Latest news with #NationalCenterforChronicDiseasePreventionandHealthPromotion
Gulf Today
07-07-2025
- Health
- Gulf Today
The ‘MAHA Report' calls for fighting chronic disease
David Hilzenrath, Tribune News Service The Trump administration has declared that it will aggressively combat chronic disease in America. Yet in its feverish purge of federal health programs, it has proposed eliminating the National Center for Chronic Disease Prevention and Health Promotion and its annual funding of $1.4 billion. That's one of many disconnects between what the administration says about health — notably, in the 'MAHA Report' that President Donald Trump recently presented at the White House — and what it's actually doing, scientists and public health advocates say. Among other contradictions: • The report says more research is needed on health-related topics such as chronic diseases and the cumulative effects of chemicals in the environment. But the Trump administration's mass cancellation of federal research grants to scientists at universities, including Harvard, has derailed studies on those subjects. • The report denounces industry-funded research on chemicals and health as widespread and unreliable. But the administration is seeking to cut government funding that could serve as a counterweight. • The report calls for 'fearless gold-standard science.' But the administration has sowed widespread fear in the scientific world that it is out to stifle or skew research that challenges its desired conclusions. 'There are many inconsistencies between rhetoric and action,' said Alonzo Plough, chief science officer at the Robert Wood Johnson Foundation, a philanthropy focused on health. The report, a cornerstone of President Donald Trump's 'Make America Healthy Again' agenda, was issued by a commission that includes Secretary of Health and Human Services Robert F. Kennedy Jr. and other top administration officials. News organisations found that it footnoted nonexistent sources and contained signs that it was produced with help from artificial intelligence. White House Press Secretary Karoline Leavitt described the problems as 'formatting issues,' and the administration revised the report. Trump ordered the report to assess causes of a 'childhood chronic disease crisis.' His commission is now working on a plan of action. Spokespeople for the White House and Department of Health and Human Services did not respond to questions for this article. The MAHA report says environmental chemicals may pose risks to children's health. Citing the National Institutes of Health, it said there's a 'need for continued studies from the public and private sectors, especially the NIH, to better understand the cumulative load of multiple exposures and how it may impact children's health.' Meanwhile, the administration has cut funding for related studies. For example, in 2020 the Environmental Protection Agency asked scientists to propose ways of researching children's exposure to chemicals from soil and dust. It said that, for kids ages 6 months to 6 years, ingesting particulates — by putting their hands on the ground or floor then in their mouths — could be a significant means of exposure to contaminants such as herbicides, pesticides, and a group of chemicals known as PFAS. One of the grants — for almost $1.4 million over several years — went to a team of scientists at Johns Hopkins University and the University of California-San Francisco. Researchers gained permission to collect samples from people's homes, including dust and diapers. But, beyond a small test run, they didn't get to analyse the urine and stool samples because the grant was terminated this spring, said study leader Keeve Nachman, a professor of environmental health and engineering at Hopkins. 'The objectives of the award are no longer consistent with EPA funding priorities,' the agency said in a May 10 termination notice. Another EPA solicitation from 2020 addressed many of the issues the MAHA report highlighted: cumulative exposures to chemicals and developmental problems such as attention-deficit/hyperactivity disorder, obesity, anxiety, and depression. One of the resulting grants funded the Center for Early Life Exposures and Neurotoxicity at the University of North Carolina-Chapel Hill. That grant was ended weeks early in May, said the center's director, Stephanie Engel, a UNC professor of epidemiology. In a statement, EPA press secretary Brigit Hirsch said the agency 'is continuing to invest in research and labs to advance the mission of protecting human health and the environment.' Due to an agency reorganisation, 'the way these grants are administered will be different going forward,' said Hirsch, who did not otherwise answer questions about specific grants. In its battle with Harvard, the Trump administration has stopped paying for research the NIH had commissioned on topics such as how autism might be related to paternal exposure to air pollution. The loss of millions of dollars of NIH funding has also undermined data-gathering for long-term research on chronic diseases, Harvard researchers said. A series of projects with names like Nurses' Health Study II and Nurses' Health Study 3 have been tracking thousands of people for decades and aimed to keep tracking them as long as possible as well as enrolling new participants, even across generations. The work has included periodically surveying participants — mainly nurses and other health professionals who enrolled to support science — and collecting biological samples such as blood, urine, stool, or toenail clippings. Researchers studying health problems such as autism, ADHD, or cancer could tap the data and samples to trace potential contributing factors, said Francine Laden, an environmental epidemiologist at Harvard's TH Chan School of Public Health. The information could retrospectively reveal exposures before people were born — when they were still in utero — and exposures their parents experienced before they were conceived. Harvard expected that some of the grants wouldn't be renewed, but the Trump administration brought ongoing funding to an abrupt end, said Walter Willett, a professor of epidemiology and nutrition at the Chan school.
