AB 2424, as amended, Gomez. Community-based Health Improvement and Innovation Fund.
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
begin delete Treasuryend delete 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 begin delete health in all policiesend delete 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 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.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Part 8 (commencing with Section 106050) is
2added to Division 103 of the Health and Safety Code, to read:
The Legislature finds and declares all of the following:
8(a) Over the past century, chronic diseases have emerged as a
9predominant challenge to public health. Chronic disease and injury
10account for eight of every 10 deaths and affects the quality of life
11of 14 million Californians.
12(b) Obesity and diabetes in particular have grown rapidly, posing
13a grave threat to health. Today over one-half of California adults
14are estimated to have either diabetes or prediabetes. Thirteen
15million adults in California, 46 percent of the adult population, are
16estimated to have prediabetes or undiagnosed diabetes, while
17another 2.5 million adults, 9 percent of the adult population, have
18already been diagnosed with diabetes.
19(c) The health inequities in this state are stark:
P3 1(1) Ethnic minorities and individuals who have low incomes
2have higher rates of diabetes. Nearly one-in-five
begin delete African-Americansend delete and Latinos in California
4have diabetes, more than double the rate of Whites.
5(2) Nearly 12 years of life separate the life expectancy at the
6top and at the bottom of neighborhood clusters in California, from
7a life expectancy of 87 years in parts of northwest Santa Clara
8County to 75.3 years in the City of
begin delete Twenty-Nineend delete Palms
9and the City of Barstow in the County of San Bernardino.
10(3) Economically disadvantaged children are far less likely to
11complete the fitness requirements of the physical fitness test offered
12to students in grade school.
13(4) Adolescents covered by Medi-Cal reported significantly
14higher rates of drinking sugar-sweetened beverages and less daily
15consumption of vegetables than the general California adolescent
16population and were significantly more likely to be obese.
17(d) The following short list of risk factors is responsible for
18much of the burden of chronic disease: tobacco use, physical
19inactivity, unhealthful diet, excessive consumption of alcohol,
20hyperlipidemia, and uncontrolled high blood pressure. These risk
21factors and chronic conditions are largely preventable and
23(e) The State Department of Public Health estimates that as
24much as 80 percent of heart disease, stroke, and type II diabetes
25and more than 30 percent of cancers can be prevented by
26eliminating the underlying risk factors.
27(f) The economic burden of chronic disease in California weighs
28heavily on families, employers, and all levels of government.
29Approximately $98 billion, or 42 percent of all health care
30expenditures in the state, was spent on treating just six common
31chronic health conditions (arthritis, asthma, cardiovascular disease,
32diabetes, cancer, and depression) in 2010.
33(g) The indirect costs associated with chronic disease in
34California are also high. According to the Economic Burden of
35Chronic Disease (EBCD) Index, the projected impact of lower
36productivity and lost workdays for individuals with chronic
37conditions and their caregiving family members in California was
38estimated to be $51 billion in 2010.
P4 1(h) The cost of health care continues to surpass the rate of
2inflation, causing increasing strain on the budgets of families,
3 employers, and the government.
4(i) Despite the fact that chronic disease results in decreased
5quality of life, premature death, and exorbitant medical costs,
6investments in measures that prevent chronic disease have been
8(j) The United States spends only 2.6 percent of health care
9dollars on all public health, yet 75 percent of health care costs are
10attributable to preventable health conditions.
11(k) Paying for prevention works and upstream strategies have
12a remarkable history of success, measured in both cost avoidance
13and health improvement. In the County of Los Angeles, smoking
14amongst high school students fell from 27 percent to 7 percent
15between 1997 and 2013, thanks to investment in policy and
16environmental changes as well as education.
