development of infrastructure, including, but not limited to, data resources or information technology resources to be shared statewide.
(C)Coordination of local efforts.
(D)Development and promotion of statewide initiatives.
(E)Grants or contracts to nonprofit organizations at the state level to provide technical assistance, resource development, or other support to the department, local health jurisdictions, and other grantees directly serving communities.
(3)The department, in consultation with the advisory committee established pursuant to Section 106054, may define state priorities and require activities supported by the fund to align with those priorities in a manner that is consistent with the intent of this part. The department may narrow the list of priority chronic health conditions, if necessary, to ensure an effective program.
(4)The department shall require activities pursuant to this part to be conducted in a manner consistent with principles of effectiveness, cost efficiency, relevance to community needs, maximal impact to improve community health, and sustainability of impact over time.
(b)The department shall award at least 80 percent of total moneys made available in the annual appropriation from the fund to eligible applicants to be used consistent with the purposes described in subdivision (b) of Section 106052. Moneys from the fund shall be distributed and awarded according to the following criteria:
(1)(A)At least 50 47 percent of total funds shall be awarded to local health jurisdictions and shall be allocated on a formula basis to local health jurisdictions, or their nonprofit designee, with approved applications for three-year funding cycles.
(B)Each local health jurisdiction shall submit an application for a three-year funding cycle, to be reviewed and approved by the department, that includes all of the following information:
(i)A detailed assessment of community health needs and factors contributing to those conditions within the local health jurisdiction with respect to priority chronic health conditions and health equity priority populations.
(ii)A health improvement and evaluation plan that includes initiatives focused on health equity priority populations.
(iii)The level of local funds, including in-kind resources, for community-based prevention activities that was provided in the most recently completed fiscal year.
(iv)Documentation of the existence and activities of a community health partnership pursuant to subparagraph (D) of paragraph (1) of subdivision (b) of Section 106052, which includes leading health care providers, local health jurisdictions, community partners, including those serving health equity priority populations, businesses, and other relevant local government agencies and community leaders. leaders and their commitments to support the efforts.
(v)How funds will be used in a manner consistent with principles of effectiveness, cost efficiency, relevance to community needs, maximal impact to improve community health, and sustainability of impact over time. time, and projections of return on investment to the state.
(C)Each local health jurisdiction with an approved application shall receive a base award of two hundred fifty thousand dollars ($250,000) for a three-year funding cycle. The balance of the funds shall be awarded to local health jurisdictions proportional to the number of residents living below the federal poverty level.
(D)Health improvement and evaluation plans shall emphasize sustainable policy, systems, and environmental change approaches to creating healthier communities.
(E)Local health jurisdictions may come together if they so desire to submit combined regional applications.
(F)No single recipient may receive more than 30 percent of the funding allocated to local health jurisdictions on a formula basis.
(G)Recipients of funds pursuant to this paragraph shall maintain the level of local funds, including in-kind resources, for community-based prevention activities that were provided in the most recently completed fiscal year prior to July 2016. Funds provided pursuant to this paragraph shall supplement and not supplant existing funding for community-based prevention activities of priority chronic health conditions.
(H)Local health jurisdiction investments shall prioritize communities in the third and fourth quartiles of the California Health Disadvantage Index or other criteria of health equity priority populations subsequently adopted by the department.
(I)The initial year of funding may be used for needs assessment, planning, and development.
(2)At least 30 33 percent of total funds shall be allocated for competitive grants as follows:
(A)(i)Competitive grants shall be awarded to local or regional level entities or statewide nonprofit organizations. Funds provided pursuant to this paragraph shall supplement and not supplant existing funding for community-based prevention activities of priority chronic health conditions.
(ii)Local or regional level entities include community-based organizations or local public agencies, Local, regional, and state level entities, including nonprofit and community-based organizations in partnership with other entities, including, but not limited to, other nonprofit and community-based organizations, other local public agencies, schools, religious organizations, businesses, labor unions, health care plans, hospitals, clinics, other health care providers, or other community-based entities.
(iii)Each participating health care plan or hospital shall identify monetary, in-kind, or both, contributions to projects.
(iv)Local or regional projects shall prioritize investments that serve communities in the third and fourth quartiles of the California Health Disadvantage Index or other criteria of health equity priority populations subsequently adopted by the department.
(v)At least 10 percent of the funds awarded as competitive grants total funds shall be used for statewide nonprofit organizations. organizations to support activities conducted regionally or at the state level.
(vi)At least 5 percent of total funds shall be used for a competitive grant program administered by the department to support healthy food incentives for low-income Californians, support community food projects, as defined under Section 106051, and aid community food producers or socially disadvantaged, beginning, military veteran, or limited resource specialty crop producers that improve the health and resilience of their communities by increasing access to any variety of fresh, canned, dried, or frozen whole or cut fruits and vegetables without added sugars, fats or oils, and salt. The department shall coordinate, as necessary, with the Department of Food and Agriculture to implement this clause.
(vi)
(vii)Organizations receiving competitive grants shall coordinate efforts with the department and any local health jurisdictions where they are carrying out activities.
(B)(i)Competitive grant applicants shall identify projects as either an evidence-based or an innovative project.
(ii)Applications for evidence-based projects shall provide evidence of cost-effectiveness or projections of return on investment to the state.
(ii)Applications for evidence-based projects shall demonstrate how funds will be used in a manner consistent with principles of effectiveness, cost efficiency, relevance to community needs, maximal impact to improve community health, and sustainability of impact over time.
(iii)At least 10 percent of the funding for competitive grants shall be set aside for innovative projects that test previously untested strategies in order to improve the evidence base of effective community-based prevention strategies for priority chronic health conditions. conditions and injuries.
(iv)Applications for innovative projects shall provide a rationale for the defined approach and any evidence that suggests the innovative project will be effective, as well as a plan and resource allocation for the evaluation.
(v)Competitive grants may be used by organizations for policy systems or environmental change efforts, direct program delivery, or for technical assistance to other grantees.
106054.(a)(1)An advisory committee, with the members serving terms not to exceed four years, shall provide expert input and offer guidance to the department on the development, implementation, and evaluation of the fund.
(2)The advisory committee shall include, at a minimum, experts on priority chronic health conditions, effective nonclinical prevention strategies, policy strategies for chronic disease prevention, and the unique needs of health equity priority populations.
(3)The advisory committee shall include representatives from the State Department of Health Care Services, the Health in All Policies Task Force, the California Health and Human Services Agency, the California Conference of Local Health Officers, and the California Public Employees Retirement System.
(b)The department shall develop a robust evaluation framework for all activities funded through the fund. This evaluation framework shall include all of the following:
(1)Regular monitoring of local health jurisdiction awards to ensure activities are conducted pursuant to approved plans and consistent with all requirements of this part.
(2)Measures to ensure funding provided pursuant to this part supplement and do not supplant existing funding or effort.
(3)Data collection and reporting requirements for grant awardees sufficient to assess impact and monitor compliance with this part.
(4)A plan to analyze the impact of this part on process measures relevant to community health promotion and, if practicable, on outcome measures.
(c)The department may define state priorities and require activities funded by the fund to align with those priorities in a manner that is consistent with the intent of this part. The department may narrow the list of priority chronic health conditions if necessary to ensure an effective program.
(d)The department shall require activities pursuant to this part to be conducted in a manner consistent with principles of effectiveness, cost efficiency, relevance to community needs, maximal impact to improve community health, and sustainability of impact over time.
(e)(1)Based on the results of programs supported by this part and any other proven methodologies available to the advisory committee, the advisory committee shall produce a comprehensive master plan for advancing chronic disease and injury prevention throughout the state.
(2)The master plan shall include recommended implementation strategies for each priority chronic health condition throughout the state and identify areas where innovative solutions are especially needed.
(3)The advisory committee shall submit the master plan, and revisions to the master plan, to the Legislature triennially.
(4)The master plan and its revisions shall include recommendations on specific goals for reduction of the burden of preventable chronic conditions and injuries by 2030, administrative arrangements, funding priorities, integration and coordination of approaches by the department, the University of California, the Health in All Policies Task Force, and their support systems, and progress reports relating to each health equity priority population.
(5)A report submitted pursuant to paragraph (3) shall be submitted in compliance with Section 9795 of the Government Code.
106054.(a)There is hereby created the Community-based Health Improvement and Innovation Fund Advisory Committee in state government that shall advise the department with respect to policy development, integration, and evaluation of community-based chronic disease and injury prevention activities funded under this part, and for development of a master plan of recommendations and proposed strategies for the future implementation of those activities.
(b)The advisory committee shall include, at a minimum, experts on priority chronic health conditions, effective nonclinical prevention strategies, policy strategies for chronic disease prevention, and the unique needs of health equity priority populations.
(c)The advisory committee shall be composed of 13 members to be appointed as follows:
(1)One member representing voluntary health organizations dedicated to the reduction of chronic disease, injuries, or health inequities appointed by the Speaker of the Assembly.
(2)One member representing an organization that represents health care employees appointed by the Senate Rules Committee.
(3)One member representing a statewide nonprofit health organization dedicated to the improvement of public health appointed by the Governor.
(4)One member representing a community-based organization with a demonstrated track record implementing community prevention programs appointed by the Governor.
(5)One representative of a university with expertise in programs intended to reduce chronic disease appointed by the Governor.
(6)Two representatives of a population group with priority health conditions appointed by the Governor.
(7)One representative of the Health and Human Services Agency appointed by the Governor.
(8)One representative of the Department of Food and Agriculture appointed by the Governor.
(9)One representative of the Health in All Policies Task Force appointed by the Strategic Growth Council.
(10)One member representing the interests of the general public appointed by the Governor.
(11)One representative of the California Conference of Local Health Officers.
(12)One representative from the California Health Benefit Exchange appointed by the executive board of the exchange.
(d)Members of the advisory committee shall serve for a term of two years, renewable at the option of the appointing authority. The initial appointments of members shall be for two or three years, to be drawn by random lot at the first meeting. The committee shall be staffed by the departments coordinator of the program as described in paragraph (3) of subdivision (a) of Section 106053.
(e)The committee shall meet as often as it deems necessary, but shall meet not less than four times per year.
(f)The members of the committee shall serve without compensation, but shall be reimbursed for necessary travel expenses incurred in the performance of the duties of the committee.
(g)The committee shall be advisory to the department, the Department of Food and Agriculture, and the Health and Human Services Agency, for all of the following purposes:
(1)Evaluation of research on community-based policies, practices, and programs funded under this part as necessary in order to assess the overall effectiveness of efforts made by the programs to reduce the occurrence of preventable chronic disease and injuries.
(2)Facilitation of programs directed at reducing and eliminating preventable chronic disease and injury that are operated jointly by more than one agency or entity. The committee shall propose strategies for the coordination of proposed programs administered by the department, the Department of Food and Agriculture, the Health and Human Services Agency in general, and the efforts of the other members, such as the Health in All Policies Task Force, in order to maximize the public benefit of the programs.
(3)Making recommendations to the department, the Department of Food and Agriculture, and the Health and Human Services Agency regarding the most appropriate criteria for the selection of, standards of operation of, and types of activities to be funded under this part.
(4)Reporting to the Legislature on or before January 1 of each year on the number and amount of chronic disease and injury prevention activities funded by the Community-based Health Improvement and Innovation Fund, the amount of money in the fund, any moneys previously appropriated to the department, but unspent by the department, a description and assessment of all programs funded under this part, and recommendations for any necessary policy changes or improvements.
(5)Ensuring that the most current research findings regarding chronic disease and injury prevention are applied in designing the Community-based Health Improvement and Innovation Fund activities administered by the department. The department shall apply the most current findings and recommendations of research, including assessments of innovations funded by the fund.
(h)(1)Based on the results of programs supported by this part and any other proven methodologies available to the advisory committee, the advisory committee shall produce a comprehensive set of recommendations and proposed strategies for advancing chronic disease and injury prevention throughout the state.
(2)The recommendations shall include implementation strategies for each priority chronic health condition throughout the state and identification of areas where innovative solutions are especially needed.
(3)The advisory committee shall submit the recommendations and proposed strategies to the Legislature triennially.
(4)The advisory committee recommendations shall include specific goals for reduction of the burden of preventable chronic conditions and injuries by 2030, administrative arrangements, funding priorities, integration and coordination of approaches by the department, the Department of Food and Agriculture, local health jurisdictions, non-profit and community-based organizations, the University of California, the Health in All Policies Task Force, and their support systems, and progress reports relating to each health equity priority population.
(i)A report submitted pursuant to section shall be submitted in compliance with Section 9795 of the Government Code.
106055.Implementation of this part shall be contingent on an appropriation provided for this purpose in the annual Budget Act or other measure.