CNN
01-07-2025
- Health
- CNN
‘MAHA Report' calls for fighting chronic disease, but Trump and Kennedy have yanked funding
The Trump administration has declared that it will aggressively combat chronic disease in America. Yet in its feverish purge of federal health programs, it has proposed eliminating the National Center for Chronic Disease Prevention and Health Promotion and its annual funding of $1.4 billion. That's one of many disconnects between what the administration says about health — notably, in the 'MAHA Report' that President Donald Trump recently presented at the White House — and what it's actually doing, scientists and public health advocates say. Among other contradictions: The report says more research is needed on health-related topics such as chronic diseases and the cumulative effects of chemicals in the environment. But the Trump administration's mass cancellation of federal research grants to scientists at universities, including Harvard, has derailed studies on those subjects. The report denounces industry-funded research on chemicals and health as widespread and unreliable. But the administration is seeking to cut government funding that could serve as a counterweight. The report calls for 'fearless gold-standard science.' But the administration has sowed widespread fear in the scientific world that it is out to stifle or skew research that challenges its desired conclusions. 'There are many inconsistencies between rhetoric and action,' said Alonzo Plough, chief science officer at the Robert Wood Johnson Foundation, a philanthropy focused on health. The report, a cornerstone of President Donald Trump's 'Make America Healthy Again' agenda, was issued by a commission that includes Secretary of Health and Human Services Robert F. Kennedy Jr. and other top administration officials. News organizations found that it footnoted nonexistent sources and contained signs that it was produced with help from artificial intelligence. White House Press Secretary Karoline Leavitt described the problems as 'formatting issues,' and the administration revised the report. Trump ordered the report to assess causes of a 'childhood chronic disease crisis.' His commission is now working on a plan of action. Spokespeople for the White House and Department of Health and Human Services did not respond to questions for this article. The MAHA report says environmental chemicals may pose risks to children's health. Citing the National Institutes of Health, it said there's a 'need for continued studies from the public and private sectors, especially the NIH, to better understand the cumulative load of multiple exposures and how it may impact children's health.' Meanwhile, the administration has cut funding for related studies. For example, in 2020 the Environmental Protection Agency asked scientists to propose ways of researching children's exposure to chemicals from soil and dust. It said that, for kids ages 6 months to 6 years, ingesting particulates — by putting their hands on the ground or floor then in their mouths — could be a significant means of exposure to contaminants such as herbicides, pesticides, and a group of chemicals known as PFAS. One of the grants — for almost $1.4 million over several years — went to a team of scientists at Johns Hopkins University and the University of California-San Francisco. Researchers gained permission to collect samples from people's homes, including dust and diapers. But, beyond a small test run, they didn't get to analyze the urine and stool samples because the grant was terminated this spring, said study leader Keeve Nachman, a professor of environmental health and engineering at Hopkins. 'The objectives of the award are no longer consistent with EPA funding priorities,' the agency said in a May 10 termination notice. Another EPA solicitation from 2020 addressed many of the issues the MAHA report highlighted: cumulative exposures to chemicals and developmental problems such as attention-deficit/hyperactivity disorder, obesity, anxiety, and depression. One of the resulting grants funded the Center for Early Life Exposures and Neurotoxicity at the University of North Carolina-Chapel Hill. That grant was ended weeks early in May, said the center's director, Stephanie Engel, a UNC professor of epidemiology. In a statement, EPA press secretary Brigit Hirsch said the agency 'is continuing to invest in research and labs to advance the mission of protecting human health and the environment.' Due to an agency reorganization, 'the way these grants are administered will be different going forward,' said Hirsch, who did not otherwise answer questions about specific grants. In its battle with Harvard, the Trump administration has stopped paying for research the NIH had commissioned on topics such as how autism might be related to paternal exposure to air pollution. The loss of millions of dollars of NIH funding has also undermined data-gathering for long-term research on chronic diseases, Harvard researchers said. A series of projects with names like Nurses' Health Study II and Nurses' Health Study 3 have been tracking thousands of people for decades and aimed to keep tracking them as long as possible as well as enrolling new participants, even across