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 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
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collaborations between begin delete localend delete 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 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.end delete
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:
5(a) Over the past century, chronic diseases have emerged as a
6predominant challenge to public health. Chronic disease and injury
7account for eight of every 10 deaths and affects the quality of life
8of 14 million Californians.
9(b) Obesity and diabetes in particular have grown rapidly, posing
10a grave threat to health. Today over one-half of California adults
11are estimated to have either diabetes or prediabetes. Thirteen
12million adults in California, 46 percent of the adult population, are
13estimated to have prediabetes or undiagnosed diabetes, while
14another 2.5 million adults, 9 percent of the adult population, have
15already been diagnosed with diabetes.
16(c) The health inequities in this state are stark:
17(1) Ethnic minorities and individuals who have low incomes
18have higher rates of diabetes. Nearly one-in-five African Americans
19and Latinos in California have diabetes, more than double the rate
21(2) Nearly 12 years of life separate the life expectancy at the
22top and at the bottom of neighborhood clusters in California, from
23a life expectancy of 87 years in parts of northwest Santa Clara
24County to 75.3 years in the City of Twentynine Palms and the City
25of Barstow in the County of San Bernardino.
26(3) Economically disadvantaged children are far less likely to
27complete the fitness requirements of the physical fitness test offered
28to students in grade school.
29(4) Adolescents covered by Medi-Cal reported significantly
30higher rates of drinking sugar-sweetened beverages and less daily
31consumption of vegetables than the general California adolescent
32population and were significantly more likely to be obese.
33(d) The following short list of risk factors is responsible for
34much of the burden of chronic disease: tobacco use, physical
35inactivity, unhealthful diet, excessive consumption of alcohol,
36hyperlipidemia, and uncontrolled high blood pressure. These risk
37factors and chronic conditions are largely
begin delete preventable and
38inequitably distributed.end delete
P4 1(e) The State Department of Public Health estimates that as
2much as 80 percent of heart disease, stroke, and type II diabetes
3and more than 30 percent of cancers can be prevented by
4eliminating the underlying risk factors.
5(f) The economic burden of chronic disease in California weighs
6heavily on families, employers, and all levels of government.
7Approximately $98 billion, or 42 percent of all health care
8expenditures in the state, was spent on treating just six common
9chronic health conditions (arthritis, asthma, cardiovascular disease,
10diabetes, cancer, and depression) in 2010.
11(g) The indirect costs associated with chronic disease in
12California are also high. According to the Economic Burden of
13Chronic Disease (EBCD) Index, the projected impact of lower
14productivity and lost workdays for individuals with chronic
15conditions and their caregiving family members in California was
16estimated to be $51 billion in 2010.
17(h) The cost of health care continues to surpass the rate of
18inflation, causing increasing strain on the budgets of families,
19employers, and the government.
21(i) Despite the fact that chronic disease results in decreased
22quality of life, premature death, and exorbitant medical costs,
23investments in measures that prevent chronic disease have been
25(j) The United
States spends only 2.6 percent of health care
26dollars on all public health, yet 75 percent of health care costs are
27attributable to preventable health conditions.
28(k) Paying for prevention works and upstream strategies have
29a remarkable history of success, measured in both cost avoidance
30and health improvement. In the County of Los Angeles, smoking
31amongst high school students fell from 27 percent to 7 percent
32between 1997 and 2013, thanks to investment in policy and
33environmental changes as well as education.
34(l) Childhood obesity amongst Los Angeles Unified School
35District 5th graders decreased by 10.6 percent (from 31.2 percent
36to 27.9 percent) between 2010 and 2013, and leveled off among
377th and 9th graders, after nine years of steady increases, reflecting
38investments to reduce the consumption of
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39 beverages, promote healthier eating, and increase
P5 1(m) The California Health and Human Services Agency, in
2partnership with the State Department of Public Health, has defined
3ambitious health improvement goals for the state through the “Let’s
4Get Healthy California” initiative, including making California
5the healthiest state in the nation by 2022, reducing health
6disparities, and achieving better health at lower cost. These goals
7cannot be met by improvements in health care or on an individual
8basis alone. Meeting these goals requires urgent and substantial
9investment in community-based prevention of chronic
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4 The existing limited resources of funding for chronic disease
5prevention are threatened, declining from past levels, and subject
6to significant restrictions.
