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PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT
A Critical Public Health Resource

At A Glance 2009

The Role of Block Grant Funding

In 1981, Congress authorized the Preventive Health and Health Services (PHHS) Block Grant. The PHHS Block Grant gives its 61 grantees—which include the 50 states and the District of Columbia, 2 American Indian tribes, and 8 U.S. territories—the autonomy and flexibility to tailor prevention and health promotion programs to their particular public health needs. States are expected to align their programs with Healthy People 2010 national health goals.

As a critical public health resource, the PHHS Block Grant supports the following activities:

• Addresses basic health issues such as fluoridating water supplies, improving food safety, and preventing falls among older adults.
   
• Responds rapidly to emerging health threats in states.
   
• Funds critical prevention efforts to address specific health issues, such as skin cancer, child safety, and untreated dental decay, that lack categorical state funding.
   
• Protects investments in and enhances the effectiveness of categorically funded programs that address specific health problems.
   
• Leverages other resources of money for greater preventive health impact.

Flexible Funding for Public Health Efforts

The health needs of communities are diverse, complex, and constantly changing. The PHHS Block Grant gives its grantees the flexibility to target funds to prevent and control chronic diseases such as heart disease, diabetes, and arthritis and helps them to respond quickly to outbreaks of foodborne infections and waterborne diseases. The PHHS Block Grant provides funding to grantees that can be tailored to address their particular public health needs and challenges.

Funding Local Communities

The PHHS Block Grant is the major source of funding that CDC provides to public health agencies to address health needs and problems such as immunization, tuberculosis, cancer, and cardiovascular disease. The PHHS Block Grant is a significant source of funding for health promotion and disease and injury prevention in communities across the nation. However, grantees do not have adequate funding to combat all the leading causes of illness, disability, injury, and death in their states.

In Fiscal Year 2008 (FY 2008), approximately 43% of PHHS Block Grant funds were distributed by the states to local entities to address county and local public health needs.

For example, Maryland has given $67,000 of its PHHS Block Grant funding to local health departments to use the American Diabetes Association Risk Assessment Tool to refer at-risk adults to a health care provider and risk-reduction activities in the community. Funds are also awarded to local health departments to provide diabetes self-management education classes to adults with diabetes who could not otherwise afford such services.

Leveraging Block Grant Funds

PHHS Block Grant funds also have provided start-up money for programs that are now supported by other sources. As these programs have become self-sustaining, PHHS Block Grant funds have been redirected to other public health priorities.

For example, falls are the primary cause of injury leading to death for older adults. Many seniors who experience fear of falling restrict their activities. A Matter of Balance: Managing Concerns About Falls is an evidence-based model developed by Boston University that uses community lay leaders to teach older adults practical strategies to reduce their fear and increase their activity levels. Using 2008 PHHS Block Grant funds, Kentucky selected six counties to test strategies outlined in A Matter of Balance. The program was so successful that the state allocated $90,000 from a Kentucky osteoporosis program to increase the number of trainers and facilitators statewide.

Meeting Health Care Needs When No Other Funds Exist

Tooth decay can affect a person’s quality of life, causing pain, difficulty in eating, and weight loss. Community water fluoridation helps prevent tooth decay safely and effectively. Florida used its PHHS Block Grant funds to initiate the Fluoridation Project, which provides technical assistance to communities making fluoridation available through their local water systems. In 2008, 77.6% of Florida’s residents had access to fluoridated water. The program also provides funding to educate community members and other decision makers about the benefits of fluoridation. Before the program’s inception in 2007, only 25% of Florida’s residents received fluoridated water.

In California, PHHS Block Grant dollars provided the primary funding for Project Lean, a program that was instrumental in changing school nutrition policies. As a result of the project, two landmark policies that address food and beverage standards in California schools were passed. The first policy limits the total fat, saturated fat, sugar, and calories allowed in foods sold outside the Federal Food Programs to students at California public elementary, middle, and high schools. The second policy restricts the sale of soft drinks on California high school campuses. This policy builds on a previous state policy that had addressed soft drink sales only in elementary and middle schools.