The Legislature finds and declares all of the following:
(a)Over the past century, chronic diseases have emerged as a predominant challenge to public health. Chronic disease and injury account for eight of every 10 deaths and affects the quality of life of 14 million Californians.
(b)Obesity and diabetes in particular have grown rapidly, posing a grave threat to health. Today over one-half of California adults are estimated to have either diabetes or prediabetes. Thirteen million adults in California, 46 percent of the adult population, are estimated to have prediabetes or undiagnosed diabetes, while another 2.5 million adults, 9 percent of the adult population, have already been diagnosed with diabetes.
(c)The health inequities in this state are stark:
(1)Ethnic minorities and individuals who have low incomes have higher rates of diabetes. Nearly one-in-five African-Americans African Americans and Latinos in California have diabetes, more than double the rate of Whites.
(2)Nearly 12 years of life separate the life expectancy at the top and at the bottom of neighborhood clusters in California, from a life expectancy of 87 years in parts of northwest Santa Clara County to 75.3 years in the City of Twenty-Nine Twentynine Palms and the City of Barstow in the County of San Bernardino.
(3)Economically disadvantaged children are far less likely to complete the fitness requirements of the physical fitness test offered to students in grade school.
(4)Adolescents covered by Medi-Cal reported significantly higher rates of drinking sugar-sweetened beverages and less daily consumption of vegetables than the general California adolescent population and were significantly more likely to be obese.
(d)The following short list of risk factors is responsible for much of the burden of chronic disease: tobacco use, physical inactivity, unhealthful diet, excessive consumption of alcohol, hyperlipidemia, and uncontrolled high blood pressure. These risk factors and chronic conditions are largely preventable and inequitably distributed.
(e)The State Department of Public Health estimates that as much as 80 percent of heart disease, stroke, and type II diabetes and more than 30 percent of cancers can be prevented by eliminating the underlying risk factors.
(f)The economic burden of chronic disease in California weighs heavily on families, employers, and all levels of government. Approximately $98 billion, or 42 percent of all health care expenditures in the state, was spent on treating just six common chronic health conditions (arthritis, asthma, cardiovascular disease, diabetes, cancer, and depression) in 2010.
(g)The indirect costs associated with chronic disease in California are also high. According to the Economic Burden of Chronic Disease (EBCD) Index, the projected impact of lower productivity and lost workdays for individuals with chronic conditions and their caregiving family members in California was estimated to be $51 billion in 2010.
(h)The cost of health care continues to surpass the rate of inflation, causing increasing strain on the budgets of families, employers, and the government.
(i)Despite the fact that chronic disease results in decreased quality of life, premature death, and exorbitant medical costs, investments in measures that prevent chronic disease have been minimal.
(j)The United States spends only 2.6 percent of health care dollars on all public health, yet 75 percent of health care costs are attributable to preventable health conditions.
(k)Paying for prevention works and upstream strategies have a remarkable history of success, measured in both cost avoidance and health improvement. In the County of Los Angeles, smoking amongst high school students fell from 27 percent to 7 percent between 1997 and 2013, thanks to investment in policy and environmental changes as well as education.
(l)Childhood obesity amongst Los Angeles Unified School District 5th graders decreased by 10.6 percent (from 31.2 percent to 27.9 percent) between 2010 and 2013, and leveled off among 7th and 9th graders, after nine years of steady increases, reflecting investments to reduce the consumption of sugar sweetened sugarsweetened beverages, promote healthier eating, and increase physical activity.
(m)The California Health and Human Services Agency, in partnership with the State Department of Public Health, has defined ambitious health improvement goals for the state through the Lets Get Healthy California initiative, including making California the healthiest state in the nation by 2022, reducing health disparities, and achieving better health at lower cost. These goals cannot be met by improvements in health care or on an individual basis alone. Meeting these goals requires urgent and substantial investment in community-based prevention of chronic disease.
(n)The existing limited resources of funding for chronic disease prevention are threatened, declining from past levels, and subject to significant restrictions.
(o)Strategic investment in upstream prevention will protect, not deplete, the coffers of government. Investment in prevention has a strong evidence base of positive return on investment through reducing health care costs on a long-term basis.
106051.For purposes of this part, the following terms have the following definitions:
(a)Department means the State Department of Public Health.
(b)Fund means the Community-based Health Improvement and Innovation Fund.
(c)Health equity priority population means, for each condition, populations that exhibit significant disparities with respect to prevalence of a priority chronic health condition or injury or worse outcomes such as higher hospitalization or death rates. Priority populations may be defined based on race, ethnicity, geography, socioeconomic status status, including income or education, other factors as defined by the department, or current findings and recommendations of research, including assessments of innovations funded by the fund.
(d) Local health jurisdiction means a county health department or a combined health department in the case of counties acting jointly or a city health department within the meaning of Section 101185.
(e)Priority chronic health conditions means asthma, type II diabetes, cardiovascular and cerebrovascular disease, cancer, dental disease, obesity, and other chronic conditions and injuries that are prevalent, largely preventable, and associated with high health care costs, as defined by the department. High-burden conditions whose prevention is not adequately supported by other funding streams shall be prioritized.
106052.(a)(1)There is hereby created in the State Treasury the Community-based Health Improvement and Innovation Fund. The fund shall consist of any revenues deposited therein, including any fine or penalty revenue allocated to the fund, any revenue from appropriations specifically designated to be credited to the fund, any funds from public or private gifts, grants, or donations, any interest earned on that revenue, and any funds provided from any other source.
(2)A target level of annual statewide investment from the fund shall be established as a set dollar amount per capita, to be allocated for the purposes described in subdivision (b) and as described in subdivision (c). Section 106053.
(b)(1)Moneys in the fund shall be available, upon appropriation by the Legislature, for any of the following purposes:
(A)Reducing health inequity and disparities in the rates and outcomes of priority chronic health conditions.
(B)Preventing the onset of priority chronic health conditions using community-based strategies in communities statewide and with particular focus on health equity priority populations.
(C)Strengthening local and regional collaborations between local public health jurisdictions and health care providers, and across government agencies and community partners to create healthier communities, using a health in all policies healthinallpolicies approach.
(D)Contributing to a stronger evidence base of effective community-based prevention strategies for priority chronic health conditions.
(E)Evaluating effectiveness and cost-effectiveness of innovative community-based prevention strategies for priority chronic health conditions, as a basis for future decisions about investment in those strategies in order to reduce the costs of providing health care services and to improve population health status.
(2)Moneys in the fund shall be used to address social, environmental, and behavioral determinants of chronic disease and injury at any phase of the life cycle, including, but not limited to, all of the following:
(A)Promotion of healthy diets and food environments.
(B)Promotion of physical activity and of a safe, physical activity-promoting environment.
(C)Prevention of unintentional and intentional injury.
(3)In expending moneys from the fund, policy, systems, and environmental change approaches are to be emphasized, although funds can support implementation of community-based programs.
(4)Moneys in the fund shall not be used for clinical services.
(c)Revenues deposited in the fund that are unexpended at the end of a fiscal year shall remain in the fund and not revert to the General Fund.
106053.(a)The department shall be allocated an amount not greater than 20 percent of the annual appropriation from the fund for all of the following activities:
(1)Mandatory activities for which the funds shall be used are as follows:
(A)Statewide media and communications campaigns, which shall be allocated 9 percent of those total funds.
(B)Evaluation of program activities, which shall be allocated at least 5 percent of those total funds.
(C)Other activities, which shall be allocated no more than 6 percent of those total funds, as follows:
(i)Overall program implementation and oversight, including review and approval of local health improvement plans, and granting of and monitoring the implementation of local health jurisdiction awards and competitive grant awards.
(i)Mandatory activities, including all of the following:
(I)Overall program implementation and oversight.
(II)Review and approval of local health improvement plans.
(III)Granting of and monitoring the implementation of local health jurisdiction awards and competitive grant awards.
(ii)The definition of criteria for evidence-based and innovative approaches to improving health and health equity, with evaluation criteria appropriate to each type of approach. Criteria for evidence-based projects shall include cost-effectiveness or projections of return on investment to the state.
(iii)The definition of priority chronic health conditions and health equity priority populations based on public health data.
(iv)The definition of criteria for participation of community partners in local health jurisdiction funding.
(v)The development of tools that can be used by the state and by grantees to monitor progress towards improving health and health equity, including establishment of a health equity index.
(2)Discretionary activities, as may be appropriate to support community-based prevention of priority chronic health conditions throughout the state, for which the funds may be used, include, but are not limited to, any of the following:
(A)Research, development, and dissemination of best practices, including training and technical assistance for grantees.
(B)Development of infrastructure, including, but not limited to, data resources or information technology resources to be shared statewide.
(C)Coordination of local efforts.
(D)Development and promotion of statewide initiatives.
(b)The department shall award at least 80 percent of total moneys made available in the annual appropriation from the fund to eligible applicants to be used consistent with the purposes described in subdivision (b) of Section 106052. Moneys from the fund shall be distributed and awarded according to the following criteria:
(1)(A)At least 50 percent of those total funds shall be awarded to local health jurisdictions and shall be allocated on a formula basis to local health jurisdictions, or their nonprofit designee, with approved applications for three-year funding cycles.
(B)Each local health jurisdiction shall submit an application for a three-year funding cycle, to be reviewed and approved by the department, that includes all of the following information:
(i)A detailed assessment of community health needs within the local health jurisdiction with respect to priority chronic health conditions and health equity priority populations.
(ii)A health improvement and evaluation plan that includes initiatives focused on health equity priority populations.
(iii)The level of local funds, including in-kind resources, for community-based prevention activities that was provided in the most recently completed fiscal year.
(iv)Documentation of the existence and activities of a community health partnership, which includes leading health care providers, local health jurisdictions, community partners, including those serving health equity priority populations, businesses, and other relevant local government agencies and community leaders.
(v)How funds will be used in a manner consistent with principles of effectiveness, cost efficiency, relevance to community needs, maximal impact to improve community health, and sustainability of impact over time.
(C)Each local health jurisdiction with an approved application shall receive a base award of two hundred fifty thousand dollars ($250,000) for a three-year funding cycle. The balance of the funds shall be awarded to local health jurisdictions proportional to the number of residents living below the federal poverty level.
(D)Health improvement and evaluation plans shall emphasize sustainable policy, systems, and environmental change approaches to creating healthier communities.
(E)Local health jurisdictions may come together if they so desire to submit combined regional applications.
(F)No single recipient may receive more than 30 percent of the funding allocated to local health jurisdictions on a formula basis.
(G)Recipients of funds pursuant to this paragraph shall maintain the level of local funds, including in-kind resources, for community-based prevention activities that were provided in the most recent recently completed fiscal year prior to July 2016. Funds provided pursuant to this paragraph shall supplement and not supplant existing funding for community-based prevention activities of priority chronic health conditions.
(H)Local health jurisdiction investments shall prioritize communities in the third and fourth quartiles of the California Health Disadvantage Index or other criteria of health equity priority populations subsequently adopted by the department.
(I)The initial year of funding may be used for needs assessment, planning, and development.
(2)At least 30 percent of those total funds shall be allocated for competitive grants as follows:
(A)(i)Competitive grants shall be awarded to local or regional level entities or statewide nonprofit organizations. Funds provided pursuant to this paragraph shall supplement and not supplant existing funding for community-based prevention activities of priority chronic health conditions.
(ii)Local or regional level entities include community-based organizations or local public agencies, in partnership with other entities, including, but not limited to, other community-based organizations, other local public agencies, schools, religious organizations, businesses, labor unions, health care plans, hospitals, clinics, other health care providers, or other community-based entities.
(iii)Each participating health care plan or hospital shall identify monetary, in-kind, or both, contributions to projects.
(iv)Local or regional projects shall prioritize investments that serve communities in the third and fourth quartiles of the California Health Disadvantage Index or other criteria of health equity priority populations subsequently adopted by the department.
(v)At least 10 percent of the funds awarded as competitive grants shall be used for statewide nonprofit organizations.
(vi)Organizations receiving competitive grants shall coordinate efforts with any local health jurisdictions where they are carrying out activities.
(B)(i)Competitive grant applicants shall identify projects as either an evidence-based or an innovative project.
(ii)Applications for evidence-based projects shall provide evidence of cost-effectiveness or projections of return on investment to the state.
(ii)
(iii)At least 10 percent of the funding for competitive grants shall be set aside for innovative projects that test previously untested strategies in order to improve the evidence base of effective community-based prevention strategies for priority chronic health conditions.
(iii)
(iv)Applications for innovative projects shall provide a rationale for the defined approach and any evidence that suggests the innovative project will be effective, as well as a plan and resource allocation for the evaluation.
(iv)
(v)Competitive grants may be used by organizations for policy systems or environmental change efforts, direct program delivery, or for technical assistance to other grantees.