8 Strategic investment
in upstream prevention will protect,
9not deplete, the coffers of government. Investment in prevention
10has a strong evidence base of positive return on investment through
11reducing health care costs on a long-term basis.
For purposes of this part, the following terms have
13the following definitions:
30 “Department” means the State Department of Public Health.
32 “Fund” means the Community-based Health Improvement
33and Innovation Fund.
38 “Health equity priority population” means, for each
39condition, populations that exhibit significant disparities with
40respect to prevalence of a priority chronic health condition or injury
P7 1or worse outcomes such as higher hospitalization or death rates.
2Priority populations may be defined based on race, ethnicity,
3geography, socioeconomic status, including income or education,
4other factors as defined by the department, or current findings and
5recommendations of research, including assessments of innovations
6funded by the fund.
8 “Local health jurisdiction” means a county health department
9or a combined health department in the case of counties acting
10jointly or a city health department within the meaning of Section
13 “Priority chronic health conditions” means asthma, type II
14diabetes, cardiovascular and cerebrovascular disease, cancer, dental
15disease, obesity, and other chronic conditions and injuries that are
16prevalent, largely preventable, and associated with high health
17care costs, as defined by the department. High-burden conditions
18whose prevention is not adequately supported by other funding
19streams shall be prioritized.
(a) (1) There is hereby created in the State Treasury
21the Community-based Health Improvement and Innovation Fund.
22The fund shall consist of any revenues deposited therein, including
23any fine or penalty revenue allocated to the fund, any revenue from
24appropriations specifically designated to be credited to the fund,
25any funds from public or private gifts, grants, or donations, any
26interest earned on that revenue, and any funds provided from any
28(2) A target level of annual statewide investment from the fund
29shall be established as a set dollar amount per capita, to be allocated
30for the purposes described in subdivision (b) and as described in
32(b) (1) Moneys in the fund shall be available, upon
33appropriation by the Legislature, for any of the following purposes:
34(A) Reducing health inequity and disparities in the rates and
35outcomes of priority chronic health
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37(B) Preventing the onset of priority chronic health conditions
38using community-based strategies in communities statewide and
39with particular focus on health equity priority populations.
P8 1(C) Strengthening
begin delete local and regionalend delete collaborations between begin delete localend delete public health jurisdictions and
3health care providers, and across government agencies and
4community partners to create healthier communities, using a
15 Contributing to a stronger evidence base of effective
16community-based prevention strategies for priority chronic health
18(E) Evaluating effectivenessend delete
19 and cost-effectiveness of
20innovative community-based prevention strategies for priority
21chronic health conditions, as a basis for future decisions about
22investment in those strategies in order to reduce the costs of
23providing health care services and to improve population health
25(2) Moneys in the fund shall be used to address social,
26environmental, and behavioral determinants of chronic disease
27and injury at any phase of the life cycle, including, but not limited
28to, all of the following:
29(A) Promotion of healthy
begin delete diets andend delete food environments.
31(B) Promotion of physical activity and of a safe, physical
33(C) Prevention of unintentional and intentional injury.
36(3) In expending moneys from the fund, policy, systems, and
37environmental change approaches are to be emphasized, although
38funds can support implementation of community-based programs.
39(4) Moneys in the fund shall not be used for clinical services.
P9 1 Revenues deposited in the fund that are unexpended at the
2end of a fiscal year shall remain in the fund and not revert to the
(a) The department shall be allocated an amount not
9greater than 20 percent of the annual appropriation from the fund
10for all of the following activities:
11(1) Mandatory activities for which the funds shall be used are
13(A) Statewide media and communications campaigns, which
14shall be allocated 9 percent of total funds.