17(l) Childhood obesity amongst Los Angeles Unified School
18District 5th graders decreased by 10.6 percent (from 31.2 percent
19to 27.9 percent) between 2010 and 2013, and leveled off among
207th and 9th graders, after nine years of steady increases, reflecting
21investments to reduce the consumption of
begin delete sugar sweetenedend delete
22 beverages, promote healthier eating, and increase
24(m) The California Health and Human Services Agency, in
25partnership with the State Department of Public Health, has defined
26ambitious health improvement goals for the state through the “Let’s
27Get Healthy California” initiative, including making California
28the healthiest state in the nation by 2022, reducing health
29disparities, and achieving better health at lower cost. These goals
30cannot be met by improvements in health care or on an individual
31basis alone. Meeting these goals requires urgent and substantial
32investment in community-based prevention of chronic disease.
33(n) The existing limited resources of funding for chronic disease
34prevention are threatened, declining from past levels, and subject
35to significant restrictions.
36(o) Strategic investment in upstream prevention will protect,
37not deplete, the coffers of government. Investment in prevention
38has a strong evidence base of positive return on investment through
39reducing health care costs on a long-term basis.
For purposes of this part, the following terms have
2the following definitions:
3(a) “Department” means the State Department of Public Health.
4(b) “Fund” means the Community-based Health Improvement
5and Innovation Fund.
6(c) “Health equity priority population” means, for each
7condition, populations that exhibit significant disparities with
8respect to prevalence of a priority chronic health condition or injury
9or worse outcomes such as higher hospitalization or death rates.
10Priority populations may be defined based on race, ethnicity,
begin delete statusend delete
including income or
12education, other factors as defined by the department, or current
13findings and recommendations of research, including assessments
14of innovations funded by the fund.
15(d) “Local health jurisdiction” means county health
16department or combined health department in the case of counties
17acting jointly or city health department within the meaning of
19(e) “Priority chronic health conditions” means asthma, type II
20diabetes, cardiovascular and cerebrovascular disease, cancer, dental
21disease, obesity, and other chronic conditions and injuries that are
22prevalent, largely preventable, and associated with high health
23care costs, as defined by the department. High-burden conditions
24whose prevention is not adequately supported by other funding
25streams shall be prioritized.
(a) (1) There is hereby created in the State Treasury
27the Community-based Health Improvement and Innovation Fund.
28The fund shall consist of any revenues deposited therein, including
29any fine or penalty revenue allocated to the fund, any revenue from
30appropriations specifically designated to be credited to the fund,
31any funds from public or private gifts, grants, or donations, any
32interest earned on that revenue, and any funds provided from any
34(2) A target level of annual statewide investment from the fund
35shall be established as a set dollar amount per capita, to be allocated
36for the purposes described in subdivision (b) and as described in
begin delete subdivision (c).end delete
38(b) (1) Moneys in the fund shall be available, upon
39appropriation by the Legislature, for any of the following purposes:
P6 1(A) Reducing health inequity and disparities in the rates and
2outcomes of priority chronic health conditions.
3(B) Preventing the onset of priority chronic health conditions
4using community-based strategies in communities statewide and
5with particular focus on health equity priority populations.
6(C) Strengthening local
and regional collaborations between
7local public health jurisdictions and health care providers, and
8across government agencies and community partners to create
9healthier communities, using a
begin delete health in all policiesend delete
11(D) Contributing to a stronger evidence base of effective
12community-based prevention strategies for priority chronic health
14(E) Evaluating effectiveness and cost-effectiveness of innovative
15community-based prevention strategies for priority chronic health
16conditions, as a basis for future decisions about investment in those
17strategies in order to reduce the costs of providing health care
18services and to improve population health status.
19(2) Moneys in the fund shall be used to address social,
20environmental, and behavioral determinants of chronic disease
21and injury at any phase of the life cycle, including, but not limited
22to, all of the following:
23(A) Promotion of healthy diets and food environments.
24(B) Promotion of physical activity and of a safe, physical
25 activity-promoting environment.
26(C) Prevention of unintentional and intentional injury.
27(3) In expending moneys from the fund, policy, systems, and
28environmental change approaches are to be emphasized, although
29funds can support implementation of community-based programs.
