Robert F. Kennedy Jr., the U.S. health secretary, has emphasized that addressing a widespread chronic disease “epidemic” will be a key focus of his Make America Healthy Again strategy, frequently citing disturbing statistics as a critical reason for overhauling public health in the nation.
On Friday, President Trump unveiled a proposed budget aiming to reduce funding for the Centers for Disease Control and Prevention (C.D.C.) by nearly 50%. This plan included completely eliminating its chronic disease center, a move that caught many state and municipal health leaders off guard.
“Many Americans are coping with some type of chronic condition,” stated Dr. Matifadza Hlatshwayo Davis, health director for St. Louis.
She questioned, “How can this align with the goal of making America healthier?”
Last month, the federal health department slashed 2,400 jobs from the C.D.C., which oversees the National Center for Chronic Disease Prevention and Health Promotion, the biggest budget within the agency.
Several initiatives, including those addressing lead poisoning, smoking cessation, and reproductive health, were eliminated during a recent reorganization.
Overall, President Trump’s budget proposes cutting C.D.C. funding to approximately $4 billion, down from $9.2 billion in 2024.
The budget details do not mention the Prevention and Public Health Fund, which amounts to $1.2 billion. Considering this factor, the cuts might be more extensive than indicated in Trump’s proposal.
The agency would also forfeit a center dedicated to injury prevention, including firearm-related injuries, along with HIV surveillance and prevention programs, plus grants to aid states in readiness for public health emergencies.
As per the proposed budget, the reductions are necessary to eliminate “overlapping, D.E.I., or simply unnecessary programs.” While Congress ultimately drafts the federal budget, questions arise regarding how much Trump’s proposal will actually change given the Republican majority’s commitment to him.
C.D.C. officials were informed that the functions of the chronic disease center would be transferred to a new entity within the health department called the Administration for a Healthy America.
Moreover, the proposal from Friday seems to designate $500 million to the health secretary with an aim to address nutrition, physical fitness, healthy lifestyles, over-dependence on medications, and treatments.
However, the budget of the chronic disease center at C.D.C. was nearly three times bigger. Even if parts of this center are revived within the A.H.A., it’s unlikely that C.D.C. scientists would be relocated from Atlanta to the new agency.
“The experts who run these programs might no longer be with C.D.C.,” remarked Dr. Scott Harris, Alabama’s state health officer. “Our state lacks the same level of expertise.”
The Department of Health and Human Services has not provided comments upon request.
C.D.C.’s chronic disease center has administered programs that tackled cancer, heart disease, diabetes, epilepsy, and Alzheimer’s disease. Additionally, it has initiated various projects, such as creating hiking trails in both urban and rural areas, and ensuring that healthy food options, like salads, are available at airports. They’ve also encouraged wellness initiatives in underrepresented communities.
Dr. Davis mentioned that her department is already struggling with cuts to programs fighting smoking, reducing lead exposure, and addressing health disparities, in addition to losing over $11 billion that the C.D.C. previously allocated to state health departments.
“I would gladly face Covid-19 again rather than deal with the current situation,” Dr. Davis stated.
In the proposed budget, the administration claimed that the discontinued programs could be managed more effectively by states. However, state health departments already oversee most chronic disease initiatives, and approximately three-quarters of the C.D.C. center’s funding is directed towards them.
The loss of this funding “would be catastrophic for us,” Dr. Harris emphasized.
Alabama faces some of the highest chronic disease rates nationwide, with about 84% of the public health department’s budget sourced from the C.D.C., according to Dr. Harris. Nearly $6 million is allocated to chronic disease initiatives, covering blood pressure screenings, diabetes nutrition education, and physical activity promotion.
If that funding disappears, “I currently can’t imagine where we would find the resources,” he stated. “It feels like there’s little clarity on what to expect, and we aren’t being consulted on this matter.”
Minnesota’s renowned health department has already reduced its workforce by 140 employees, with more layoffs likely if C.D.C. funding continues to decline. Cuts in chronic disease prevention will impact nursing homes, vaccine clinics, and public health services for Native Americans in the region.