15(B) Evaluation of program activities, which shall be allocated
16at least 5 percent of total funds.
32(C) Other activities, which shall be allocated no more than 6
33percent of total funds, as follows:
34(i) Overall program implementation and oversight, including
35review and approval of local health improvement plans, and
36granting of and monitoring the implementation of local health
37jurisdiction awards and competitive grant awards.
38(ii) The definition of criteria for evidence-based and innovative
39approaches to improving health and health equity, with evaluation
40criteria appropriate to each type of approach. Criteria for
P10 1evidence-based projects shall include cost-effectiveness or
2projections of return on investment to the state.
3(iii) The definition of priority chronic health conditions and
4 health equity priority populations based on public health data.
5(iv) The definition of criteria for participation of community
6partners in local health jurisdiction funding.
7(v) The development of tools that can be used by the state and
8by grantees to monitor progress towards improving health and
9health equity, including establishment of a health equity
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11(2) Discretionary activities, as may be appropriate to support
12community-based prevention of priority chronic health conditions
13throughout the state, for which the funds may be used, include,
14but are not limited to, any of the following:
15(A) Research, development, and dissemination of best practices,
16including training and technical assistance for grantees.
17(B) Development of infrastructure, including, but not limited
18to, data resources or information technology resources to be shared
20(C) Coordination of local efforts.
21(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
P11 1fund shall be distributed and awarded according to the following
3(1) (A) At least
begin delete 50end delete percent of total 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 local health jurisdiction
12with respect to priority chronic health conditions and health equity
14(ii) A health improvement and evaluation plan that includes
15initiatives focused on health equity priority populations.
16(iii) The level of local funds, including in-kind resources, for
17community-based prevention activities that was provided in the
18most recently completed fiscal year.
19(iv) Documentation of the existence and activities of a
20community health partnership, which includes
22leading health care providers, local health jurisdictions, community
23partners, including those serving health equity priority populations,
24businesses, and other relevant local government agencies and
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27(v) How funds will be used in a manner consistent with
28principles of effectiveness, cost efficiency, relevance to community
29needs, maximal impact to improve community health,
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30 sustainability of impact over
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32(C) Each local health jurisdiction with an approved application
33shall receive a base award of two hundred fifty thousand dollars
34($250,000) for a three-year funding cycle. The balance of the funds
35shall be awarded to local health jurisdictions proportional to the
36number of residents living below the federal poverty level.
37(D) Health improvement and evaluation plans shall emphasize
38sustainable policy, systems, and environmental change approaches
39to creating healthier communities.
P12 1(E) Local health jurisdictions may come together if they so
2desire to submit combined regional applications.
3(F) No single recipient may receive more than 30 percent of the
4funding allocated to local health jurisdictions on a formula basis.
5(G) Recipients of funds pursuant to this paragraph shall maintain
6the level of local funds, including in-kind resources, for
7community-based prevention activities that were provided in the
8most recently completed fiscal year prior to July 2016. Funds
9provided pursuant to this paragraph shall supplement and not
10supplant existing funding for community-based prevention
11activities of priority chronic health conditions.
12(H) Local health jurisdiction investments shall prioritize
13communities in the third and fourth quartiles of the California
14Health Disadvantage Index or other criteria of health equity priority
15populations subsequently adopted by the department.
16(I) The initial year of funding may be used for needs assessment,
17planning, and development.
18(2) At least
begin delete 30end delete percent of total funds shall be allocated for
19competitive grants as follows:
20(A) (i) Competitive grants shall be awarded to local or regional
21level entities or statewide nonprofit organizations. Funds provided
22pursuant to this paragraph shall supplement and not supplant
23existing funding for community-based prevention activities of
24priority chronic health conditions.
begin deleteLocal or regional level entities include community-based in partnership with other entities, including, but not
26organizations or local public agencies, end delete
29limited to, other community-based organizations,
30other local public agencies, schools, religious organizations,
31businesses, labor unions, health care plans, hospitals, clinics, other
32health care providers, or other community-based entities.
