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Preventive Health and Health Services Block Grant

A Critical Public Health Resource
At A Glance 2011

Block Grant At A Glance cover

The Role of Block Grant Funding

In 1981, Congress authorized the Preventive Health and Health Services (PHHS) Block Grant. The PHHS Block Grant gives its 61 grantees—which include all 50 states, the District of Columbia, 2 American Indian tribes, and 8 U.S. territories—the independence and flexibility to tailor prevention and health promotion programs to their particular public health needs. States are expected to align their programs with Healthy People 2020 national health goals. As a critical public health resource, the PHHS Block Grant supports the following activities:

  • Addressing basic health concerns such as tooth decay among children, food sanitation, and injuries to older adults from falling.

  • Responding rapidly to emerging health threats in states.

  • Funding critical prevention efforts to address health concerns such as skin cancer, child safety, and untreated dental decay that lack specific state funding.

  • Protecting investments in and enhancing the effectiveness of funded programs that address specific health problems.

  • Leveraging other monetary resources to increase the benefit of preventive health measures.

Flexible Funding for Public Health Efforts

The health needs of communities are diverse, complex, and constantly changing. The PHHS Block Grant gives grantees the flexibility to use funds to prevent and control chronic diseases such as heart disease, diabetes, and arthritis. It also helps grantees respond quickly to outbreaks of foodborne infections and waterborne diseases, and it allows them to use funding to address their specific public health needs and challenges.

Funding Local Communities

The PHHS Block Grant is the major source of funding that CDC provides to public health agencies to address health needs and problems such as immunization, tuberculosis, cancer, and heart disease. It is a significant source of funding for promoting health and preventing disease and injury in communities across the United States. Despite this support, grantees do not have adequate funding to take action against all the leading causes of illness, disability, injury, and death in their states.

In Fiscal Year 2010 (FY 2010), about $28 million of PHHS Block Grant funds were distributed by the states to local entities to address county and local public health needs. For example, Arizona invests $399,087 of its PHHS Block Grant funding in local health departments to reverse the trend of Arizona youth becoming increasingly less physically active. The money is used to promote programs and policies that are designed to increase access to and knowledge of the benefits of daily physical activity. These programs and policies focus on populations at highest risk of not being physically active, with the goal of increasing the proportion of adolescents who get the recommended amounts of physical activity.

Pie chart showing the role of block grant dollars. Text description provided.

[A text description of this map is also available.]

Leveraging Block Grant Funds

PHHS Block Grant funds also have provided start-up money for programs that are now supported by other sources. As these programs have become self-sustaining, PHHS Block Grant funds have been redirected to other public health priorities. For example, the Texas EMS/Trauma Registry is a public health surveillance initiative mandated by the Texas legislature to collect data on all calls for emergency medical services (EMS) in the state, as well as to collect data from hospitals about major trauma cases. These data are used to analyze trends in injury-related deaths and to measure progress toward the national health objective of reducing deaths from intentional and unintentional injuries.

In 2009, Texas used PHHS Block Grant funds to assess the existing registry, gather feedback on what users would like to see in an updated system, study best practices in other states, and develop recommendations for improvement. Using this analysis as leverage, the Texas EMS/Trauma Registry was able to get funding from the Texas Department of Transportation to implement a new system.

Meeting Health Care Needs When No Other Funds Exist

Saving Lives in Kansas

Children in Kansas are less likely to suffer from unintentional injury now than they were a decade ago, but preventable injury remains the leading killer for this group. On average, about 170 Kansas children younger than age 15 are injured as a result of a cycling crash every year, and head injury is the leading cause of death in bicycle accidents. During 1999–2000, 45% of Kansas children hospitalized for injuries sustained from a bicycle accident had a traumatic brain injury.

PHHS Block Grant Funding for State and Local Health Departments, FY 2010. Text description provided.

[A text description of this map is also available.]

The single most effective safety device available to reduce head injury and death from bicycle crashes is a bicycle helmet. Funds from the PHHS Block Grant allowed the Safe Kids Kansas CYCLE SMART program to distribute more than 100,000 low-cost and free helmets to children in Kansas through local coalitions. The program, which also provides educational materials and has received several national awards, is credited with saving 12 lives since 1992.

Positive Discipline in Ohio Schools

School-based violence has not increased dramatically in recent years, but aggressive behaviors such as verbal abuse, sexual harassment, and bullying have. These behaviors contribute to an atmosphere of insecurity and may escalate to more violent acts if left unaddressed. With PHHS Block Grant funding, the Union County Health Department in Ohio implemented a Positive Discipline program in county elementary schools during 2005–2009. The program taught teachers and staff how to help students practice and learn social skills that can create an environment of mutual respect in the classroom.