“The federal government’s actions have left us hanging without any support,” said Dr. Brooke Cunningham, the health commissioner for Minnesota.
Recently, “there appeared to be a mutual understanding at local, state, and federal levels that investing in health was crucial,” said Dr. Cunningham.
The work of the C.D.C. chronic disease center impacts many areas of American life in surprising ways.
In Prairie Village, Kansas, Stephanie Barr first learned about the center 15 years ago when, working as a waitress without health insurance, she discovered a breast lump the size of a lemon.
Thanks to the C.D.C.’s National Breast and Cervical Cancer Early Detection Program, she received a mammogram, ultrasound, and assistance enrolling in Medicaid for treatment after a biopsy confirmed the lump to be malignant, according to Ms. Barr.
“It was detected just in time,” said Ms. Barr, now 45 and cancer-free.
Since that program…
Since its inception in 1991, the organization has administered over 16.3 million screening tests to more than 6.3 million individuals who lack affordable access, according to Lisa Lacasse, president of the American Cancer Society Cancer Action Network.
This group is among 530 health organizations that have urged lawmakers to oppose the proposed H.H.S. budget, which aims to reduce discretionary spending by nearly one-third. The organizations warn that these cuts would “effectively devastate” the country’s research and public health infrastructure.
The budget additionally suggests the elimination of disease registries and monitoring systems.
“If you don’t gather data or maintain these monitoring systems, you lose track of what’s happening and can’t identify trends,” stated Dr. Philip Huang, head of Dallas County Health and Human Services in Texas.
“You lose all that historical context,” he remarked.
In his former role as director of chronic diseases in Texas, Dr. Huang collaborated closely with C.D.C. specialists who effectively decreased tobacco use among Americans.
“Abolishing the Office on Smoking and Health is utterly nonsensical if you aim to tackle chronic diseases,” he emphasized.
Cigarette smoking remains the top cause of preventable deaths in the U.S., leading to over 480,000 fatalities annually, as reported by the C.D.C.
Currently, over 10% of American adults are regular smokers, though the rates differ significantly across regions, and C.D.C. surveillance is crucial for targeting cessation efforts where they’re most needed.
“While smoking rates have declined, if the federal government eases regulations, tobacco companies will be ready to rebound,” warned Erika Sward, assistant vice president for advocacy at the American Lung Association.
She cautioned that tobacco firms are continuously innovating products like nicotine pouches, which saw a significant increase in use among teenagers last year. “It would require substantial resources to reverse this trend,” she stated.
The C.D.C.’s chronic disease center collaborates with communities and academic institutions to implement effective initiatives, from establishing quitting hotlines aimed at young individuals in rural Iowa to training members of Black churches in Columbia, S.C., to conduct exercise and nutrition sessions for their congregants.
In rural Missouri, several walking trails have been developed in the southeastern “boot heel” region, an area known for high obesity and diabetes rates, noted Ross Brownson, a public health researcher at Washington University in St. Louis, who leads the Prevention Research Center in partnership with the C.D.C.
“There is strong evidence that enhancing a community’s walkability encourages residents to engage in more physical activity,” explained Dr. Brownson. “While health clubs may be scarce in rural areas, access to nature and affordable land for walking trails is abundant.”
With assistance from the C.D.C., individuals who are deaf or hard-of-hearing in Rochester, N.Y., are being trained to facilitate exercise and wellness programs tailored for those with similar hearing impairments who may face barriers to conventional gym classes.
In San Diego, researchers are exploring methods to safeguard farm workers from harmful ultraviolet radiation and heat-related illnesses.
“Once these initiatives are established, they are driven by the community and do not rely on government support,” remarked Allison Bay, who recently lost her job managing such projects at the C.D.C.
The C.D.C.’s restructuring has also led to the discontinuation of lead poisoning initiatives. Lead poisoning is considered “one of our greatest public health threats in Cleveland,” according to Dr. David Margolius, the city’s public health director.
Though the C.D.C. does not directly finance Cleveland’s lead programs—funding instead comes from the state—Dr. Margolius highlighted the significant impact of having federal expertise available to assist in achieving a lead-free future.