33(iii) Each participating health care plan or hospital shall identify
34monetary, in-kind, or both, contributions to projects.
35(iv) Local or regional projects shall prioritize investments that
36serve communities in the third and fourth quartiles of the California
37Health Disadvantage Index or other criteria of health equity priority
38populations subsequently adopted by the department.
39(v) At least 10 percent of the
begin delete funds awarded as competitive shall be used for statewide nonprofit
begin delete organizations.end delete
16 Organizations receiving competitive grants shall coordinate
17efforts with any local health jurisdictions where
18they are carrying out activities.
19(B) (i) Competitive grant applicants shall identify projects as
20either an evidence-based or an innovative project.
21(ii) Applications for evidence-based projects shall provide
22evidence of cost-effectiveness or projections of return on
23investment to the state.
29(iii) At least 10 percent of the funding for competitive grants
30shall be set aside for innovative projects that test previously
31untested strategies in order to improve the evidence base of
32effective community-based prevention strategies for priority
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34(iv) Applications for innovative projects shall provide a rationale
35for the defined approach and any evidence that suggests the
36innovative project will be effective, as well as a plan and resource
37allocation for the evaluation.
38(v) Competitive grants may be used by organizations for policy
39systems or environmental change efforts, direct program delivery,
40or for technical assistance to other grantees.
(a) (1) An advisory committee, with the members
2serving terms not to exceed four years, shall provide expert input
3and offer guidance to the department on the development,
4implementation, and evaluation of the fund.
5(2) The advisory committee shall include, at a minimum, experts
6on priority chronic health conditions, effective nonclinical
7prevention strategies, policy strategies for chronic disease
8prevention, and the unique needs of health equity priority
10(3) The advisory committee shall include representatives from
11the State Department of Health Care Services, the Health in All
12Policies Task Force, the California Health and Human Services
13 Agency, the California Conference of Local Health Officers, and
14the California Public Employees’ Retirement System.
15(b) The department shall develop a robust evaluation framework
16for all activities funded through the fund. This evaluation
17framework shall include all of the following:
18(1) Regular monitoring of local health jurisdiction awards to
19ensure activities are conducted pursuant to approved plans and
20consistent with all requirements of this part.
21(2) Measures to ensure funding provided pursuant to this part
22supplement and do not supplant existing funding or effort.
23(3) Data collection and reporting requirements for grant
24awardees sufficient to assess impact and monitor compliance with
26(4) A plan to analyze the impact of this part on process measures
27relevant to community health promotion and, if practicable, on
29(c) The department may define state priorities and require
30activities funded by the fund to align with those priorities in a
31manner that is consistent with the intent of this part. The
32department may narrow the list of priority chronic health conditions
33if necessary to ensure an effective program.
34(d) The department shall require activities pursuant to this part
35to be conducted in a manner consistent with principles of
36effectiveness, cost efficiency, relevance to community needs,
37maximal impact to improve community health, and sustainability
38of impact over time.
39(e) (1) Based on the results of programs supported by this part
40and any other proven methodologies available to the advisory
P15 1committee, the advisory committee shall produce a comprehensive
2master plan for advancing chronic disease and injury prevention
3throughout the state.
4(2) The master plan shall include recommended implementation
5strategies for each priority chronic health condition throughout the
6state and identify areas where innovative solutions are especially
8(3) The advisory committee shall submit the master plan, and
9revisions to the master plan, to the Legislature triennially.
10(4) The master plan and its revisions shall include
11recommendations on specific goals for reduction of the burden of
12preventable chronic conditions and injuries by 2030, administrative
13arrangements, funding priorities, integration and coordination of
14approaches by the department, the University of California, the
15Health in All Policies Task Force, and their support systems, and
16progress reports relating to each health equity priority population.
17(5) A report submitted pursuant to paragraph (3) shall be
18submitted in compliance with Section 9795 of the Government
Implementation of this part shall be contingent on an
15appropriation provided for this purpose in the annual Budget Act
16or other measure.