106054.(a)(1)An advisory committee, with the members serving terms not to exceed four years, shall provide expert input and offer guidance to the department on the development, implementation, and evaluation of the fund.
(2)The advisory committee shall include, at a minimum, experts on priority chronic health conditions, effective nonclinical prevention strategies, policy strategies for chronic disease prevention, and the unique needs of health equity priority populations.
(3)The advisory committee shall include representatives from the State Department of Health Care Services, the Health in All Policies Task Force, the California Health and Human Services Agency, the California Conference of Local Health Officers, and the California Public Employees Retirement System.
(b)The department shall develop a robust evaluation framework for all activities funded through the fund. This evaluation framework shall include all of the following:
(1)Regular monitoring of local health jurisdiction awards to ensure activities are conducted pursuant to approved plans and consistent with all requirements of this part.
(2)Measures to ensure funding provided pursuant to this part supplement and do not supplant existing funding or effort.
(3)Data collection and reporting requirements for grant awardees sufficient to assess impact and monitor compliance with this part.
(4)A plan to analyze the impact of this part on process measures relevant to community health promotion and, if practicable, on outcome measures.
(c)The department may define state priorities and require activities funded by the fund to align with those priorities in a manner that is consistent with the intent of this part. The department may narrow the list of priority chronic health conditions if necessary to ensure an effective program.
(d)The department shall require activities pursuant to this part to be conducted in a manner consistent with principles of effectiveness, cost efficiency, relevance to community needs, maximal impact to improve community health, and sustainability of impact over time.
(d)
(e)(1)Based on the results of programs supported by this part and any other proven methodologies available to the advisory committee, the advisory committee shall produce a comprehensive master plan for advancing chronic disease and injury prevention throughout the state.
(2)The master plan shall include recommended implementation strategies for each priority chronic health condition throughout the state and identify areas where innovative solutions are especially needed.
(3)The advisory committee shall submit the master plan, and revisions to the master plan, to the Legislature triennially.
(4)The master plan and its revisions shall include recommendations on specific goals for reduction of the burden of preventable chronic conditions and injuries by 2030, administrative arrangements, funding priorities, integration and coordination of approaches by the department, the University of California, the Health in All Policies Task Force, and their support systems, and progress reports relating to each health equity priority population.
(5)A report submitted pursuant to paragraph (3) shall be submitted in compliance with Section 9795 of the Government Code.
106055.Implementation of this part shall be contingent on an appropriation provided for this purpose in the annual Budget Act or other measure.
The Legislature finds and declares all of the following:
(a)Over the past century, chronic diseases have emerged as a predominant challenge to public health. Chronic disease and injury account for eight of every 10 deaths and affects the quality of life of 14 million Californians.
(b)Obesity and diabetes in particular have grown rapidly, posing a grave threat to health. Today over one-half of California adults are estimated to have either diabetes or prediabetes. Thirteen million adults in California, 46 percent of the adult population, are estimated to have prediabetes or undiagnosed diabetes, while another 2.5 million adults, 9 percent of the adult population, have already been diagnosed with diabetes.
(c)The health inequities in this state are stark:
(1)Ethnic minorities and individuals who have low incomes have higher rates of diabetes. Nearly one-in-five African-Americans and Latinos in California have diabetes, more than double the rate of Whites.
(2)Nearly 12 years of life separate the life expectancy at the top and at the bottom of neighborhood clusters in California, from a life expectancy of 87 years in parts of northwest Santa Clara County to 75.3 years in the City of Twenty-Nine Palms and the City of Barstow in the County of San Bernardino.
(3)Economically disadvantaged children are far less likely to complete the fitness requirements of the physical fitness test offered to students in grade school.
(4)Adolescents covered by Medi-Cal reported significantly higher rates of drinking sugar-sweetened beverages and less daily consumption of vegetables than the general California adolescent population and were significantly more likely to be obese.
(d)The following short list of risk factors is responsible for much of the burden of chronic disease: tobacco use, physical inactivity, unhealthful diet, excessive consumption of alcohol, hyperlipidemia, and uncontrolled high blood pressure. These risk factors and chronic conditions are largely preventable and inequitably distributed.
(e)The State Department of Public Health estimates that as much as 80 percent of heart disease, stroke, and type II diabetes and more than 30 percent of cancers can be prevented by eliminating the underlying risk factors.
(f)The economic burden of chronic disease in California weighs heavily on families, employers, and all levels of government. Approximately $98 billion, or 42 percent of all health care expenditures in the state, was spent on treating just six common chronic health conditions (arthritis, asthma, cardiovascular disease, diabetes, cancer, and depression) in 2010.
(g)The indirect costs associated with chronic disease in California are also high. According to the Economic Burden of Chronic Disease (EBCD) Index, the projected impact of lower productivity and lost workdays for individuals with chronic conditions and their caregiving family members in California was estimated to be $51 billion in 2010.
(h)The cost of health care continues to surpass the rate of inflation, causing increasing strain on the budgets of families, employers, and the government.
(i)Despite the fact that chronic disease results in decreased quality of life, premature death, and exorbitant medical costs, investments in measures that prevent chronic disease have been minimal.
(j)The United States spends only 2.6 percent of health care dollars on all public health, yet 75 percent of health care costs are attributable to preventable health conditions.
(k)Paying for prevention works and upstream strategies have a remarkable history of success, measured in both cost avoidance and health improvement. In the County of Los Angeles, smoking amongst high school students fell from 27 percent to 7 percent between 1997 and 2013, thanks to investment in policy and environmental changes as well as education.
(l)Childhood obesity amongst Los Angeles Unified School District 5th graders decreased by 10.6 percent (from 31.2 percent to 27.9 percent) between 2010 and 2013, and leveled off among 7th and 9th graders, after nine years of steady increases, reflecting investments to reduce the consumption of sugar sweetened beverages, promote healthier eating, and increase physical activity.
(m)The California Health and Human Services Agency, in partnership with the State Department of Public Health, has defined ambitious health improvement goals for the state through the Lets Get Healthy California initiative, including making California the healthiest state in the nation by 2022, reducing health disparities, and achieving better health at lower cost. These goals cannot be met by improvements in health care or on an individual basis alone. Meeting these goals requires urgent and substantial investment in community-based prevention of chronic disease.
(n)The existing limited resources of funding for chronic disease prevention are threatened, declining from past levels, and subject to significant restrictions.
(o)Strategic investment in upstream prevention will protect, not deplete, the coffers of government. Investment in prevention has a strong evidence base of positive return on investment through reducing health care costs on a long-term basis.
106051.For purposes of this part, the following terms have the following definitions:
(a)Department means the State Department of Public Health.
(b)Fund means the Community-based Health Improvement and Innovation Fund.
(c)Health equity priority population means, for each condition, populations that exhibit significant disparities with respect to prevalence of a priority chronic health condition or injury or worse outcomes such as higher hospitalization or death rates. Priority populations may be defined based on race, ethnicity, geography, socioeconomic status including income or education, other factors as defined by the department, or current findings and recommendations of research, including assessments of innovations funded by the fund.
(d) Local health jurisdiction means county health department or combined health department in the case of counties acting jointly or city health department within the meaning of Section 101185.
(e)Priority chronic health conditions means asthma, type II diabetes, cardiovascular and cerebrovascular disease, cancer, dental disease, obesity, and other chronic conditions and injuries that are prevalent, largely preventable, and associated with high health care costs, as defined by the department. High-burden conditions whose prevention is not adequately supported by other funding streams shall be prioritized.
106052.(a)(1)There is hereby created in the State Treasury the Community-based Health Improvement and Innovation Fund. The fund shall consist of any revenues deposited therein, including any fine or penalty revenue allocated to the fund, any revenue from appropriations specifically designated to be credited to the fund, any funds from public or private gifts, grants, or donations, any interest earned on that revenue, and any funds provided from any other source.
(2)A target level of annual statewide investment from the fund shall be established as a set dollar amount per capita, to be allocated for the purposes described in subdivision (b) and as described in subdivision (c).
(b)(1)Moneys in the fund shall be available, upon appropriation by the Legislature, for any of the following purposes:
(A)Reducing health inequity and disparities in the rates and outcomes of priority chronic health conditions.
(B)Preventing the onset of priority chronic health conditions using community-based strategies in communities statewide and with particular focus on health equity priority populations.
(C)Strengthening local and regional collaborations between local public health jurisdictions and health care providers, and across government agencies and community partners to create healthier communities, using a health in all policies approach.
(D)Contributing to a stronger evidence base of effective community-based prevention strategies for priority chronic health conditions.
(E)Evaluating effectiveness and cost-effectiveness of innovative community-based prevention strategies for priority chronic health conditions, as a basis for future decisions about investment in those strategies in order to reduce the costs of providing health care services and to improve population health status.
(2)Moneys in the fund shall be used to address social, environmental, and behavioral determinants of chronic disease and injury at any phase of the life cycle, including, but not limited to, all of the following:
(A)Promotion of healthy diets and food environments.
(B)Promotion of physical activity and of a safe, physical activity-promoting environment.
(C)Prevention of unintentional and intentional injury.
(3)In expending moneys from the fund, policy, systems, and environmental change approaches are to be emphasized, although funds can support implementation of community-based programs.
(4)Moneys in the fund shall not be used for clinical services.
(c)Revenues deposited in the fund that are unexpended at the end of a fiscal year shall remain in the fund and not revert to the General Fund.
106053.(a)The department shall be allocated an amount not greater than 20 percent of the annual appropriation from the fund for all of the following activities:
(1)Mandatory activities for which the funds shall be used are as follows:
(A)Statewide media and communications campaigns, which shall be allocated 9 percent of those funds.
(B)Evaluation of program activities, which shall be allocated at least 5 percent of those funds.
(C)Other activities, which shall be allocated no more than 6 percent of those funds, as follows:
(i)Mandatory activities, including all of the following:
(I)Overall program implementation and oversight.
(II)Review and approval of local health improvement plans.
(III)Granting of and monitoring the implementation of local health jurisdiction awards and competitive grant awards.
(ii)The definition of criteria for evidence-based and innovative approaches to improving health and health equity, with evaluation criteria appropriate to each type of approach.
(iii)The definition of priority chronic health conditions and health equity priority populations based on public health data.
(iv)The definition of criteria for participation of community partners in local health jurisdiction funding.
(v)The development of tools that can be used by the state and by grantees to monitor progress towards improving health and health equity, including establishment of a health equity index.
(2)Discretionary activities, as may be appropriate to support community-based prevention of priority chronic health conditions throughout the state, for which the funds may be used, include, but are not limited to, any of the following:
(A)Research, development, and dissemination of best practices, including training and technical assistance for grantees.
(B)Development of infrastructure, including, but not limited to, data resources or information technology resources to be shared statewide.
(C)Coordination of local efforts.
(D)Development and promotion of statewide initiatives.
(b)The department shall award at least 80 percent of total moneys made available in the annual appropriation from the fund to eligible applicants to be used consistent with the purposes described in subdivision (b) of Section 106052. Moneys from the fund shall be distributed and awarded according to the following criteria:
(1)(A)At least 50 percent of those funds shall be awarded to local health jurisdictions and shall be allocated on a formula basis to local health jurisdictions, or their nonprofit designee, with approved applications for three-year funding cycles.
(B)Each local health jurisdiction shall submit an application for a three-year funding cycle, to be reviewed and approved by the department, that includes all of the following information:
(i)A detailed assessment of community health needs within the local health jurisdiction with respect to priority chronic health conditions and health equity priority populations.
(ii)A health improvement and evaluation plan that includes initiatives focused on health equity priority populations.
(iii)The level of local funds, including in-kind resources, for community-based prevention activities that was provided in the most recently completed fiscal year.
(iv)Documentation of the existence and activities of a community health partnership, which includes leading health care providers, local health jurisdictions, community partners, including those serving health equity priority populations, businesses, and other relevant local government agencies and community leaders.
(C)Each local health jurisdiction with an approved application shall receive a base award of two hundred fifty thousand dollars ($250,000) for a three-year funding cycle. The balance of the funds shall be awarded to local health jurisdictions proportional to the number of residents living below the federal poverty level.
(D)Health improvement and evaluation plans shall emphasize sustainable policy, systems, and environmental change approaches to creating healthier communities.
(E)Local health jurisdictions may come together if they so desire to submit combined regional applications.
(F)No single recipient may receive more than 30 percent of the funding allocated to local health jurisdictions on a formula basis.
(G)Recipients of funds pursuant to this paragraph shall maintain the level of local funds, including in-kind resources, for community-based prevention activities that were provided in the most recent completed fiscal year prior to July 2016. Funds provided pursuant to this paragraph shall supplement and not supplant existing funding for community-based prevention activities of priority chronic health conditions.