generations. The work has included periodically surveying participants — mainly nurses and other health professionals who enrolled to support science — and collecting biological samples such as blood, urine, stool, or toenail clippings. Researchers studying health problems such as autism, ADHD, or cancer could tap the data and samples to trace potential contributing factors, said Francine Laden, an environmental epidemiologist at Harvard's T.H. Chan School of Public Health. The information could retrospectively reveal exposures before people were born — when they were still in utero — and exposures their parents experienced before they were conceived. Harvard expected that some of the grants wouldn't be renewed, but the Trump administration brought ongoing funding to an abrupt end, said Walter Willett, a professor of epidemiology and nutrition at the Chan school. As a result, researchers are scrambling to find money to keep following more than 200,000 people who enrolled in studies beginning in the 1980s — including children of participants who are now adults themselves — and to preserve about 2 million samples, Willett said. 'So now our ability to do exactly what the administration wants to do is jeopardized,' said Jorge Chavarro, a professor of nutrition and epidemiology at the Chan school. 'And there's not an equivalent resource. It's not like you can magically recreate these resources without having to wait 20 or 30 years to be able to answer the questions' that the Trump administration 'wants answered now.' Over the past few months, the administration has fired or pushed out almost 5,000 NIH employees, blocked almost $3 billion in grant funding from being awarded, and terminated almost 2,500 grants totaling almost $5 billion, said Sen. Patty Murray (D-Wash.), vice chair of the Senate Appropriations Committee, at a June 10 hearing on the NIH budget. In addition, research institutions have been waiting months to receive money under grants they've already been awarded, Murray said. In canceling hundreds of grants with race, gender, or sexuality dimensions, the administration engaged in blatant discrimination, a federal judge ruled on June 16. After issuing the MAHA report, the administration published budget proposals to cut funding for the NIH by $17.0 billion, or 38%, the Centers for Disease Control and Prevention by $550 million, or 12%, and the EPA by $5 billion, or 54%. 'This budget reflects the President's vision of making Americans the healthiest in the world while achieving his goal of transforming the bureaucracy,' the HHS 'Budget in Brief' document says. Elements of Trump's proposed budget for the 2026 fiscal year clash with priorities laid out in the MAHA report. Kennedy has cited diabetes as part of a crisis in children's health. The $1.4 billion unit the White House has proposed to eliminate at the CDC — the National Center for Chronic Disease Prevention and Health Promotion — has housed a program to track diabetes in children, adolescents, and young adults. 'To say that you want to focus on chronic diseases' and then 'to, for all practical purposes, eliminate the entity at the Centers for Disease Control and Prevention which does chronic diseases,' said Georges Benjamin, executive director of the American Public Health Association, 'obviously doesn't make a lot of sense.' In a May letter, Office of Management and Budget Director Russell Vought listed the chronic disease center as 'duplicative, DEI, or simply unnecessary,' using an abbreviation for diversity, equity, and inclusion programs. Within the NIH, the White House has proposed cutting $320 million from the National Institute of Environmental Health Sciences, a reduction of 35%. That unit funds or conducts a wide array of research on issues such as chronic disease. Trump's budget proposes spending $500 million 'to tackle priority activities to Make America Healthy Again,' including $260 million for his new Administration for a Healthy America to address the 'chronic illness epidemic.' The MAHA report argues that corporate influence has compromised government agencies and public health through 'corporate capture.' It alleges that most research on chronic childhood diseases is funded by the food, pharmaceutical, and chemical industries, as well as special interest organizations and professional associations. It says, for example, that a 'significant portion of environmental toxicology and epidemiology studies are conducted by private corporations,' including pesticide manufacturers, and it cites 'potential biases in industry-funded research.' It's 'self-evident that cutbacks in federal funding leave the field open to the very corporate funding RFK has decried,' said Peter Lurie, president of the Center for Science in the Public Interest, a watchdog group focused on food and health. Lurie shared the report's concern about industry-funded research but said ceding ground to industry won't help. 'Industry will tend to fund those studies that look to them like they will yield results beneficial to industry,' he said. In search of new funding sources, Harvard's school of public health 'is now ramping up targeted outreach to potential corporate partners, with careful review to ensure the science meets the highest standards of research integrity,' Andrea Baccarelli, dean of the school's faculty, wrote in a June 11 letter to students, faculty, and others. 