These types of programs can decrease discipline problems, bullying, and negative classroom behaviors, as well as improve teacher-student and peer-to-peer relationships. After 4 years of using this program, one school surveyed its students and found that 97% felt encouraged to succeed, 95% felt safer to ask questions, and 92% felt they could voice their opinions without fear of being bullied or harassed by fellow students.

Improving Health in Rhode Island

Central Falls is a small, densely populated city in Rhode Island with a large Hispanic population. Rates of diabetes, high blood pressure, cancer, heart disease, and sexually transmitted diseases are high among the city's 19,000 residents. Because many residents have emigrated from other countries, they often face problems getting the health services they need because of language barriers, lack of insurance or knowledge about resources, lack of legal status, and distrust of local institutions.

To assess local health care needs, the staff of a nonprofit agency called Progreso Latino surveyed clients of its Wellness Clinic, 98% of whom are Latino. The 2010–2011 survey found that 79% of clients had not had a dental or eye exam in the past 3–4 years, 40% of Latino men said they often went to pharmacies instead of doctors for health care services, 80% of clients did not have a primary care doctor, and 89% said they needed medical services that they were not receiving.

To improve access to preventive and health care services for underserved populations in Central Falls, Progreso Latino applied for PHHS Block Grant funding to keep its Wellness Clinic open at night to provide free services to residents who do not have health insurance and cannot access services during the day because of work. The clinic offers vaccinations (e.g., hepatitis A and B, pneumonia, influenza); screening for HIV infection; and screening for blood sugar, cholesterol, and blood pressure levels.

To help improve health literacy among local residents, the clinic also provides health fairs, educational workshops, and physical activity classes that include nutritional counseling. In 2010, the clinic served more than 1,500 adults in Central Falls and is making a difference in the lives of Spanish-speaking residents and other minority groups living in Central Falls.

CDC 's National Leadership

CDC's Commitment to Success

The PHHS Block Grant is committed to developing a framework that holds programs accountable, fosters innovation at state and local levels, and improves public health. To achieve these objectives, CDC officials have developed national goals and performance measures that will be pilot tested and then implemented by each state.

Each indicator selected to measure a state's performance was assessed to determine whether relevant data (1) are available, consistent across specific time periods and all states, reliable and valid, and population-based; (2) focused on primary prevention; and (3) have standard numerators and denominators.

In addition, CDC is training state PHHS Block Grant coordinators on how to develop and sustain effective public health policies by creating partnerships across public and private sectors. Through CDC's leadership, states continue to improve their ability to identify and use evidence-based guidelines and strategies to design and implement public health programs in communities across the country.

Future Directions

The PHHS Block Grant will continue to work with partners to implement core performance measures. This multiyear process is in the implementation stage, and final health status indicators, strategies to meet these indicators, and data collection methods are being identified. Each data collection process associated with each indicator will be tested extensively in selected states before full implementation.

In 2011, CDC's Block Grant Management Information System, which monitors how grantees spend their funding, will be redesigned to reflect the new objectives in Healthy People 2020. This redesign also will

  • Increase the system's capacity to serve as a repository for program performance data.

  • Enhance the ability of grantees to report how their activities link national and state health objectives.

  • Provide a more efficient way for grantees to submit information about their programs to a variety of audiences.

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Success Stories

North Carolina: Working with Faith-Based and Community Groups to Improve Health

More than six million North Carolinians are overweight or obese, putting them at higher risk of chronic diseases such as heart disease, diabetes, and some types of cancer. Paying the medical expenses for these diseases, which are often associated with poor nutrition and physical inactivity, costs the state $2 billion each year.

Studies have shown that these chronic diseases affect African Americans in North Carolina at significantly higher rates than those reported for other racial and ethnic groups. For example, compared with whites, African Americans in North Carolina have a higher rate of obesity (38.9% versus 26.4%), are less likely to eat five or more fruits and vegetables a day (18.4% versus 33.1%), and are less likely to get the recommended amounts of daily physical activity (37.9% versus 46.8%).

To address health disparities among African Americans living in Wake County, North Carolina, the Wake County Human Services (WCHS) partnered with local faith-based and community groups to find ways to create healthier environments for local residents. These partnerships are part of the WCHS's Health Promotion Chronic Disease Prevention Program.

Since the program began, WCHS has worked with 46 African American and Latino faith-based and community organizations to help their members make healthy lifestyle choices. With the use of Preventive Health and Health Services (PHHS) Block Grant funds, more than 20,000 people have benefited from policy changes and improvements to church facilities that have made it easier for members to eat healthy and be physically active.