(H)Local health jurisdiction investments shall prioritize communities in the third and fourth quartiles of the California Health Disadvantage Index or other criteria of health equity priority populations subsequently adopted by the department.
(I)The initial year of funding may be used for needs assessment, planning, and development.
(2)At least 30 percent of those funds shall be allocated for competitive grants as follows:
(A)(i)Competitive grants shall be awarded to local or regional level entities or statewide nonprofit organizations.
(ii)Local or regional level entities include community-based organizations or local public agencies, in partnership with other entities, including, but not limited to, other community-based organizations, other local public agencies, schools, religious organizations, businesses, labor unions, health care plans, hospitals, clinics, other health care providers, or other community-based entities.
(iii)Each participating health care plan or hospital shall identify monetary, in-kind, or both, contributions to projects.
(iv)Local or regional projects shall prioritize investments that serve communities in the third and fourth quartiles of the California Health Disadvantage Index or other criteria of health equity priority populations subsequently adopted by the department.
(v)At least 10 percent of the funds awarded as competitive grants shall be used for statewide nonprofit organizations.
(vi)Organizations receiving competitive grants shall coordinate efforts with any local health jurisdictions where they are carrying out activities.
(B)(i)Competitive grant applicants shall identify projects as either an evidence-based or an innovative project.
(ii)At least 10 percent of the funding for competitive grants shall be set aside for innovative projects that test previously untested strategies in order to improve the evidence base of effective community-based prevention strategies for priority chronic health conditions.
(iii)Applications for innovative projects shall provide a rationale for the defined approach and any evidence that suggests the innovative project will be effective, as well as a plan and resource allocation for the evaluation.
(iv)Competitive grants may be used by organizations for policy systems or environmental change efforts, direct program delivery, or for technical assistance to other grantees.
106054.(a)(1)An advisory committee, with the members serving terms not to exceed four years, shall provide expert input and offer guidance to the department on the development, implementation, and evaluation of the fund.
(2)The advisory committee shall include, at a minimum, experts on priority chronic health conditions, effective nonclinical prevention strategies, policy strategies for chronic disease prevention, and the unique needs of health equity priority populations.
(3)The advisory committee shall include representatives from the State Department of Health Care Services, the Health in All Policies Task Force, the California Health and Human Services Agency, the California Conference of Local Health Officers, and the California Public Employees Retirement System.
(b)The department shall develop a robust evaluation framework for all activities funded through the fund.
(c)The department may define state priorities and require activities funded by the fund to align with those priorities in a manner that is consistent with the intent of this part. The department may narrow the list of priority chronic health conditions if necessary to ensure an effective program.
(d)(1)Based on the results of programs supported by this part and any other proven methodologies available to the advisory committee, the advisory committee shall produce a comprehensive master plan for advancing chronic disease and injury prevention throughout the state.
(2)The master plan shall include recommended implementation strategies for each priority chronic health condition throughout the state and identify areas where innovative solutions are especially needed.
(3)The advisory committee shall submit the master plan, and revisions to the master plan, to the Legislature triennially.
(4)The master plan and its revisions shall include recommendations on specific goals for reduction of the burden of preventable chronic conditions and injuries by 2030, administrative arrangements, funding priorities, integration and coordination of approaches by the department, the University of California, the Health in All Policies Task Force, and their support systems, and progress reports relating to each health equity priority population.
(5)A report submitted pursuant to paragraph (3) shall be submitted in compliance with Section 9795 of the Government Code.
SECTION 1.Part 8 (commencing with Section 106100) is added to Division 103 of the Health and Safety Code, to read:8.Health Improvement and Innovation Fund106100.(a)There is hereby created in the State Treasury the Health Improvement and Innovation Fund.
(b)Moneys in the fund shall be available, upon appropriation by the Legislature, for the following purposes:
(1)Reduce the rates of preventable health conditions.
(2)Address health disparities.
(3)Reduce state health care costs.
(4)Build evidence of effective prevention programs.
(c)(1)The State Department of Public Health shall award moneys from the fund to eligible applicants.
(2)Eligible applicants shall include, but not be limited to, community-based organizations and local governments.
(a)There is hereby created in the State Treasury the Health Improvement and Innovation Fund.
(b)Moneys in the fund shall be available, upon appropriation by the Legislature, for the following purposes:
(1)Reduce the rates of preventable health conditions.
(2)Address health disparities.
(3)Reduce state health care costs.
(4)Build evidence of effective prevention programs.
(c)(1)The State Department of Public Health shall award moneys from the fund to eligible applicants.
(2)Eligible applicants shall include, but not be limited to, community-based organizations and local governments.
|
Date
|
Status
|
|---|---|
| Jun 2, 2016 | Read third time. Passed. Ordered to the Senate. |
| Aug 11, 2016 | In committee: Held under submission. |
| Aug 8, 2016 | Referred to APPR. suspense file. |
| Aug 2, 2016 | Read second time and amended. Re-referred to Com. on APPR. |
| Aug 1, 2016 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 7. Noes 0.) (June 29). |
| Jun 20, 2016 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH. |
| Jun 16, 2016 | In committee: Set, first hearing. Hearing canceled at the request of author. |
| Jun 9, 2016 | Referred to Com. on HEALTH. |
| Jun 6, 2016 | In Senate. Read first time. To Com. on RLS. for assignment. |
| Jun 2, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 57. Noes 22.) |
| Jun 2, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 57. Noes 22. Page 5191.) |
| Feb 19, 2016 | Introduced. To print. |
| Jun 1, 2016 | Read second time. Ordered to third reading. |
| May 31, 2016 | Read second time and amended. Ordered returned to second reading. |
| May 27, 2016 | From committee: Amend, and do pass as amended. (Ayes 14. Noes 6.) (May 27). |
| May 11, 2016 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| Apr 20, 2016 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 14. Noes 2.) (April 19). Re-referred to Com. on APPR. |
| Apr 7, 2016 | Re-referred to Com. on HEALTH. |
| Apr 6, 2016 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Mar 8, 2016 | Referred to Com. on HEALTH. |
| Feb 22, 2016 | Read first time. |
| Feb 21, 2016 | From printer. May be heard in committee March 22. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 8, 2016 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jun 29, 2016 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| Jun 2, 2016 | AB 2424 GOMEZ Assembly Third Reading | Assembly Floor |
Passed |
|
| May 27, 2016 | Do pass as amended. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 19, 2016 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| American Cancer Society California Division Inc. | * Support | Jun 29, 2016 |
| American Cancer Society Cancer Action Network Inc. | * Support | Jun 29, 2016 |
| American Heart Association | ** Support | Jun 29, 2016 |
| American Stroke Association | ** Support | Jun 29, 2016 |
| Boehringer - Ingelheim Pharmaceuticals, Inc. | * Support | Jun 29, 2016 |
| Boehringer Ingelheim Pharmaceuticals Inc. | * Support | Jun 29, 2016 |
| California Department of Public Health | * Support | Jun 29, 2016 |
| California Dialysis Council | * Support | Jun 29, 2016 |
| California Immigrant Policy Center | ** Support | Jun 29, 2016 |
| California Naturopathic Doctors Association | * Support | Jun 29, 2016 |
| California Pan-Ethnic Health Network | * Support | Jun 29, 2016 |
| Community Clinic Association of Los Angeles County | ** Support | Jun 29, 2016 |
| County Health Executives Association | * Support | Jun 29, 2016 |
| Department of Public Health | ** Against | Jun 29, 2016 |
| Health Access California | ** Support | Jun 29, 2016 |
| Health Officers Association Of California | * Support | Jun 29, 2016 |
| Kaiser Permanante | * Support | Jun 29, 2016 |
| Public Health Institute | * Support | Jun 29, 2016 |
| Sonoma County Board of Supervisors | * Support | Jun 29, 2016 |
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 2424 (Gomez) - Community-based Health Improvement and Innovation Fund
Version: August 2, 2016 | Policy Vote: HEALTH 7 - 0 |
Urgency: No | Mandate: No |
Hearing Date: August 8, 2016 | Consultant: Brendan McCarthy |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
AB 2424 would create the Community-based Health Improvement Fund, to support programs to improve public health.
Fiscal Impact:
- Unknown costs to support the programs authorized in the bill, likely in the tens of millions per year (General Fund). The intention of the bill is to provide funding for a wide array of programs designed to improve public health and reduce health disparities. The total amount of funding that would be available for the Fund would depend on future appropriations. To have a significant impact on statewide public health, funding for the program would likely be in the tens of millions per year. The bill would require local health jurisdictions to be awarded $250,000 each, which would make up about one-half of the available funding. This indicates an overall program size of at least $30 million per year.
- One-time startup costs in the millions to develop program guidelines, develop an information technology system to allow for grant making and oversight, and undertake other administrative tasks by the Department of Public Health (General Fund). Given the broad range of potential projects that could be funded under the bill and the requirements for monitoring and evaluation of projects, the Department will incur substantial upfront costs to set up the processes and systems for implementing the bill, regardless of the future funding amounts.
- Likely ongoing administrative costs in the millions to conduct public education campaigns, solicit grant proposals, review applications, oversee grant funding, and perform program evaluations (General Fund). The amount of ongoing administrative costs incurred by the Department would depend on the overall amount of funding made available for the program.
- Unknown potential long-run cost savings to state health care programs (various funds). There is published research that indicates a strong cost-benefit ratio for some community-based public health programs. To the extent that funding authorized in the future to implement the bill is used to fund evidence-based public health programs, there are likely to be improvements in overall public health The Medi-Cal program provides health care coverage to over 12 million Californians. Therefore, any overall reduction in health care costs due to successful public health interventions would likely result in some unknown level of cost savings to the state and federal government.
Background:
The public health system in the state is a partnership between the Department of Public Health and local health jurisdictions (mostly county health departments and a few city health departments). Historically, the state has provided substantial funding for public health activities. However, during the 2008-09 and 2009-10 budget years, most state General Fund funding for public health activities was eliminated. Currently, public health programs in the state are supported largely by local funds and federal funds.
Proposed Law:
AB 2424 would create the Community-based Health Improvement Fund, to support programs to improve public health.
Specific provisions of the bill would:
- Create the Community-based Health Improvement and Innovation Fund;
- Require a target level of annual statewide investment to be set, on a per capita basis (presumably by the Department of Public Health or the advisory committee created in the bill);
- Specify the allowable uses of monies in the fund, including reducing health inequality and disparities, preventing the onset of chronic conditions, evaluating the effectiveness of prevention strategies, and other uses;
- Require the Fund to be used to address the social, environmental, and behavioral determinants of chronic disease;
- Require the Department of Public Health to allocate up to 20% of available funding for statewide media campaigns, evaluation of program activities, program implementation and oversight;
- Of the remaining 80% of funding, require at least 47% to be allocated to local health jurisdictions (including a base award of $250,000) and 33% to be allocated through competitive grants;
- Establish an advisory committee, with specified membership;
- Make implementation of the bill contingent on an appropriation of funding.
Staff Comments:
The recently enacted 2016 Budget Act includes about $40 million in new General Fund spending on a variety of public health programs. None of that funding would be available to fund the program established in this bill.
-- END --
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2424
AUTHOR: | Gomez | ||
VERSION: | June 20, 2016 | ||
HEARING DATE: | June 29, 2016 | ||
CONSULTANT: | Reyes Diaz | ||
SUBJECT: Community-based Health Improvement and Innovation Fund
SUMMARY:
Creates the Community-based Health Improvement and Innovation Fund for allocation to the Department of Public Health to reduce health inequity and disparities in the rates and outcomes of priority chronic health conditions, as defined, and to evaluate the effectiveness of community-based prevention strategies, as specified.
Existing law:
- Establishes the Department of Public Health (DPH) to protect and improve the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. Establishes the California Diabetes Program (CDP) within DPH.
- Provides DPH with the authority to perform activities that protect, preserve, and advance public health, including studies and dissemination of information.
This bill:
- Creates in the State Treasury the Community-based Health Improvement and Innovation Fund (CHII Fund) consisting of any revenues deposited, including, but not limited to, fine or penalty revenue, any revenue from appropriation credited to the CHII Fund, and any funds from public or private gifts, grants, or donations.
- Required moneys from the CHII Fund to be available, as specified, for purposes that include, but are not limited to:
- Reducing health inequity and disparities in the rates and outcomes of “priority chronic health conditions,” as defined, and injuries. Defines “priority chronic health conditions” as asthma, type II diabetes, cardiovascular and cerebrovascular disease, cancer, dental disease, obesity, and other chronic conditions and injuries, as specified;
- Preventing the onset of priority chronic health conditions using community-based strategies, as specified;
- Strengthening local, regional, and state-level collaborations between public health jurisdictions and health care providers, and across government agencies and community partners, as specified;
- Supporting collaboration between public health entities and non-health organizations and agencies in fields to include housing, transportation, land use planning, and food access; and,
- Evaluating the effectiveness and cost-effectiveness of innovative community-based prevention strategies for priority chronic health conditions, as specified.