'It's just simple math that if you devastate governmental funding by tens of billions of dollars, then the percentage of industry funding dollars will go up,' said Plough, who is also a clinical professor at the University of Washington School of Public Health. 'So therefore, what they claim to fear more,' he said, will 'become even more influential.' The MAHA report says 'the U.S. government is committed to fostering radical transparency and gold-standard science.' But many scientists and other scholars see the Trump administration waging a war on science that conflicts with its agenda. In March, members of the National Academies of Sciences, Engineering, and Medicine accused the administration of 'destroying' scientific independence, 'engaging in censorship,' and 'pressuring researchers to alter or abandon their work on ideological grounds.' In May, NIH employees wrote that the administration was politicizing research — for example, by halting or censoring work on health disparities, health impacts of climate change, gender identity, and immunizations. Recent comments by Kennedy pose another threat to transparency, researchers and health advocates say. Kennedy said on a podcast that he would probably create in-house government journals and stop NIH scientists from publishing their research in The Lancet, The New England Journal of Medicine, The Journal of the American Medical Association, and others. Creating new government outlets for research would be a plus, said Dariush Mozaffarian, director of the Food is Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University. But confining government scientists to government journals, he said, 'would be a disaster' and 'would basically amount to censorship.' 'That's just not a good idea for science,' Mozaffarian said. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Boston Globe
03-05-2025
- Health
- Boston Globe
Trump budget cuts funding for chronic disease prevention
Of the proposed cuts, she said, 'How do you reconcile that with trying to make America healthy again?' Advertisement The federal health department last month cut 2,400 jobs from the CDC, whose National Center for Chronic Disease Prevention and Health Promotion runs on the largest budget within the agency. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up Programs on lead poisoning, smoking cessation and reproductive health were jettisoned in a reorganization last month. Overall, the proposed budget would cut the CDC's funding to about $4 billion, compared with $9.2 billion in 2024. The budget blueprint makes no mention of the Prevention and Public Health Fund, a $1.2 billion program. If that figure is taken into account, the cut may be even larger than Trump's proposal indicates. The agency would also lose a center focused on preventing injuries, including those caused by firearms, as well as programs for HIV surveillance and prevention, and grants to help states prepare for public health emergencies. Advertisement According to the proposed budget, the cuts are needed to eliminate 'duplicative, DEI, or simply unnecessary programs.' Congress draws up the U.S. budget, but given the Republican majority and its fealty to Trump, it is unclear how much the proposal will change. CDC officials had been told that the functions of the chronic disease center would be moved to a new agency within the health department called the Administration for a Healthy America. And the proposal released Friday appears to allocate $500 million to the health secretary in part 'to tackle nutrition, physical activity, healthy lifestyles, overreliance on medication and treatments.' But at the CDC, the chronic disease center's budget was nearly three times as large. And even if part of the chronic disease center is resuscitated in the AHA, it's unlikely that its new iteration would involve CDC scientists relocated from Atlanta. 'The actual subject-matter experts, who administer the programs, might not be there at CDC anymore,' said Dr. Scott Harris, state health officer at the Alabama Department of Public Health. 'We certainly don't have the same level of expertise in my state.' The Department of Health and Human Services did not respond to a request for comment. The CDC's chronic disease center ran programs aimed at preventing cancer, heart disease, diabetes, epilepsy and Alzheimer's disease. But the center has also seeded initiatives further afield, ranging from creating rural and urban hiking trails to ensuring that healthy options such as salads are offered in airports. It also promoted wellness programs in marginalized communities. Davis said her department was already reeling from cuts to programs to curb smoking and reduce lead poisoning and health disparities, as well as the rescinding of more than $11 billion that the CDC had been providing to state health departments. Advertisement 'I would take back COVID-19 in a heartbeat over what's happening right now,' Davis said. In the proposed budget, the administration suggested that the eliminated programs would be better managed by states. But state health departments already manage most chronic disease programs, and three-fourths of the CDC center's funding goes to support them. Loss of those funds 'would be devastating for us,' said Harris. Alabama has one of the highest rates of chronic diseases in the country, and about 84% of the public health department's budget comes from the CDC, Harris said. About $6 million goes to chronic disease programs, including blood pressure screening, nutrition education for diabetes and promotion of physical activity. If those funds are cut, 'I am at a loss right now to tell you where that would come from,' he added. 