30(4) Moneys in the fund shall not be used for clinical services.
31(c) Revenues deposited in the fund that are unexpended at the
32end of a fiscal year shall remain in the fund and not revert to the
(a) The department shall be allocated an amount not
35greater than 20 percent of the annual appropriation from the fund
36for all of the following activities:
37(1) Mandatory activities for which the funds shall be used are
39(A) Statewide media and communications campaigns, which
40shall be allocated 9 percent of
begin delete thoseend delete funds.
P7 1(B) Evaluation of program activities,
which shall be allocated
2at least 5 percent of
begin delete thoseend delete funds.
3(C) Other activities, which shall be allocated no more than 6
begin delete thoseend delete funds, as follows:
9(i) Mandatory activities, including all of the following:end delete
10(I) Overall program implementation and oversight.end delete
11(II) Review and approval of local health improvement plans.end delete
12(III) Granting of and monitoring the implementation of local
13health jurisdiction awards and competitive grant awards.
14(ii) The definition of criteria for evidence-based and innovative
15approaches to improving health and health equity, with evaluation
16criteria appropriate to each type of approach.
19(iii) The definition of priority chronic health conditions and
20health equity priority populations based on public health data.
21(iv) The definition of criteria for participation of community
22partners in local health jurisdiction funding.
23(v) The development of tools that can be used by the state and
24by grantees to monitor progress towards improving health and
25health equity, including establishment of a health equity index.
26(2) Discretionary activities, as may be appropriate to support
27community-based prevention of priority chronic health conditions
28throughout the state, for which the funds may be used, include,
29but are not limited to, any of the following:
30(A) Research, development, and dissemination of best practices,
31including training and technical assistance for grantees.
32(B) Development of infrastructure, including, but not limited
33to, data resources or information technology resources to be shared
35(C) Coordination of local efforts.
36(D) Development and promotion of statewide initiatives.
37(b) The department shall award at least 80 percent of total
38moneys made available in the annual appropriation from the fund
39to eligible applicants to be used consistent with the purposes
40described in subdivision (b) of Section 106052. Moneys from the
P8 1fund shall be distributed and awarded according to the following
3(1) (A) At least 50 percent of
begin delete thoseend delete funds shall be awarded
4to local health jurisdictions and shall be allocated on a formula
5basis to local health jurisdictions, or their nonprofit designee, with
6approved applications for three-year funding cycles.
7(B) Each local health jurisdiction shall submit an application
8for a three-year funding cycle, to be reviewed and approved by
9the department, that includes all of the following information:
10(i) A detailed assessment of community health needs within the
11local health jurisdiction with respect to priority chronic health
12conditions and health equity priority populations.
13(ii) A health improvement and evaluation plan that includes
14initiatives focused on health equity priority populations.
15(iii) The level of local funds, including in-kind resources, for
16community-based prevention activities that was provided in the
17most recently completed fiscal year.
18(iv) Documentation of the existence and activities of a
19community health partnership, which includes leading health care
20providers, local health jurisdictions, community partners, including
21those serving health equity priority populations, businesses, and
22other relevant local government agencies and community leaders.
27(C) Each local health jurisdiction with an
28shall receive a base award of two hundred fifty thousand dollars
29($250,000) for a three-year funding cycle. The balance of the funds
30shall be awarded to local health jurisdictions proportional to the
31number of residents living below the federal poverty level.
32(D) Health improvement and evaluation plans shall emphasize
33sustainable policy, systems, and environmental change approaches
34to creating healthier communities.
35(E) Local health jurisdictions may come together if they so
36desire to submit combined regional applications.
37(F) No single recipient may receive more than 30 percent of the
38funding allocated to local health jurisdictions on a formula basis.
39(G) Recipients of funds pursuant to this paragraph shall maintain
40the level of local funds, including in-kind resources, for
P9 1community-based prevention activities that were provided in the
begin delete recentend delete completed fiscal year prior to July 2016.