- Requires CHII Fund moneys to be used to address social, environmental, and behavioral determinants of chronic disease and injury, as specified, including, but not limited to promotion of health diets, improved access to healthy foods, and health food environments; promotion of physical activity and of a safe, physical activity-promoting environment; prevention of unintentional and intentional injury; and building partnerships to address social determinants of chronic disease. Requires policy, systems, and environmental change approaches to be emphasized when expending CHII Fund moneys, and allows moneys to support implementation of community-based programs. Prohibits CHII Fund moneys from being used for clinical services and from reverting to the State General Fund.
- Requires DPH to be allocated an amount not greater than 20% of the annual appropriation from the CHII Fund for activities that include, but are not limited to:
- Mandatory activities that include: statewide media and communications campaigns; evaluation of all program activities supported through the CHII Fund, including regular monitoring, data collection and reporting requirements, and ensuring moneys supplement and do not supplant existing funds or efforts; and other activities, including overall program implementation and oversight, the definition of criteria for evidence-based and innovative approaches to improving health and health equity, the definition of priority chronic health conditions and health equity priority populations, and development of tools that can be used by the state and grantees to monitor progress, as specified; and,
- Discretionary activities to support community-based prevention that include: research, development, and dissemination of best practices; development of infrastructure, as specified; coordination of local efforts and statewide initiatives; and grants or contracts to nonprofit organizations at the state level, as specified.
- Requires DPH to award at least 80% of moneys from the CHII Fund to eligible applicants to be used consistent with requirements in 2) above, and distributed and awarded according to criteria that includes, but is not limited to:
- At least 47% of funds awarded to local health jurisdictions, as specified, that submit an application for a three-year funding cycle that includes, but is not limited to: a detailed assessment of community health needs, as specified; a health improvement and evaluation plan; the level of local funds; documentation of the existence and activities of a community health partnership, as specified; and how funds will be used in a manner consistent with provisions in this bill; and,
- At least 33% of funds allocated for competitive grants, including, but not limited to: grants awarded to local or regional-level entities or statewide nonprofit organizations; the identification by participating health care plans or hospitals of monetary, in-kind, or both, contributions to projects; investments by local or regional projects that serve communities, as specified; funds used for statewide nonprofit organizations to support activities; funds used for competitive grant programs administered by DPH to support health food incentives for low-income Californians and community food projects, as specified; and coordinated efforts of grant awardees with DPH and any local health jurisdiction, as specified.
- Creates the CHII Fund Advisory Committee (Committee) that is required to advise DPH on policy development, integration, and evaluation of community-based chronic disease and injury prevention activities, as specified. Requires the Committee to include, at a minimum, experts on priority chronic health conditions, effective nonclinical prevention strategies, and policy strategies for prevention. Requires the Committee to be composed of 13 members appointed for a term of two years, renewable at the option of the appointing authority as follows:
- One member representing voluntary health organizations, as specified, appointed by the Speaker of the Assembly;
- One member representing health care employees appointed by the Senate Rules Committee;
- One member representing a statewide nonprofit health organization, as specified, appointed by the Governor;
- One member representing a community-based organization, as specified, appointed by the Governor;
- One representative of a university, as specified, appointed by the Governor;
- Two representatives of a population group with priority health conditions appointed by the Governor;
- One representative of the Health and Human Services Agency appointed by the Governor;
- One representative of the Department of Food and Agriculture appointed by the Governor;
- One representative of the Health in All Policies Task Force appointed by the Strategic Growth Council;
- One member representing the interests of the general public appointed by the Governor;
- One representative of the California Conference of Local Health Officers; and,
- One representative from the California Health Benefit Exchange appointed by the executive board of the exchange.
- Requires the Committee to meet as deemed necessary but not less than four times per year. Requires the Committee members to serve without compensation, except as specified, and to be advisory to DPH, the Department of Food and Agriculture (DFA), and the Health and Human Services Agency (HHSA) for purposes that include, but are not limited to:
- Evaluation of research on community-based policies, practices, and programs, as specified;
- Facilitation of programs directed at reducing and eliminating preventable chronic disease and injury, as specified;
- Making recommendations to DPH, DFA, and HHSA, as specified;
- Reporting to the Legislature on or before January 1 of each year on the number and amount of activities funded by the CHII Fund, as specified; and,
- Ensuring that the most current research findings are applied in designing CHII Fund activities, as specified.
- Requires the Committee, based on results of programs funded by the CHII Fund and other proven methodologies, to produce a comprehensive set of recommendations and proposed strategies for advancing chronic disease and injury prevention throughout the state that include specific goals for reduction of the burden of preventable chronic conditions and injuries by 2030. Requires the recommendations to include implementation strategies for each priority chronic health condition throughout the state and identification of areas where innovative solutions are especially needed. Requires the Committee to submit the recommendations and proposed strategies to the Legislature triennially.
FISCAL EFFECT: According to the Assembly Appropriations Committee:
- DPH would incur one-time costs for staffing, information technology, and contracts, likely in the low millions of dollars. Ongoing costs would depend on the total allocation and the number of grants and contracts to be managed.
- This bill does not specify a funding source or amount, but it is safe to assume a program of the scale envisioned would cost in the tens of millions of dollars General Fund (GF) per three-year cycle, in absence of another fund source. Based on the minimum $250,000 allocated to each local health jurisdiction, which would make up 50% of the funding, as well as the ambitious nature and comprehensiveness of the program, staff estimates cost pressure of $30.5 million GF at a minimum. Assuming a program of this size, $2.8 million would be allocated to communications and media, $1.5 million to evaluation, up to $1.8 million for DPH administration and oversight, $15.3 to local health jurisdictions to implement community-based health improvement activities, and $9.1 million for competitive grants.
- A related stakeholder proposal request for a $380 million GF appropriation for a CHII Fund was discussed in the Assembly Budget Subcommittee 1 on April 11, 2016. This represents nearly a $10 per capita investment, which would support one cycle of a three-year grant program.
- Research indicates funding evidence-based, community-based chronic disease prevention activities can have a high return on investment in terms of health care cost savings. A return on investment (ROI) analysis is beyond the scope of this estimate, but as this bill focuses on the most costly and preventable conditions, including obesity, heart disease, and diabetes, and assuming the activities were evidence-based and well-implemented, it is reasonable they could lead to improvements in population health and a corresponding reduction in health care cost growth statewide, and for the state as a large payer. In addition, the bill's focus on health equity priority populations is likely to have a significant overlap with the Medi-Cal population, increasing the chances of a positive ROI for the state. Finally, the bill's emphasis on funding systems and policy changes means health-promoting changes adopted pursuant to this program may have a lasting impact. For example, the tobacco control program led to changes in public acceptance of tobacco use, which in turn resulted in policies that are unlikely to be reversed, such as tobacco-free workplaces.
PRIOR VOTES:
Assembly Floor: | 57 - 22 |
Assembly Appropriations Committee: | 14 - 6 |
Assembly Health Committee: | 14 - 2 |
COMMENTS:
- Author’s statement. According to the author, this bill would create the CHII Fund to ensure that all Californians are able to achieve optimal, equitable health regardless of their socioeconomic status, race, ethnicity, or place of residence. Specifically, money allocated from the CHII Fund would support sustainable funding toward public health and prevention programs and efforts within disadvantaged communities. The sources of funding for public health and prevention programs are perpetually threatened. These funds are currently declining from past levels of prior funding, and are often subject to significant federal restrictions. Strategic investment in upstream and primary prevention would protect, not deplete, our crucial health programs. Investment in prevention has a strong evidence base of positive returns on investment by reducing health care costs on a long-term basis. Soaring health care costs for government, business, and labor takes money out of wages and hurts competitiveness. Eighty percent of our health spending is on chronic disease, most of which is preventable. Other innovations may improve care, but innovation increases costs. Preventing obesity and chronic disease is the only way to save money in the long-term.
- Diabetes in California. DPH issued a study, The Burden of Chronic Disease and Injury, in 2013 that highlights some of the leading causes of death, such as heart disease, cancer, stroke, and respiratory disease, all of which have a strong connection to obesity. Diabetes is another serious chronic disease stemming from obesity that adversely affects quality of life and results in serious medical costs. The last decade has witnessed a 32% rise in diabetes prevalence, affecting some 3.9 million people and costing upwards of $24 billion per year. According to the Centers for Disease Control and Prevention (CDC), more than one-third of U.S. adults are obese, and approximately 12.5 million children and adolescents ages two to 19 years are obese. Research indicates a tripling in the youth obesity rate over the past three decades. While this increase has stabilized between the years 2005 and 2010, in 2010, 38% of public school children were overweight and obese. Overweight youth face increased risks for many serious detrimental health conditions that do not commonly occur during childhood, including high cholesterol and type-2 diabetes. Additionally, more than 80% of obese adolescents remain obese as adults.
- CDP. The CDP was established in 1981 and represents a partnership between DPH and the University of California, San Francisco. It primarily receives its funding from the CDC. A few key objectives that the CDP focuses on include:
- Monitoring statewide diabetes health status and risk factors;
- Engaging in outreach to increase awareness about the disease;
- Guiding public policy to support at-risk and vulnerable populations;
- Offering leadership, guidance, and resources to community health interventions;
- Seeking to improve the health care delivery system; and,
- Reducing diabetes-related health disparities.
The CDP achieves these through partnering with different individual, community, health care, policy, and environmental entities.
- The California Wellness Plan (Plan). In February 2014, DPH’s Chronic Disease Prevention Branch published the Plan, the result of a statewide process led by DPH to develop a roadmap for DPH and partners to promote health and eliminate preventable chronic disease in California. The Plan aligns with the Let's Get Healthy California Taskforce priorities and includes 26 priorities and performance measures developed in 2012 that are based upon evidence-based strategies to prevent chronic disease and promote equity. The Plan contains short, intermediate, and long-term objectives with measurable effects on a variety of chronic diseases, of which diabetes is a major focus. The Plan also contains 15 objectives specific to diabetes, including objectives to increase utilization of diabetes prevention and self-management programs, as well as broad objectives to reduce the prevalence of obesity and diabetes among children and adults. DPH's chronic disease programs plan to collaborate with local and state partners, including the Office of Health Equity (OHE), that are engaged in diabetes prevention to implement the objectives. DPH intends to monitor the progress of Plan objectives and publish regular reports on outcomes.
According to DPH, the Chronic Disease Control Branch Chief ensures that, at a minimum, the Plan is reviewed in conjunction with partners every five years to assess the need for a new version. This review process will be consistent with the CDC and Evaluation Program guidelines. Triggers for reviewing the Plan sooner than the five year cycle include, but are not limited to: a) major changes to DPH authority; or b) major changes in federal and/or state funding, guidance, or requirements. Any future versions of the Plan developed in conjunction with partners will also be available to the public on DPH’s Web site. DPH further states that a one-day statewide conference is planned for 2017 for partners and programs to report on progress or short term outcomes of goals of the Plan. A summary of conference reports will be posted online after the conference.
- Health equity. According to the CDC, health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and, access to treatment. Established in 2012, DPH's OHE aims to reduce health and mental health disparities in vulnerable communities. OHE’s work is directed through their advisory committee and stakeholder meeting process. The OHE is required to consult with community-based organizations and local governmental agencies to ensure that community perspectives and input are included in policies, strategic plans, recommendations, and implementation activities. According to the U.S. Department of Health and Human Services' report, “Healthy People 2020: An Opportunity to Address the Societal Determinants of Health in the United States,” Americans do not all have equal opportunities to make healthy choices. A person's health and chances of becoming sick and dying early are greatly influenced by powerful social factors including education, income, nutrition, housing, and neighborhoods. The “Healthy People 2020” report indicates that if we, as a state, develop strategies and programs to help more Californians become physically active and adopt good nutrition practices, and create social and physical environments that promote good health for all, California could substantially improve health and reduce health care costs.
- Related legislation. AB 2696 (Beth Gaines), would require DPH to submit a report to the Legislature, as specified with certain criteria, regarding the prevention and management of diabetes and its complications. Requires DPH to post annually specified information on its Internet Web site. AB 2696 is pending in the Senate Appropriations Committee.
- Prior legislation. AB 572 (Beth Gaines of 2015), would have required DPH to update the California Wellness Plan 2014 to include specified items, including priorities and performance measures that are based upon evidence-based strategies to prevent and control diabetes, and to submit a report to the Legislature by January 1, 2018, to include the progress of those specified plan items. AB 572 was held under submission in the Senate Appropriations Committee.