'It just seems that no one really knows what to expect, and we're not really being asked for any input on that.' Minnesota's vaunted health department has already laid off 140 employees, and hundreds more may be affected if more CDC funding is lost. Cuts to chronic disease prevention will affect nursing homes, vaccine clinics and public health initiatives for Native Americans in the state. 'The actions of the federal government have left us out on a flimsy limb with no safety net below us,' said Dr. Brooke Cunningham, the state's health commissioner. Until recently, 'there seemed to be a shared understanding at the local, state and federal level that health was important to invest in,' Cunningham said. The chronic disease center's work touches American lives in many unexpected ways. Advertisement In Prairie Village, Kansas, Stephanie Barr learned about the center 15 years ago when, working as a waitress with no health insurance, she discovered a lump in her breast the size of a lemon. Through the CDC's National Breast and Cervical Cancer Early Detection Program, she was able to get a mammogram and an ultrasound, and staff members helped her enroll in Medicaid for treatment after a biopsy determined the lump was malignant, Barr said. 'It was caught in the nick of time,' said Barr, now 45 and cancer free. (STORY CAN END HERE. OPTIONAL MATERIAL FOLLOWS.) Since that program began in 1991, it has provided more than 16.3 million screening exams to more than 6.3 million people with no other affordable access, said Lisa Lacasse, president of the American Cancer Society Cancer Action Network. The organization is one of 530 health associations that have signed a petition asking lawmakers to reject the proposed HHS budget, which cuts the department's discretionary spending by about one-third. The signatories said the cuts would 'effectively devastate' the nation's research and public health infrastructure. The budget also proposes dismantling disease registries and surveillance systems. 'If you don't collect the information or keep these surveillance systems going, you don't know what's happening, you don't know what the trends are,' said Dr. Philip Huang, director of Dallas County Health and Human Services. 'You're losing all of that history,' he said. In a previous position as director of chronic diseases for Texas, Huang said he worked closely with CDC experts who successfully reduced tobacco use among Americans. 'Eliminating the Office on Smoking and Health is just craziness if you're still wanting to address chronic diseases,' he said. Advertisement Smoking is still the leading cause of preventable death in the United States, causing more than 480,000 deaths each year, according to the CDC. More than 1 in 10 American adults still smoke cigarettes regularly, but rates vary drastically by region, and CDC surveillance helps target cessation programs to areas where they are needed most. 'Smoking rates have come down, but if the federal government takes its foot off the gas, the tobacco companies are ready to pop back up again,' said Erika Sward, assistant vice president for advocacy for the American Lung Association. She warned that tobacco companies are constantly developing new products such as nicotine pouches, whose use by teenagers doubled last year. 'It will take a lot more money to put the genie back in the bottle,' she said. The CDC's chronic disease center works with communities and academic centers to promote effective programs, from creating quitting hotlines to reach young Iowans in rural areas to training members of Black churches in Columbia, South Carolina, to lead exercise and nutrition classes for their congregations. In rural Missouri, dozens of walking trails have been developed in the 'boot heel' in the southeastern part of the state, an area with high rates of obesity and diabetes, said Ross Brownson, a public health researcher at Washington University in St. Louis who directs the Prevention Research Center in collaboration with the CDC. 'There's strong evidence now that if you change the walkability of a community, people will get more physical activity,' Brownson said. 'There aren't going to be health clubs in rural communities, but there is nature and the ability to have walking trails, and land is relatively cheap.' Advertisement With CDC support, in Rochester, New York, people who are deaf and hard of hearing are being trained to lead exercise and wellness programs for other hearing-impaired people who can't easily participate in other gym classes. In San Diego, researchers are testing ways to protect farmworkers from exposure to ultraviolet rays and heat-related illnesses. 'Once they are up and started, they are community-driven and don't depend on the government,' said Allison Bay, who recently lost her job managing such projects at the CDC. The CDC's reorganization also eliminated lead-poisoning programs. Lead poisoning is also 'one of our greatest public health threats in the city of Cleveland,' said Dr. David Margolius, director of public health for the city. The CDC does not directly fund Cleveland's lead programs -- the funding comes from the state. 'But just having the federal expertise to call on to help lead us toward a lead-free future, I mean, yeah, that has a big impact on us,' he said. This article originally appeared in
