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LETTER |
Correspondence: Requests for reprints should be sent to Thomas R. Frieden, MD, MPH, New York City Department of Health and Mental Hygiene, 125 Worth St, Room 331, CN #28, New York, NY 10013 (e-mail: tfrieden{at}health.nyc.gov).
I agree with Phillips that lack of funding remains a significant obstacle to chronic disease prevention and control. Federal, state, and local public health agencies must all increase funding of and leadership in chronic disease prevention and control while at the same time continuing core public health services, including communicable disease control. A 2003 survey of 14 large US city and metropolitan area health departments found that budget allocations for chronic disease prevention and control programs ranged from 0.1% to about 10% (median 1.1%).1
In most jurisdictions, only a small portion of funding for chronic disease prevention and control was provided directly by the federal government, with the bulk coming from state and local sources. In New York City, for example, spending for chronic disease programs in 2003 was 1.1% of the total Health Department budget; two thirds of this amount came from city funds and almost all of the remainder from New York State.1
While state and local public health agencies have made progress on tobacco control, they have done so despite the fact that many states have diverted Master Settlement Agreement funds away from tobacco control and public health in general.2,3 Inadequate funding of tobacco control has undoubtedly contributed to the slower rate of decrease in smoking among US adults since the early 1990s, and among teens since 2002.4,5 Lack of action has also contributed to the twin epidemics of obesity and diabetes, which have spiraled out of control in the past decade.6,7
McCord is correct that money alone is not sufficient. We must strengthen and maintain the political resolve necessary to implement effective interventions to combat chronic disease. In New York City, for example, our success in strengthening smoke-free workplace laws was won despite great controversy and orchestrated opposition.8
Public health agencies also need to apply traditional public health tools more creatively and aggressively to prevent and control chronic diseases. Although public health as a whole has made a start, we have much farther to go.
References
1. Georgeson M, Thorpe LE, Merlino M, et al. Short-changed? An assessment of chronic disease programming in major US city health departments. J Urban Health. In press.
2. Sloan FA, Allsbrook JS, Madre LK, Masselink LE, Mathews CA. States’ allocations of funds from the tobacco master settlement agreement. Health Aff (Millwood). 2005;24:220–227.
3. Clegg Smith KM, Wakefield MA, Nichter M. Press coverage of public expenditure of Master Settlement Agreement funds: how are non–tobacco control related expenditures represented? Tob Control. 2003;12:257–263.
4. Smoking Prevalence Among U.S. Adults, July 2002. Available at: http://www.cdc.gov/tobacco/research_data/adults_prev/prevali.htm. Accessed April 5, 2005.
5. Centers for Disease Control and Prevention (CDC). Tobacco use, access, and exposure to tobacco in media among middle and high school students—United States 2004. MMWR Morb Mortal Wkly Rep. 2005;54:297–301.[Medline]
6. Prevalence of Overweight and Obesity Among Adults: United States, 1999–2002. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/obese/obse99.htm. Accessed April 5, 2005.
7. Data and Trends: Diabetes Surveillance System. Available at: http://www.cdc.gov/diabetes/statistics/prev/national/figage.htm. Accessed April 5, 2005.
8. Chang C, Leighton J, Mostashari F, McCord C, Frieden TR. The New York City Smoke-Free Air Act: second-hand smoke as a worker health and safety issue. Am J Ind Med.2004;46:188–195.[Medline]
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