AB 270 (Nazarian of 2015), would have required DPH to apply to the State Department of Motor Vehicles to sponsor a diabetes awareness, education, and research specialized license plate program. Would have established the Diabetes Awareness Fund, with revenues to be used by DPH to fund programs related to diabetes awareness and prevention. AB 270 was held under submission in the Senate Appropriations Committee.
SB 1316 (Cannella of 2014), would have required the Department of Health Care Services, DPH, and the Board of Administration of the Public Employees' Retirement System to submit a report to the Legislature regarding their respective diabetes-related programs. SB 1316 was never referred out of Senate Rules Committee.
AB 1592 (Beth Gaines of 2014), would have required DPH to complete and submit to the Legislature a Diabetes Burden Report by December 31, 2015, including, among other things, actionable items for consideration by the Legislature that would aid in attaining the goals set forth by DPH in the California Wellness Plan for 2014. Would have required DPH to include in the report guidelines that would reduce the fiscal burden of diabetes to the state. AB 1592 was vetoed by the Governor, stating that DPH had already submitted its Diabetes Burden Report to the CDC, as required, and is unable to withdraw the report to include additional information prescribed by the bill.
- Support. Supporters of this bill argue that chronic disease accounts for eight out of every 10 deaths in the state and affects the quality of life for approximately 14 million Californians, and disproportionately affects communities of color. Supporters state that, in 2010, 42% of all health care expenditures in the state was spent on treating common chronic health conditions: arthritis, asthma, cardiovascular disease, diabetes, cancer, and depression, most of which can be prevented. Supporters argue that this bill will empower entities to enact primary prevention programs to help improve policies and behaviors, which can be bigger determinants of health.
- Opposition. DPH states that, while it is committed to achieving health equity and supports efforts to reduce and prevent the chronic disease burden among all Californians, this bill requires the administration of a program without identifying a funding source or providing funding for the program. DPH states that without funding it would not be able to award any grants.
- Amendments. The author requests the following amendments in bold, italics, and underline:
On page 11, line 27:
(v) How funds will be used in a manner consistent with principles of effectiveness, cost efficiency, relevance to community needs, maximal impact to improve community health, and and sustainability of impact over time. time, and projections of return on investment to the state. over time.
SUPPORT AND OPPOSITION:
Support: American Cancer Society Cancer Action Network
American Heart Association/American Stroke Association
Boehringer Ingelheim Pharmaceuticals, Inc.
California Immigrant Policy Center
California Naturopathic Doctors Association
California Pan-Ethnic Health Network
Community Clinic Association of Los Angeles County
Health Access California
Health Officers Association of California
Public Health Institute
SEIU California
Sonoma County Board of Supervisors
Oppose: Department of Public Health
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ASSEMBLY THIRD READING
ATR Bill Id:
Author:(Gomez)
As Amended Ver:May 31, 2016
Majority vote
Committee | Votes | Ayes | Noes |
Health | 14-2 | Wood, Maienschein, Bonilla, Burke, Campos, Chiu, Dababneh, Gomez, Roger Hernández, Lackey, Nazarian, Rodriguez, Santiago, Waldron | Olsen, Patterson |
Appropriations | 14-6 | Gonzalez, Bloom, Bonilla, Bonta, Calderon, Daly, Eggman, Eduardo Garcia, Roger Hernández, Holden, Quirk, Santiago, Weber, Wood | Bigelow, Chang, Gallagher, Jones, Obernolte, Wagner |
SUMMARY: Creates a Community-based Health Improvement and Innovation (CHII) Fund for certain purposes, including funding for health inequity and disparities in the rates and outcomes of priority chronic health conditions. Specifies funds are available to reduce health inequity; prevent the onset of priority chronic health conditions, as defined; strengthen local and regional collaborations; and evaluate effectiveness and cost-effectiveness of community-based prevention strategies for priority chronic health conditions. Specifies funds can be used for activities as described. Specifies policy, systems, and environmental change approaches. Specifies a target level of annual statewide investment from the fund that must be established as a set dollar amount per capita, and allocates funds to the California Department of Public Health (DPH). Specifies funds shall supplement and not supplant existing funding for community-based prevention activities of priority chronic health conditions, and that participating hospitals and health plan partners must identify monetary or in-kind contributions to local projects. Creates an advisory committee to offer expert input and guidance to DPH on the development, implementation, and evaluation of the fund. Requires implementation contingent on a budget appropriation.
FISCAL EFFECT: According to the Assembly Appropriations Committee:
- DPH would incur one-time costs for staffing, information technology, and contracts, likely in the low millions of dollars. Ongoing costs would depend on the total allocation and the number of grants and contracts to be managed.
- This bill does not specify a funding source or amount, but it is safe to assume a program of the scale envisioned would cost in the tens of millions of dollars General Fund (GF) per three-year cycle, in absence of another fund source. Based on the minimum $250,000 allocated to each local health jurisdiction, which would make up 50% of the funding, as well as the ambitious nature and comprehensiveness of the program, staff estimates cost pressure of $30.5 million GF at a minimum. Assuming a program of this size, $2.8 million would be allocated to communications and media, $1.5 million to evaluation, up to $1.8 million for DPH administration and oversight, $15.3 to local health jurisdictions to implement community-based health improvement activities, and $9.1 million for competitive grants.
- A related stakeholder proposal request for a $380 million GF appropriation for a CHII Fund was discussed in the Assembly Budget Subcommittee 1 on April 11, 2016. This represents nearly a $10 per capita investment, which would support one cycle of a three-year grant program.
- Research indicates funding evidence-based, community-based chronic disease prevention activities can have a high return on investment in terms of health care cost savings. A return on investment (ROI) analysis is beyond the scope of this estimate, but as this bill focuses on the most costly and preventable conditions, including obesity, heart disease, and diabetes, and assuming the activities were evidence-based and well-implemented, it is reasonable they could lead to improvements in population health and a corresponding a reduction in health care cost growth statewide, and for the state as a large payer. In addition, the bill's focus on health equity priority populations is likely to have a significant overlap with the Medi-Cal population, increasing the chances of a positive ROI for the state. Finally, the bill's emphasis on funding systems and policy changes means health-promoting changes adopted pursuant to this program may have a lasting impact. For example, the tobacco control program led to changes in public acceptance of tobacco use, which in turn resulted in policies that are unlikely to be reversed, such as tobacco-free workplaces.
COMMENTS: The author states that with this bill and with proper management, innovative investment strategies, and equitable distribution and implementation plans, the CHII Fund would help the state achieve greater health equity and advance the "Triple Aim" of health improvement: 1) better care; 2) better health; and, 3) lower costs. According to the author, a $10 per capita investment over three years (for prevention of disease which accounts for 80% of health care costs) is actually fairly modest for a statewide program with these goals. For comparison, Massachusetts has invested a $60 million one-time in a similar fund, which is similar in scale based on their population. The state spends over $450 per capita from the General Fund just on Medi-Cal every year – and much more when accounting for California Public Employees' Retirement System employees and retirees, as well as correctional health. According to the author, DPH received a grant from the Centers for Disease Control and Prevention (CDC) for $3.8 million to promote healthy behaviors and reduce diabetes.
As part of the Patient Protection and Affordable Care Act of 2010, the Prevention and Public Health Investment Fund (Prevention Fund) was created to provide communities around the country with more than $15 billion over the next 10 years to invest in effective, proven prevention efforts, like childhood obesity and tobacco cessation. The Prevention Fund, in recent years, has suffered legislative reduction and elimination of major programs.
In 2012, the Assembly and Senate Committees on Health conducted a joint hearing with the goal of highlighting the health benefits and cost savings associated with investing in community-wide health promotion and disease prevention. The hearing also highlighted prevention activities currently underway at the time across the state to implement successful strategies aimed at reducing health care costs and promoting health and wellness.
In 2014, the Assembly Committee on Health held an Information Hearing, entitled Supporting Public Health in California: The Critical Role of the State and Local Departments in Disease Surveillance and Control. The background included some information of the following:
- Department of Public Health. The mission of DPH is to optimize the health and well-being of Californians, primarily through population-based programs, strategies, and initiatives. DPH is broadly organized into the Center for Chronic Disease Prevention and Health Promotion, the Center for Environmental Health, the Center for Family Health, the Center for Health Care Quality, and the Center for Infectious Diseases. California created the Health in All Policies Task Force in 2010. The Task Force was charged with identifying priority programs, policies, and strategies to improve the health of Californians.
- Local Health Departments. There are 61 local health jurisdictions in California representing the 58 counties and three cities: Berkeley, Long Beach, and Pasadena. Public health officers have broad far-reaching authority and responsibility under the law. For example, public health officers have the authority to order testing for individuals or communities, quarantine individuals or groups, and close beaches, restaurants, and other facilities for public safety. Public health officers receive reports from health providers and laboratories concerning the incidence of more than 80 statutorily reportable diseases including HIV/AIDs, tuberculosis, and syphilis. County health departments must submit monthly, quarterly, or annual public health and program reports to state agencies including DPH and the Emergency Medical Services Authority. County public health programs vary substantially in their administrative structures, scope, funding levels, staffing, and specific services and programs offered.
- Public Health Spending in California. The Governor's fiscal year (FY) 2014-15 Budget provides $3 billion for the support of DPH programs and services, a decrease of 11.4% from the previous year. Of the amount approved, 23% ($683.3 million) is for state operations and 77% ($2.3 billion) is for local assistance.
- Health Equity. According to the CDC, health equity is achieved when every person has the opportunity to "attain his or her full health potential" and no one is "disadvantaged from achieving this potential because of social position or other socially determined circumstances." Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and, access to treatment. Established in 2012, DPH's Office of Health Equity (OHE) aims to reduce health and mental health disparities in vulnerable communities. The OHE is required to consult with community-based organizations and local governmental agencies to ensure that community perspectives and input are included in policies, strategic plans, recommendations, and implementation activities
- Targeted federally funded programs. The largest prevention program DPH administers is the Nutrition Education and Obesity Prevention program, which provides health education interventions to recipients of Supplemental Nutrition Assistance Program benefits. In federal FY 2014, the CDC provided about $303 million to entities in California, including health departments, universities, and other public and private agencies. Of this total, about $62 million of this funding statewide was allocated to different entities for chronic disease and prevention activities.
Analysis Prepared by: Kristene Mapile/ HEALTH / (916) 319-2097 FN: 0003240
Date of Hearing: May 11, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
ABPCA Bill Id:AB 2424
Author:(Gomez) – As Amended Ver:April 6, 2016
Policy Committee: | Health | Vote: | 14 - 2 |
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill creates a Community-based Health Improvement and Innovation (CHII) Fund, a program and funding structure to allocate funds to community-based chronic disease prevention, with a focus on health equity priority populations. Specifically, this bill:
- Specifies funds are available to reduce health inequity; prevent the onset of priority chronic health conditions, as defined; strengthen local and regional collaborations; and evaluate effectiveness and cost-effectiveness of community-based prevention strategies for priority chronic health conditions.
- Specifies funds can be used for activities including promotion of healthy diets and food environments, promotion of physical activity and of a safe, physical activity-promoting environment, and prevention of unintentional and intentional injury.
- Specifies policy, systems, and environmental change approaches shall be emphasized, and that funds cannot be used to fund clinical services.
- Specifies a target level of annual statewide investment from the fund must be established as a set dollar amount per capita, and allocates funds to the California Department of Public Health as follows:
- Statewide media and communications campaigns,
- Evaluation of program activities, least 5%
- Other program implementation activities, including review and approval of local health improvement plans, the definition of priority chronic health conditions and health equity priority populations based on public health data, development of tools that to monitor progress towards improving health and health equity, and related activities, up to 6%.
- A grant program for local health jurisdictions, with a $250,000 base award per three-year funding cycle, with the balance of the funding awarded proportional to the number of residents living below the federal poverty level, at least 50%.
- A competitive grant program for community-based organizations or local public entities, for evidence-based or innovative approaches, at least 30%.
- Specifies funds shall supplement and not supplant existing funding for community-based prevention activities of priority chronic health conditions, and that participating hospitals and health plan partners must identify monetary or in-kind contributions to local projects.
- Creates an advisory committee, as specified, and requires the committee to produce a comprehensive master plan for advancing chronic disease and injury prevention throughout the state, to be submitted and revised triennially.
FISCAL EFFECT:
- CDPH would incur one-time costs for staffing, information technology, and contracts, likely in the low millions of dollars. Ongoing costs would depend on the total allocation and the number of grants and contracts to be managed.