3Funds provided pursuant to this paragraph shall supplement and
4not supplant existing funding for community-based prevention
5activities of priority chronic health conditions.
6(H) Local health jurisdiction investments shall prioritize
7communities in the third and fourth quartiles of the California
8Health Disadvantage Index or other criteria of health equity priority
9populations subsequently adopted by the department.
10(I) The initial year of funding may be used for needs assessment,
11planning, and development.
12(2) At least 30 percent of
begin delete thoseend delete funds shall be allocated
13for competitive grants as follows:
14(A) (i) Competitive grants shall be awarded to local or regional
15level entities or statewide nonprofit organizations.
19(ii) Local or regional level entities include community-based
20organizations or local public agencies, in partnership with other
21entities, including, but not limited to, other community-based
22organizations, other local public agencies, schools, religious
23organizations, businesses, labor unions, health care plans, hospitals,
24clinics, other health care providers, or other community-based
26(iii) Each participating health care plan or hospital shall identify
27monetary, in-kind, or both, contributions to projects.
28(iv) Local or regional projects shall prioritize investments that
29serve communities in the third and fourth quartiles of the California
30Health Disadvantage Index or other criteria of health equity priority
31populations subsequently adopted by the department.
32(v) At least 10 percent of the funds awarded as competitive
33grants shall be used for statewide nonprofit organizations.
34(vi) Organizations receiving competitive grants shall coordinate
35efforts with any local health jurisdictions where they are carrying
37(B) (i) Competitive grant applicants shall identify projects as
38either an evidence-based or an innovative project.
5 At least 10 percent of the funding for competitive grants
6shall be set aside for innovative projects that test previously
7untested strategies in order to improve the evidence base of
8effective community-based prevention strategies for priority
9chronic health conditions.
11 Applications for innovative projects shall provide a rationale
12for the defined approach and any evidence that suggests the
13innovative project will be effective, as well as a plan and resource
14allocation for the evaluation.
16 Competitive grants may be used by organizations for policy
17systems or environmental change efforts, direct program delivery,
18or for technical assistance to other grantees.
(a) (1) An advisory committee, with the members
20serving terms not to exceed four years, shall provide expert input
21and offer guidance to the department on the development,
22implementation, and evaluation of the fund.
23(2) The advisory committee shall include, at a minimum, experts
24on priority chronic health conditions, effective nonclinical
25prevention strategies, policy strategies for chronic disease
26prevention, and the unique needs of health equity priority
28(3) The advisory committee shall include representatives from
29the State Department of Health Care Services, the Health in All
30Policies Task Force, the California Health and Human Services
31 Agency, the California Conference of Local Health Officers, and
32the California Public Employees’ Retirement System.
33(b) The department shall develop a robust evaluation framework
34for all activities funded through the fund.
7(c) The department may define state priorities and require
8activities funded by the fund to align with those priorities in a
9manner that is consistent with the intent of this part. The
10department may narrow the list of priority chronic health conditions
11if necessary to ensure an effective program.
18 (1) Based on the results of programs supported by this part
19and any other proven methodologies available to the advisory
20committee, the advisory committee shall produce a comprehensive
21master plan for advancing chronic disease and injury prevention
22throughout the state.
23(2) The master plan shall include recommended implementation
24strategies for each priority chronic health condition throughout the
25state and identify areas where innovative solutions are especially
27(3) The advisory committee shall submit the master plan, and
28revisions to the master plan, to the Legislature triennially.
29(4) The master plan and its revisions shall include
30recommendations on specific goals for reduction of the burden of
31preventable chronic conditions and injuries by 2030, administrative
32arrangements, funding priorities, integration and coordination of
33approaches by the department, the University of California, the
34Health in All Policies Task Force, and their support systems, and
35progress reports relating to each health equity priority population.
36(5) A report submitted pursuant to paragraph (3) shall be
37submitted in compliance with Section 9795 of the Government