In Nebraska, the PHHS Block Grant-funded Diabetes Program focuses on preventing diabetes-related death and disability and eliminating the risk factors that lead to the development of type 2 diabetes in Nebraska’s minority population. PHHS Block Grant funds expand the services provided by the Nebraska Department of Health and Human Services’ Nebraska Diabetes Prevention
and Control Program (NDPCP). The funds allow the NDPCP to contract with providers of care for minority populations and people with low-incomes and with a school that has developed a nutrition and physical activity program to help prevent diabetes in Native American children.

Block Grant Management Information System

The PHHS Block Grant Application and Reporting System (GARS) has been used for over 10 years to track grantees’ progress toward achieving their objectives. The system is one of CDC’s first electronic grants management systems.

However, current CDC, grantee, and national needs require a more flexible and accessible system to meet stakeholders’ demands. As a result, CDC developed the Web-based Block Grant Management Information System (BGMIS) to replace GARS. In 2008, CDC successfully transitioned the PHHS Block Grant from GARS to the BGMIS.

The new system provides improved accessibility and usability of grantee information and integrates critical PHHS Block Grant information. The BGMIS captures and reports on federal block grant work plans and other information submitted by grantees each fiscal year. The system contains current data
on the grantees’ reporting requirements and work plans.

In 2009, CDC will expand the system to collect information on performance measures, annual progress reports linked to performance measures, success stories demonstrating health outcomes, and compliance review information. The BGMIS also will be enhanced to streamline data collection and support national evaluation, monitoring, communication, and dissemination efforts for the PHHS Block Grant.

Future Directions

In 2008, CDC, PHHS Block Grant State Representatives, the National Association of Chronic Disease Directors (NACDD), the Association of State and Territorial Health Officials (ASTHO), the Directors of Health Promotion and Education (DHPE), and other partners convened on two occasions to discuss ways to increase support for sustaining and expanding the PHHS Block Grant. At the meeting sponsored by ASTHO, senior state public health agency leadership and ASTHO affiliate representatives recommended making the PHHS Block Grant more accountable and innovative by better defining its goals and parameters and building a stronger constituency.

NACDD convened a 2-day meeting with representation from DHPE, NACDD, CDC, PHHS Block Grant states, Emergency Medical Services, and past block grant leadership to address ASTHO’s recommendations and identify next steps. The participants identified national overarching goals for the PHHS Block Grant and recommended that the Block Grant (1) develop and implement an evaluation plan, (2) develop core performance measures based on the overarching goals, (3) increase monitoring and technical assistance to grantees, and (4) continue to improve grantee capacity to identify and use evidence-based guidelines and best practices to design and implement effective public health programs in communities across the country.

During the next 2 years, the PHHS Block Grant has placed a priority on engaging its partners to develop and implement an evaluation plan, develop and implement core performance measures, and increase monitoring and technical assistance to grantees. The PHHS Block Grant will continue to improve capacity and demonstrate its important contribution to public health.

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Success Stories

Texas

A large—and growing—number of residents of Williamson County, Texas, are at risk of developing life-threatening diseases such as diabetes and heart disease. Community nutrition surveys
confirm that residents of the central Texas county are eating foods that are low in nutrition and high in calories. In addition to a higher risk for premature death, an unhealthy diet is also associated with the burden of high cost on the medical care system.

To promote a healthy diet, Preventive Health and Health Services (PHHS) Block Grant funds were used to develop and implement the Community Garden and Nutrition Program, which encourages participants to grow and eat their own fresh seasonal fruits and vegetables. Williamson County and Cities Health District (WCCHD) formed partnerships with local volunteer organizations, cities, and school districts to establish the gardening program.

Using PHHS Block Grant funds, WCCHD hired a horticulturalist to lead the Community Garden and Nutrition Program. Since 2005, the horticulturalist has designed the first Expert Gardener Certification course, created a gardening education curriculum, and developed and taught “From the Garden to the Table/Del Jardín a la Mesa,” cooking and nutrition classes for both English- and Spanish-speaking participants. Participants who are gardening also are benefiting from low-impact physical activity.