- This bill does not specify a funding source or amount, but it is safe to assume a program of the scale envisioned would cost in the tens of millions of dollars GF per three-year cycle, in absence of another fund source. Based on the minimum $250,000 allocated to each local health jurisdiction, which would make up 50% of the funding, as well as the ambitious nature and comprehensiveness of the program, staff estimates cost pressure of $30.5 million GF at a minimum. Assuming a program of this size, $2.8 million would be allocated to communications and media, $1.5 million to evaluation, up to $1.8 million for CDPH administration and oversight, $15.3 to local health jurisdictions to implement community-based health improvement activities, and $9.1 million for competitive grants.
- A related stakeholder proposal request for a $380 million GF appropriation for a Community Health Improvement and Innovation Fund was discussed in the Assembly Budget Subcommittee #1 on April 11, 2016. This represents nearly a $10 per capita investment, which would support one cycle of a three-year grant program.
- Research indicates funding evidence-based, community-based chronic disease prevention activities can have a high return on investment in terms of health care cost savings. An ROI analysis is beyond the scope of this estimate, but as this bill focuses on the most costly and preventable conditions, including obesity, heart disease, and diabetes, and assuming the activities were evidence-based and well-implemented, it is reasonable they could lead to improvements in population health and a corresponding a reduction in health care cost growth statewide, and for the state as a large payer. In addition, the bill's focus on health equity priority populations is likely to have a significant overlap with the Medi-Cal population, increasing the chances of a positive ROI for the state. Finally, the bill's emphasis on funding systems and policy changes means health-promoting changes adopted pursuant to this program may have a lasting impact. For example, the tobacco control program led to changes in public acceptance of tobacco use, which in turn resulted in policies that are unlikely to be reversed, such as tobacco-free workplaces.
COMMENTS:
- Purpose. The author states that through implementation of the Affordable Care Act and other state actions, the state has improved access to health care coverage. However, despite the staggering monetary and human cost, the state has made very little effort to address the root causes of our high levels of obesity and chronic disease, and our dramatic health inequities. The author states the evidence demands we act to recalibrate our efforts towards improving health, and that California's worsening health status indicates the current level of funding for prevention activities are inadequate to affect meaningful change in obesity and chronic disease on a population basis. This bill sets up a structure for investment to prevent chronic disease with a particular emphasis on communities that suffer worse health status, which will improve health, productivity, well-being and health equity of Californians. Furthermore, this bill focuses on primary prevention—prevention of disease before it occurs—which is shown to be effective and cost-effective, and for which there is otherwise very little funding. This bill is author-sponsored and supported by the Health Officers Association of California, the California Pan-Ethnic Health Network, Health Access, and other groups.
- Background. The burden of chronic disease in California is high and growing. Chronic conditions account for 80% of health care expenditures and 80% of hospital admissions. Approximately 60% of health expenditures are on behalf of individuals with multiple chronic conditions. Many chronic diseases and conditions have common, preventable risk behaviors including poor diet, tobacco use, and lack of physical activity. The World Health Organization (WHO) estimates eliminating these chronic disease risk factors could eliminate 80 percent of all heart disease, stroke, and type 2 diabetes worldwide—and 40% of cancers.
Over the past 30 years, obesity rates have tripled. Only 40% of the state's adults have a healthy weight, while the other 60% are overweight or obese. One in four California adults do not engage in any physical activity. More than one in ten California adults has diabetes, and over 50% of California adults have either diabetes or pre-diabetes. Nationwide, one in three U.S. children born in 2000 are likely to develop diabetes over their lifetimes. There are also significant disparities in health status by race and ethnicity, education, income, geography, and sexual orientation.
- Current health spending. Overall health spending in California was $230 billion in 2009. In 2016-17, California is projected to spend nearly $85 billion on health care services in Medi-Cal ($19 billion General Fund), and around $5 billion on behalf of state employees in CalPERS. At this time, the state allocates nearly no state dollars to either state-based or community-based approaches to preventing chronic disease. Most GF dollars for public health and prevention were cut during the Great Recession. In 2008-09, $60 million was cut and in 2009-10 it was $154 million, which eliminated the majority of state prevention funding, including funding for HIV/AIDS prevention, community–based preventative health, sex education, support of local health departments, and other programs. The federal Centers for Disease Control and Prevention provides about $62 million across a number of different entities in the state for all chronic disease related activities, including local health jurisdictions.
- Community-based prevention. Community-based prevention uses a variety of strategies to improve health on a population basis within a community. These strategies often include partnerships with other entities, such as non-profits, local governments, school districts, and hospitals and other community institutions. The CDPH California Wellness Plan, which aims to prevent and control chronic disease, describes a number of strategies. For example, to improve physical activity, one strategy is to increase the number of municipal general plans that contain a health element, with language specific to environments that promote daily physical activity. Another is to increase the percentage of schools that have a joint use agreement for shared use of physical activity facilities, so the school grounds can be leveraged for community sports and recreation after hours. Many strategies have the potential to be lasting changes that impact more and more of the population over time, as people cycle in and are touched by institutions and their policies.
- Key findings on cost-effectiveness. A recent policy brief by the Robert Wood Johnson Foundation summarizes key findings based on a review of studies published between 2008 and 2013. This brief indicates strategic investments in proven, community-based prevention programs save lives and money. Findings include:
- Local public health spending saves lives in a cost-effective way. Increased spending by local health departments had large and significant effects on mortality from leading preventable causes of death over a thirteen-year period ending in 2005. This relationship was consistent across several different mortality measures, and it persisted after accounting for differences in demographic and socioeconomic characteristics, medical resources, and other community characteristics. The study also found achieving similar health improvements through delivering more health care—for example, by providing more primary care visits— would cost around 15 times more than investing in public health.
- Low-income communities benefit more. A follow-up to the study above found the positive effects of increased public health spending were 21-44% greater in low-income communities as compared to average communities.
- Primary prevention can lower costs. A 2011 Urban Institute study concluded it is in the nation's best interest, from a health and economic standpoint, to maintain funding for evidence-based public health programs. Specifically, it showed investments in primary prevention programs will not only help slow the chronic disease rate, but have also been shown to lower private insurance costs and improve economic productivity while reducing worker absenteeism. It notes savings achieved through prevention programs can significantly and quickly outweigh initial, upfront investments.
- Community prevention is the only health investment that is projected to lower costs. A 2011 study published in Health Affairs showed that a combination of three strategies—expanding health insurance, delivering better preventive and chronic care, and implementing community prevention—is more effective at improving health than any one strategy. Community prevention was the only strategy that slowed the growth in prevalence of disease and injury, and the only strategy that did not increase health costs. Finally, adding community prevention to an insurance expansion is projected to significantly improve health and lower costs over a 10- to 25-year time horizon.
- Substantial return on investment is possible. A 2008 report by Trust for America's Health and the Robert Wood Johnson Foundation showed an investment of $10 per person annually in proven, community-based public health programs could result in a return on investment averaging $5.60 for every $1 invested over 5 years.
- Staff Comments. Three cities, Berkeley, Pasadena, and Long Beach, operate as their own health jurisdictions. An adjustment to the funding minimum could be made for cities that have their own LHJs in order to maintain equity in a statewide allocation.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: April 19, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 2424
Author:(Gomez) – As Amended Ver:April 6, 2016
SUBJECT: Community-based Health Improvement and Innovation Fund.
SUMMARY: Creates a Community-based Health Improvement and Innovation (CHII) Fund for certain purposes, including funding for health inequity and disparities in the rates and outcomes of priority chronic health conditions. Specifically, this bill:
- Creates in the State Treasury the CHII Fund that consists of any revenues deposited therein, including any fine or penalty revenue allocated to the fund, any revenue from appropriations specifically designated to be credited to the CHII Fund, any funds from public or private gifts, grants, or donations, any interest earned on that revenue, and any funds provided by any other source. States that a target level of annual statewide investment from the fund is to be established as a set dollar amount per capita.
- Requires CHII Fund to be available, upon appropriation by the Legislature, for any of the following purposes:
- Reducing health inequity and disparities in the rates and outcomes of priority chronic health conditions;
- Preventing the onset of priority chronic health conditions using community-based strategies in communities statewide and with particular focus on health equity priority populations;
- Strengthening local and regional collaborations between local public health jurisdictions and health care providers, and across government agencies and community partners to create healthier communities, as specified;
- Contributing to a stronger evidence base of effective community-based prevention strategies for priority chronic health conditions; and,
- Evaluating effectiveness and cost-effectiveness of innovative community-based prevention strategies for priority chronic health conditions, as specified.
- Requires the CHII Fund to be used to address social, environmental, and behavioral determinants of chronic disease and injury at any phase of life cycle, including, but not limited to all of the following:
- Promotion of healthy diets and food environments;
- Promotion of physical activity and of a safe, physical activity-promoting environment; and,
- Prevention of unintentional and intentional injury.
- Emphasizes policy, systems, and environmental changes approaches, although the CHII Fund can support implementation of community-based programs and prohibits the CHII Fund to be used for clinical services.
- Requires deposited revenues that are not expended at the end of a fiscal year to remain in the CHII Fund and not revert to the General Fund.
- Requires the Department of Public Health (DPH) to allocate an amount not greater than 20% of the annual appropriation from the CHII Fund for any of the following activities:
- Mandatory activities:
- Statewide media and communication campaigns: 9% of funds;
- Evaluation of program activities: At least 5% of funds;
- Other activities: No more than 6% of those funds, including;
- Mandatory activities like the overall program implementation and oversight; review and approval of local health improvement plans; and granting of and monitoring the implementation of local health jurisdictions and competitive grant awards; and,
- Discretionary activities as may be appropriate to support community-based prevention of priority chronic health conditions, as specified, including but not limited to any of the following:
- Research, development, dissemination of best practices, as specified;
- Development of infrastructure, as specified;
- Coordination of local efforts; and,
- Development and promotion of statewide initiatives.
- Requires DPH to award at least 80 percent of the CHII Fund made available in the annual appropriation to eligible applicants to be used consistent with the purposes identified in the CHII Fund and provides for distribution and award according to the following criteria:
- At least 50% of those funds awarded to local health jurisdictions and allocated on a formula basis to local health jurisdictions, or their nonprofit designee, with approved applications for three-year funding cycles; and,
- Each local health jurisdiction will submit an application for a three-year funding cycle, reviewed and approved by DPH, which includes all of the following:
- Detailed, assessment of community health needs, as specified;
- Health improvement and evaluation plan, as specified;
- Level of local funds, including in-kind resources, for community-based prevention activities, as specified; and,
- Documentation of the existence and activities of a community health partnership, as specified.
- Each local health jurisdiction with an approved application shall receive a base award of $250,000 for a three-year funding cycle. The balance of funds will be awarded to local health jurisdictions proportional to the number of residents living below the federal poverty level;
- Health improvement and evaluation plans will emphasize sustainable policy, systems, and environmental change approaches to creating healthier communities;
- Local health jurisdictions may submit combined regional applications;
- No single recipient will receive more than 30 percent of the funding allocated to local health jurisdictions on a formula basis;
- Recipients will maintain the level of local funds, including in-kind resources, for community-based prevention activities that were provided in the most recent completed fiscal year prior to July 2016. CHII Funds will supplement and not supplant existing funding for community-based prevention activities, as specified; and,
- Local health jurisdiction investments will prioritize communities in the third and fourth quartiles of the California Health Disadvantage Index (CHDI) or other criteria of health equity priority populations as subsequently adopted by DPH.
- Requires DPH to allocate at least 30% for competitive grants as follows:
- To be awarded to local or regional level entities or statewide nonprofit organizations;
- Local or regional level entities include community-based organizations or local public agencies, in partnership with other entities, as specified;
- Each participating health care plan or hospital will identify monetary, in-kind, or both, contributions to projects;
- Local or regional projects will prioritize investments that serve communities in the third or fourth quartiles of the CHDI or other criteria, as specified;
- At least 10% of the funds awarded will be used for statewide nonprofit organizations; and,
- Organizations receiving competitive grants will coordinate efforts with any local health jurisdictions where they are carrying out activities.
- Provides that competitive grants will identify projects as either evidence-based or an innovative project. Requires at least 10% of the funding to be set aside for innovative projects, as specified, and applications for innovative projects to include a rationale for the defined approach and any evidence that suggests effectiveness, as well as a plan and resource allocation for the evaluation. Provides that competitive grants may be used by organization for policy systems or environmental change efforts, direct program delivery, or for technical assistance to other grantees.
- Mandatory activities:
- Creates an advisory committee, with members serving no more than four years, to provide expert input and offer guidance to DPH on the development, implementation, and evaluation of the CHII Fund and will include, at a minimum, experts on priority chronic health conditions, effective nonclinical prevention strategies for chronic disease prevention, and the unique needs of health equity priority populations. Requires representatives from the State Department of Health Care Services, the Health in All Policies Task Force, the California Health and Human Services Agency, the California Conference of Local Health Officers, and the California Public Employees’ Retirement System.