New York Times
02-05-2025
- Health
- New York Times
Trump Budget Cuts Funding for Chronic Disease Prevention
Robert F. Kennedy Jr., the nation's health secretary, has said that tackling a chronic disease 'epidemic' would be a cornerstone of his Make America Healthy Again agenda, often invoking alarming statistics as an urgent reason for reforming public health in this country. On Friday, President Trump released a proposed budget that called for cutting the funding of the Centers for Disease Control and Prevention by almost half. Its chronic disease center was slated for elimination entirely, a proposal that came as a shock to many state and city health officials. 'Most Americans have some sort of ailment that could be considered chronic,' said Dr. Matifadza Hlatshwayo Davis, health director for the city of St. Louis. Of the proposed cuts, she said, 'How do you reconcile that with trying to make America healthy again?' The federal health department last month cut 2,400 jobs from the Centers for Disease Control and Prevention, whose National Center for Chronic Disease Prevention and Health Promotion runs on the largest budget within the agency. Programs on lead poisoning, smoking cessation and reproductive health were jettisoned in a reorganization last month. Overall, the proposed budget would cut the C.D.C.'s budget to about $4 billion, compared with $9.2 billion in 2024. The budget blueprint makes no mention of the Prevention and Public Health Fund, a $1.2 billion program. If that figure is taken into account, the cut may be even larger than Mr. Trump's proposal indicates. The agency would also lose a center focused on preventing injuries, including those caused by firearms, as well as programs for H.I.V. surveillance and prevention, and grants to help states prepare for public health emergencies. According to the proposed budget, the cuts are needed to eliminate 'duplicative, D.E.I., or simply unnecessary programs.' Congress draws up the U.S. budget, but given the Republican majority and its fealty to Mr. Trump, it is unclear how much the proposal will change. C.D.C. officials had been told that the functions of the chronic disease center would be moved to a new agency within the health department called the Administration for a Healthy America. And the proposal released on Friday appears to allocate $500 million to the health secretary in part 'to tackle nutrition, physical activity, healthy lifestyles, overreliance on medication and treatments.' But at the C.D.C., the chronic disease center's budget was nearly three times as large. And even if part of the chronic disease center is resuscitated in the A.H.A., it's unlikely that its new iteration would involve C.D.C. scientists relocated from Atlanta. 'The actual subject-matter experts, who administer the programs, might not be there at C.D.C. anymore,' said Dr. Scott Harris, state health officer at the Alabama Department of Public Health. 'We certainly don't have the same level of expertise in my state.' The department of Health and Human Services did not respond to a request for comment. The C.D.C.'s chronic disease center ran programs aimed at preventing cancer, heart disease, diabetes, epilepsy and Alzheimer's disease. But the center has also seeded initiatives farther afield, ranging from creating rural and urban hiking trails to ensuring that healthy options like salads are offered in airports. It also promoted wellness programs in marginalized communities. Dr. Davis, the health director in St. Louis, said her department was already reeling from cuts to programs to curb smoking and reduce lead poisoning and health disparities, as well as the rescinding of more than $11 billion that the C.D.C. had been providing to state health departments. 'I would take back Covid-19 in a heartbeat over what's happening right now,' Dr. Davis said. In the proposed budget, the administration suggested that the eliminated programs would be better managed by states. But state health departments already manage most chronic disease programs, and three-quarters of the C.D.C. center's funding goes to support them. Loss of those funds 'would be devastating for us,' said Dr. Harris, the health officer in Alabama. The state has one of the highest rates of chronic diseases in the country, and about 84 percent of the public health department's budget comes from the C.D.C., Dr. Harris said. About $6 million goes to chronic disease programs, including blood pressure screening, nutrition education for diabetes and promotion of physical activity. If those funds are cut, 'I am at a loss right now to tell you where that would come from,' he added. 