Some churches started community gardens to improve access to fresh fruits and vegetables, while others installed exercise equipment for members. Several faith-based organizations offer youth and adult soccer leagues, as well as walking and aerobic exercise programs. They also hand out maps of local greenways and trails. As a result of these changes, Wake County residents are making it a way of life to eat smart and move more.

South Carolina: Promoting Smoke-Free Policies in Churches and Homes

In South Carolina, where 1 of 5 adults smokes, tobacco use is the leading preventable cause of disease and premature death. In addition, about 800 South Carolinians die every year from secondhand smoke exposure, and 70% of state residents live in an area not covered by a smoke-free law. Tobacco use is estimated to cost South Carolina more than $1 billion in health care expenses annually.

In 2009, the South Carolina Department of Health and Environmental Control's Region 7 Public Health Office used funding from CDC's Preventive Health and Health Services (PHHS) Block Grant to partner with a faith-based, nonprofit group called Hold Out the Lifeline: A Mission to Families. One of this group's initiatives is the Mothers Eliminating Secondhand Smoke program, which promotes tobacco-free and smoke-free policies in homes, vehicles, and faith-based settings.

During 2009–2010, the tobacco health educator working in Region 7 helped participating churches conduct the following activities:

  • Host educational sessions for youth and adults on the dangers of tobacco use.

  • Develop and adopt a 100% tobacco-free policy that bans smoking in buildings and on church grounds.

  • Get members to commit to not smoking in their homes and vehicles.

  • Post no-smoking signs and educational posters on church grounds.

  • Refer smokers to local cessation services and the state's tobacco quitline.

Other successes of the Mothers Eliminating Secondhand Smoke program include the following:

  • Leaders from more than 25 churches in the Lowcountry region's Charleston, Berkeley, and Dorchester counties were trained to use the program in their churches. As a result, more than 2,000 residents were educated about the harmful effects of tobacco use and secondhand smoke.

  • More than 500 people signed pledges to keep their homes, vehicles, and faith-based institutions smoke-free.

  • Eighteen churches adopted tobacco-free policies on their campuses.

Wisconsin: Saving Lives by Reducing Teen Alcohol Use

Teen alcohol use is a serious public health problem nationwide. In Wisconsin, school officials in Barron County used data from CDC's Youth Risk Behavior Survey (YRBS) to assess alcohol use among students in this rural county of 45,000 residents. They found that drinking levels among the more than 3,000 students surveyed were well above state and national averages for adults.

One-third (33%) of Barron County students in grade 12 reported binge drinking (defined as 5 or more drinks within a couple of hours for males and 4 or more for females) in the past 30 days. By comparison, 23% of Wisconsin adults and 16% of U.S. adults reported binge drinking.

On July 4, 2009, excessive drinking among a group of high school students in Barron County led to the death of a 17-year-old girl and serious criminal charges against two teenagers. In the wake of this tragedy, local community leaders developed a collaborative response with the help of CDC's PHHS Block Grant. The Barron County Department of Health & Human Services funded a surveillance study to support development of a community-based initiative with the Barron County Safe & Stable Families Coalition, which includes 98 members from all sectors of the community. When coalition members looked at the YRBS data, they found several major factors associated with the high levels of teen alcohol use. These factors included a low perceived risk of harm from alcohol and easy access.

To address the problem of teen alcohol use in Barron County, coalition members

  • Adopted the Strategic Prevention Framework, a community-based approach recommended by the National Institutes of Health.

  • Launched a media campaign designed to discourage adults from providing alcohol to minors.

  • Trained local schools on how to use two evidence-based curricula designed to prevent alcohol use among youth.

  • Increased enforcement of laws related to alcohol sales to minors and adults who provide alcohol to minors.

Preliminary results from the initiative have been promising. The partnership between the Barron County Safe & Stable Families Coalition and the county health department reported the following first-year accomplishments:

  • The county sheriff's department increased enforcement of existing laws that prohibit retail stores from selling alcohol to minors and adults from providing alcohol to minors. When the sheriff's department initially checked local stores for compliance in August 2009, 11 of 23 retailers were selling to minors. A month later, the number had dropped to 2 of the 17 retailers checked. During July–December 2009, thirty citations were given to adults for providing alcohol to minors—up from the 28 citations issued during the previous 3½ years.

  • In 2009, the county leveraged its PHHS Block Grant to get $1 million in new grants that will help Barron County identify and implement environmental strategies to reduce underage alcohol, drug, and tobacco abuse.

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