- Requires DPH to develop a robust evaluation framework for all activities and states that DPH may define state priorities as specified, and may narrow the list of priority chronic health conditions if necessary to ensure an effective program.
- Requires the advisory committee to produce a comprehensive master plan for advancing chronic disease and injury prevention through the state, based on the results of programs and any other proven methodologies available to the advisory committee. Provides that the master plan include recommendations of implementation strategies, as specified; specific goals for reduction of the burden of preventable chronic conditions and injuries by 2030; administrative arrangements; funding priorities; integration and coordination of approaches by DPH, the University of California, the Health in All Policies Task Force, and their support systems; and, progress reports relating to each health equity priority population. Requires the advisory committee to submit the master plan to the Legislature triennially.
- Defines various terms including health equity priority population and priority chronic health conditions.
- Finds and declares the importance of treating chronic diseases and identifies the health inequities in this State.
EXISTING LAW establishes DPH, within the California Health and Human Services Agency, vested with certain duties, powers, functions, jurisdiction, and responsibilities over specified public health programs.
FISCAL EFFECT: This bill has yet to be analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. The author states that with this bill and with proper management, innovative investment strategies, and equitable distribution and implementation plans, the CHII Fund would help the State achieve greater health equity and advance the “Triple Aim” of health improvement: a) better care; b) better health; and, c) lower costs. According to the author, a $10 per capita investment over 3 years (for prevention of disease which accounts for 80% of health care costs) is actually fairly modest for a statewide program with these goals. For comparison, Massachusetts has invested a $60 million one-time in a similar fund, which is similar in scale based on their population. The state spends over $450 per capita from the General Fund just on Medi-Cal every year-- and much more when accounting for California Public Employees' Retirement System employees and retirees, as well as correctional health.
According to the author, DPH received a grant from the Centers for Disease Control (CDC) and Prevention for $3.8 million to promote healthy behaviors and reduce diabetes. DPH’s Nutrition Education and Obesity Prevention Branch (NEOPB), which addresses California’s obesity epidemic by focusing on healthy behavior changes in at-risk, low-income communities, has major restrictions on the use of funds, and will face a 30% reduction in federal funds by 2018. Funding from Proposition 99 for tobacco control and First 5 California has also declined due to successful tobacco control efforts.
- BACKGROUND. As part of the Patient Protection and Affordable Care Act (ACA) of 2010, the Prevention and Public Health Investment Fund (Prevention Fund) was created to provide communities around the country with more than $15 billion over the next 10 years to invest in effective, proven prevention efforts, like childhood obesity and tobacco cessation. The Prevention Fund, in recent years, has suffered legislative reduction and elimination of major programs.
In 2012, the Assembly and Senate Committees on Health conducted a joint hearing with the goal of highlighting the health benefits and cost savings associated with investing in community-wide health promotion and disease prevention. The hearing was also meant to highlight new developments with federal funding for health prevention that California received as a result of the ACA, as well as new findings about voter options on prevention. The hearing also highlighted prevention activities currently underway at the time across the state to implement successful strategies aimed at reducing health care costs and promoting health and wellness.
In 2014, the Assembly Committee on Health held an Information Hearing, entitled Supporting Public Health in California: The Critical Rose of the State and Local Departments in Disease Surveillance and Control. The background included information of the following:- Department of Public Health. The mission of DPH is to optimize the health and well-being of Californians, primarily through population-based programs, strategies, and initiatives. DPH is broadly organized into Center for Chronic Disease Prevention and Health Promotion (CCDP&HP), Center for Environmental Health, Center for Family Health, Center for Health Care Quality, and Center for Infectious Diseases (CID). CCDP&HP is DPH's lead on climate change and on Health in All Policies. The State of California created the Health in All Policies Task Force in 2010. The Task Force was charged with identifying priority programs, policies, and strategies to improve the health of Californians while advancing the goals of improving air and water quality, protecting natural resources and agricultural lands, increasing the availability of affordable housing, improving infrastructure systems, promoting public health, planning sustainable communities, and meeting climate change goals. CID protects Californians from the threat of preventable infectious disease and assists individuals suffering from infectious disease by securing prompt and appropriate access to health care, medications, and associated support services. CID activities are a particular focus of this hearing, specifically, the responsibility to help investigate and diagnose infectious diseases of public health significance, such as the flu.
- Local Health Departments. There are 61 local health jurisdictions in California representing the 58 counties and three cities: Berkeley, Long Beach, and Pasadena. Public health officers have broad far-reaching authority and responsibility under the law. For example, public health officers have the authority to order testing for individuals or communities, quarantine individuals or groups, and close beaches, restaurants, and other facilities for public safety. Public health officers receive reports from health providers and laboratories concerning the incidence of more than 80 statutorily reportable diseases including HIV/AIDs, tuberculosis, and syphilis. County health departments must submit monthly, quarterly, or annual public health and program reports to state agencies including DPH and the Emergency Medical Services Authority. County public health programs vary substantially in their administrative structures, scope, funding levels, staffing, and specific services and programs offered. Counties generally provide maternal and child health care, child health and disability prevention, tuberculosis control, and AIDS services. Most counties provide services related to sexually transmitted diseases, smoking/tobacco cessation, childhood lead poisoning, and immunizations. Many counties have also developed their own innovative programs. For example, the City of Berkeley Public Health Department has modeled a Healthy Restaurant Program on the Bay Area Green Business Project, which works with businesses to implement sustainable practices and is working with restaurants to help them to increase healthy menu options. The Community Health Department in Fresno County developed the Women's Health Education and Outreach Program, which instituted Valley Women Care Clubs that hosted monthly workshops for a total of eight months in a chosen community. The workshops focused on reducing chronic disease risk through nutrition education, food tastings and food preparation demonstrations, physical activity sessions, and discussion on health perceptions and practices. Unfortunately due to a lack of funding this program was later cut.
- Public Health Spending in California. At the State level, the Governor's fiscal year (FY) 2014-15 Budget provides $3 billion for the support of DPH programs and services, a decrease of 11.4% from the previous year. Of the amount approved, 23% ($683.3 million) is for state operations and 77% ($2.3 billion) is for local assistance. There are two broad types of funding for public health in California: categorical (consisting largely of federal funding) and flexible (consisting of funding from public health realignment and local sources). Each local health department is unique in its mixture of these funds. A consistent challenge is that flexible funds must be prioritized to support mandated functions such as communicable disease control, which receives little to no categorical funding. Consequently, flexible funding available for other public health functions - such as chronic disease prevention - is very limited. When there are reductions to flexible funding, there is a disproportionate impact on mandated public health services. Recent reductions to realignment may further reduce funding for public health programs as they compete with other county services, including clinical services for indigent care, for fewer resources. Public-private partnerships have been developed to cover gaps in some jurisdictions, but these funds are only temporary and are usually initiative-specific.
- Health Equity. According to the CDC, health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and, access to treatment. Established in 2012, DPH's Office of Health Equity (OHE) aims to reduce health and mental health disparities in vulnerable communities. OHE’s work is directed through their advisory committee and stakeholder meeting process. The OHE is required to consult with community-based organizations and local governmental agencies to ensure that community perspectives and input are included in policies, strategic plans, recommendations, and implementation activities. According to the U.S. Department of Health and Human Services' report, “Healthy People 2020: An Opportunity to Address the Societal Determinants of Health in the United States,” Americans do not all have equal opportunities to make healthy choices. A person's health and chances of becoming sick and dying early are greatly influenced by powerful social factors including education, income, nutrition, housing, and neighborhoods. The “Healthy People 2020” report indicates that if we, as a state, develop strategies and programs to help more Californians become physically active and adopt good nutrition practices, and create social and physical environments that promote good health for all, California could substantially improve health and reduce health care costs.
- Concept Paper. Additionally, a concept paper presented this bill’s proposal to develop a Health Improvement and Innovation Fund, a funding and allocation structure to implement such an effort by providing resources for community-based obesity and chronic disease prevention. In addition to providing background for the proposal, the paper identified principles for an investment in improving the health and well-being of Californians by preventing and mitigating the impact of chronic disease, including but not limited to, size and scope of the funding commitment; focus on primary, community-based prevention; a mix of evidence-based and innovative approaches; and, allocation to improve health in a manner that enhances health equity, ensures a base level of resources in local communities, and encourages efficient use. Finally, the paper also identified expected outcomes in improving health and reducing premature death and disability, catalyzing partnerships, and building capacity for local health agencies to reconfigure their activities to address the most costly and burdensome health conditions.
- Targeted federally funded programs. The largest prevention program DPH administers is the Nutrition Education and Obesity Prevention program, which provides health education interventions to recipients of Supplemental Nutrition Assistance Program (SNAP) benefits. This program receives funding through the U.S. Department of Agriculture, and had a budget of around $90 million in 2014-15. The mission of the program is to create innovative partnerships that empower low-income Californians to increase fruit and vegetable consumption, physical activity, and food security with the goal of preventing obesity and other diet related chronic diseases. The Women, Infants, and Children program also offers nutrition and breastfeeding education to program clients.
In federal fiscal year 2014, the CDC provided about $303 million to entities in California, including health departments, universities, and other public and private agencies. Of this total, about $62 million of this funding statewide was allocated to different entities for chronic disease and prevention activities.
- Department of Public Health. The mission of DPH is to optimize the health and well-being of Californians, primarily through population-based programs, strategies, and initiatives. DPH is broadly organized into Center for Chronic Disease Prevention and Health Promotion (CCDP&HP), Center for Environmental Health, Center for Family Health, Center for Health Care Quality, and Center for Infectious Diseases (CID). CCDP&HP is DPH's lead on climate change and on Health in All Policies. The State of California created the Health in All Policies Task Force in 2010. The Task Force was charged with identifying priority programs, policies, and strategies to improve the health of Californians while advancing the goals of improving air and water quality, protecting natural resources and agricultural lands, increasing the availability of affordable housing, improving infrastructure systems, promoting public health, planning sustainable communities, and meeting climate change goals. CID protects Californians from the threat of preventable infectious disease and assists individuals suffering from infectious disease by securing prompt and appropriate access to health care, medications, and associated support services. CID activities are a particular focus of this hearing, specifically, the responsibility to help investigate and diagnose infectious diseases of public health significance, such as the flu.
- SUPPORT. The Health Officers Association of California (HOAC) states that with sound policies and adequate funding, most chronic illnesses (arthritis, asthma, cardiovascular disease, diabetes, cancer, and depression) can be prevented. HOAC contends that preventing chronic disease before it starts will lead to decreased medical costs and improved productivity in California.
- RELATED LEGISLATION.
- AB 2782 (Bloom) of 2016 imposes a health promotion a fee of $0.02 per fluid ounce on bottled sugar sweetened beverages and concentrates and establishes the Health California Fund (Fund) and allocates moneys from the Fund to various state departments for purposes of reducing the incidence and impact of diabetes, obesity, and dental disease in California. AB 2782 is pending in the Assembly Health Committee.
- AB 2430 (Gaines) of 2016 allows a taxpayer to designate an amount in excess of personal income tax liability to be deposited to the Type 1 Diabetes Research Fund, which the bill would create. The bill would require moneys transferred to the Type 1 Diabetes Research Fund, upon appropriation by the Legislature, to be allocated to the Franchise Tax Board and the Controller, as provided, and to an authorized diabetes research organization, as defined, for the purpose of type 1 diabetes research, as provided. AB 2430 is pending in the Assembly Revenue and Taxation.
- PREVIOUS LEGISLATION.
- AB 572 (Gaines) of 2015 would have required DPH to create a detailed diabetes action plan for the state, and to report the results of the plan to the Legislature biennially. Requirements include the development of a detailed budget blueprint identifying needs, costs, and resources required to implement the plan and a proposed budget for each action step, as well as policy recommendations for the prevention and treatment of diabetes. AB 572 was held on the Suspense File in the Senate Appropriations Committee.
- SCR 34 (Monning), Resolution Chapter 99, Statutes of 2015 proclaimed the month of September 2015, and each year thereafter, as Childhood Obesity Awareness Month, and expressed the Legislature's support of various programs that work to reduce obesity among children.
- SR 47 (Hall), Resolution Chapter 59, Statutes of 2015 proclaimed November 2016 as Diabetes Awareness Month, and expressed the Senate’s support of aggressive early detection and treatment of diabetes.
REGISTERED SUPPORT / OPPOSITION:
Support
California Immigrant Policy Center
California Pan-Ethnic Health Network
Health Access California
Health Officers Association of California
Opposition
None on file.
Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097
Discussed in Hearing
21MIN
Senate Standing Committee on Health
1MIN
Assembly Floor
5MIN
Assembly Standing Committee on Health
Bill Author
Bill Co-Author(s):