The Community Garden and Nutrition Program has been successful in raising awareness among county residents about community gardening, improving nutrition, and increasing physical activity.

In particular, the program has

• Certified 165 Expert Gardener volunteers.
   
• Provided gardening, cooking, and nutrition classes to more than 400 participants.
   
• Donated more than 5,000 pounds of fresh, organic produce to local food pantries, Meals on Wheels, nursing homes, retirement facilities, and free lunch programs at a local senior center.
   
• Hosted field trips for about 1,700 preschool-aged children and 650 school-aged children.

Virginia

Chronic diseases are the leading causes of death for Virginians. It is estimated that 2.2 million Virginians live with one or more of the following chronic diseases: heart disease, stroke, cancer, asthma, diabetes, and arthritis. The annual cost of chronic disease in Virginia totals $24.6 billion; nationally, chronic disease annual costs represent approximately 75% of the nation’s $1.4 trillion annual health care costs.

Virginia is proactive about chronic disease prevention and control. Programs such as the Chronic Disease Self-Management Program (CDSMP) provide the information and resources needed to help reduce risks and promote healthier lifestyles. Since 2005, PHHS Block Grant funds have been used to bring this program to areas of the state that have a higher prevalence of heart disease, stroke, high blood pressure, and diabetes. In health districts across the state, the CDSMP coordinator recruits adults living with chronic diseases as well as their caregivers. Program participants complete a 6-week course that teaches self-management strategies such as medication management, pain management, and relaxation techniques.

Because the program offers strategies that promote self-management techniques, participants are improving their skills in managing their chronic diseases, using more self-management strategies, and adopting healthy lifestyle behaviors (e.g., increased walking, better diet, proper use of medications). Participants are also reporting a decrease in hospital visits, which could potentially save Virginia thousands of dollars in health care costs.

In 2006, CDSMP completed three leader trainings that resulted in 25 new leaders who are now teaching CDSMP in two health districts. Some program participants have become leaders. With continued support, CDSMP will help Virginians spend less time in the hospital and more time practicing self-management strategies to improve their health.

Kansas

Lawrence and Douglas Counties in Kansas are working to reduce the number of overweight and inactive children and adolescents. In 2001, Wakarusa Valley Elementary school in Lawrence became the first Douglas County school to launch Get Moving!, a program that encourages early prevention of obesity. With PHHS Block Grant funds, the Get Moving! program focuses on participation in physical activity outside the physical education program in schools, encourages families to exercise together (especially during the winter months), and aims to increase the percentage of children and families who participate in regular physical activity.

Program elements include the following:

• A supply of Get Moving! cards. Participants use the cards to detail up to 12.5 hours of physical activity recorded in 30-minute increments.
   
• Any type of physical activity done outside of school time may be recorded on the card.
   
• Participants receive extra points for involving a “buddy” (family or friend) in the activity.
   
• Participants record the days they consumed at least five fruits and vegetables.
   
• Prizes are awarded for the first three cards returned during the year. A pool pass to the indoor or outdoor Lawrence Aquatic Center is awarded when the fourth card is turned in.
   
• The class with the highest participation percentage wins a pool party.

 Over the past 5 years, the Get Moving! program has grown to include all 26 schools and educational service centers in Lawrence and 20 elementary schools in surrounding communities. During the 2004–2005 school year,

• The number of students completing at least four cards jumped from 256 to 753.
   
• Participants in the 1st–6th grades increased their physical activity, recorded in 30-minute increments, more than 6,000 hours.
   
• The number of cards turned in increased by 2,312.

A program that started in one Douglas county school has grown to become an effective and fun way for schools throughout the county to combat the growing epidemic of childhood obesity and the chronic health issues caused by this condition.

Related Materials

• Block Grant—At A Glance 2009 (PDF–5.7Mb)
• Block Grant—Success Stories (PDF–890Kb)
• CDC's Block Grant Web Site
• State and Program Examples (118K–PDF)

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Page last reviewed: January 15, 2009
Page last modified: January 15, 2009
Content source: National Center for Chronic Disease Prevention and Health Promotion