'It just seems that no one really knows what to expect, and we're not really being asked for any input on that.' Minnesota's vaunted health department has already laid off 140 employees, and hundreds more may be affected if more C.D.C. funding is lost. Cuts to chronic disease prevention will affect nursing homes, vaccine clinics and public health initiatives for Native Americans in the state. 'The actions of the federal government have left us out on a flimsy limb with no safety net below us,' said Dr. Brooke Cunningham, the state's health commissioner. Until recently, 'there seemed to be a shared understanding at the local, state and federal level that health was important to invest in,' Dr. Cunningham said. The chronic disease center's work touches American lives in many unexpected ways. In Prairie Village, Kan., Stephanie Barr learned about the center 15 years ago when, working as a waitress with no health insurance, she discovered a lump in her breast the size of a lemon. Through the C.D.C.'s National Breast and Cervical Cancer Early Detection Program, she was able to get a mammogram and an ultrasound, and staff members helped her enroll in Medicaid for treatment after a biopsy determined the lump was malignant, Ms. Barr said. 'It was caught in the nick of time,' said Ms. Barr, now 45 and cancer free. Since that program began in 1991, it has provided more than 16.3 million screening exams to more than 6.3 million people with no other affordable access, said Lisa Lacasse, president of the American Cancer Society Cancer Action Network. The organization is one of 530 health associations that have signed a petition asking lawmakers to reject the proposed H.H.S. budget, which cuts the department's discretionary spending by about one-third. The signatories said the cuts would 'effectively devastate' the nation's research and public health infrastructure. The budget also proposes dismantling disease registries and surveillance systems. 'If you don't collect the information or keep these surveillance systems going, you don't know what's happening, you don't know what the trends are,' said Dr. Philip Huang, director of Dallas County Health and Human Services. 'You're losing all of that history,' he said. In a previous position as director of chronic diseases for Texas, Dr. Huang said he worked closely with C.D.C. experts who successfully reduced tobacco use among Americans. 'Eliminating the Office on Smoking and Health is just craziness if you're still wanting to address chronic diseases,' he said. Smoking is still the leading cause of preventable death in the United States, causing more than 480,000 deaths each year, according to the C.D.C. More than one in 10 American adults still smoke cigarettes regularly, but rates vary drastically by region, and C.D.C. surveillance helps target cessation programs to areas where they are needed most. 'Smoking rates have come down, but if the federal government takes its foot off the gas, the tobacco companies are ready to pop back up again,' said Erika Sward, assistant vice president for advocacy for the American Lung Association. She warned that tobacco companies are constantly developing new products like nicotine pouches, whose use by teenagers doubled last year. 'It will take a lot more money to put the genie back in the bottle,' she said. The C.D.C.'s chronic disease center works with communities and academic centers to promote effective programs, from creating quitting hotlines to reach young Iowans in rural areas to training members of Black churches in Columbia, S.C., to lead exercise and nutrition classes for their congregations. In rural Missouri, dozens of walking trails have been developed in the 'boot heel' in the southeastern part of the state, an area with high rates of obesity and diabetes, said Ross Brownson, a public health researcher at Washington University in St. Louis who directs the Prevention Research Center in collaboration with the C.D.C. 'There's strong evidence now that if you change the walkability of a community, people will get more physical activity,' Dr. Brownson said. 'There aren't going to be health clubs in rural communities, but there is nature and the ability to have walking trails, and land is relatively cheap.' With C.D.C. support, in Rochester, N.Y., people who are deaf and hard-of-hearing are being trained to lead exercise and wellness programs for other hearing-impaired people who can't easily participate in other gym classes. In San Diego, researchers are testing ways to protect farm workers from exposure to ultraviolet rays and heat-related illnesses. 'Once they are up and started, they are community-driven and don't depend on the government,' said Allison Bay, who recently lost her job managing such projects at the C.D.C. The C.D.C.'s reorganization also eliminated lead poisoning programs. Lead poisoning is also 'one of our greatest public health threats in the city of Cleveland,' said Dr. David Margolius, director of public health for the city. The C.D.C. does not directly fund Cleveland's lead programs — the funding comes from the state. 'But just having the federal expertise to call on to help lead us toward a lead-free future, I mean, yeah, that has a big impact on us,' he said.
