National Health Secretary Robert F. Kennedy Jr. says tackling the “epidemic” of chronic disease is the cornerstone of his American healthy agenda and often evokes surprising statistics as an urgent reason to reform the country's public health.
On Friday, President Trump announced a budget proposal calling for a cut in the Centers for Disease Control and Prevention funds by almost half. The Chronic Disease Center was to be eliminated entirely, a proposal that shocked many state and city health officials.
“Most Americans have a certain type of illness that could be considered chronic,” said Dr. Matifha Frathschwei Davis, the city of St. Louis' health director.
Of the proposed cuts, she said, “How would you reconcile that by trying to make America healthy again?”
The Federal Health Administration cut 2,400 jobs from the CDC last month. The CDC is implemented by the National Centre for Chronic Disease Prevention and Health Promotion with the largest budget within the institution.
Last month, programs on lead poisoning, smoking cessation and reproductive health were abandoned in a reorganization.
Overall, the proposed budget cut CDC funding to approximately $4 billion compared to $9.2 billion in 2024.
The budget blueprint doesn't mention the $1.2 billion program, the Prevention and Public Health Fund. Given that number, the cut could be even greater than Trump's proposal suggests.
Agents will also lose centers focused on preventing injuries, including those caused by firearms, programs for HIV surveillance and prevention, as well as grants to help states prepare for public health emergencies.
According to the proposed budget, reductions are needed to eliminate “duplicate, DEI, or simply unnecessary programs.” Congress will create a federal budget, but it is unclear how different his proposal will change given the Republican majority and his loyalty to Trump.
CDC officials were told that the function of the Chronic Disease Center would be moved to a new organization within the health department called Management for a Healthy America.
And the proposal released Friday appears to allocate $500 million to the Health Secretary to address “reliance on nutrition, physical activity, healthy lifestyle, medication and treatment.”
However, at the CDC, the Chronic Disease Centre's budget was almost tripled. Also, even if some of the chronic disease centers are resuscitated with AHA, it is unlikely that a new iteration will involve CDC scientists who have moved from Atlanta.
“The actual subject experts managing the program may not be at the CDC anymore,” said Dr. Scott Harris, state health officer with 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 requests for comment.
CDC's Chronic Disease Center has implemented a program aimed at preventing cancer, heart disease, diabetes, epilepsy and Alzheimer's disease. But the centre also seeds initiatives further away, from creating country and urban hiking trails to ensuring healthy options like salads are offered at airports. They also promoted wellness programs in marginalized communities.
St. Louis Health Director Dr. Davis said her department has already been caught up in the program to curb smoking from the cuts and reduce lead poisoning and health disparities, with the withdrawal of more than $11 billion the CDC was offering to the state's health department.
“I'm going to get Covid-19 back with the heartbeat of what's going on,” Dr. Davis said.
In the proposed budget, the administration proposed that abolished programs would be better managed by the state. But the state's health department already manages most chronic disease programs, with three-quarters of the CDC Center's funding supporting them.
Alabama health officer Dr. Harris said the losses in these funds were “devastating for us.”
The state has one of the highest rates of chronic disease in the country, with around 84% of the Department of Public Health budget coming from the CDC, Dr. Harris said. Approximately $6 million will be spent on chronic disease programs, including blood pressure screening, diabetes nutrition education and promoting physical activity.
If these funds are cut, he added, “I'm at a loss now to tell you where it's coming from.” “No one really seems to know what to expect and we're not asked for an opinion on that.”
Minnesota's proud health department has already fired 140 employees, and hundreds more could be affected if more CDC funds were lost. Reducing chronic disease prevention impacts the state's Native American nursing homes, vaccine clinics and public health initiatives.
“Federal actions have ruled out us in the flimsy limbs that don't have a safety net under us,” said Dr. Brooke Cunningham, the state health commissioner.
Until recently, “it seemed to have a common understanding at the local, state and federal levels that health is important for investment,” Dr. Cunningham said.
The work of the CDC Chronic Disease Center touches American life in many unexpected ways.
In Prairie Village, Kansas, Stephanie Bar learned about the center she worked as a waitress without health insurance 15 years ago when she discovered a lump in her lemon-sized breast.
Through the CDC's National Early Breast and Cervical Cancer Detection Program, she was able to take mammograms and ultrasounds, and staff helped her register with Medicaid for treatment after biopsy determined the mass was malignant, Burr said.
“It got caught up in time's nick,” said Barr, now 45, who is cancer-free.
Since its launch in 1991, the program has provided over 16.3 million screening trials to over 6.3 million people, with no other affordable access.
The organisation is one of 530 health associations that signed a petition asking lawmakers to reject the proposed HHS budget, reducing discretionary spending by about a third. The signatories said the cuts would “effectively devastate” the country's research and public health infrastructure.
The budget also proposes dismantling the disease registry and surveillance system.
“If you don't gather information or maintain these surveillance systems, you don't know what the trend is,” said Dr. Philip Fan, director of the Dallas County Health and Human Services in Texas.
“You're losing everything in that history,” he said.
In his previous position as Director of Chronic Diseases in Texas, Dr. Huang said he worked closely with CDC experts who successfully reduced tobacco use among Americans.
“Eliminating smoking and health offices is just too insane if you're still looking to deal with chronic illnesses,” he said.
Smoking remains a leading cause of preventable deaths in the United States, causing more than 480,000 deaths each year, according to the CDC.
More than one in ten Americans smoke regularly, but rates vary dramatically from region to region, and CDC monitoring helps target areas where a shutdown program is most needed.
“The smoking rate has fallen, but if the federal government stepped out of the gas, cigarette companies are ready to jump again,” said Erica Seward, vice president of advocacy for the American Lung Association.
She warned that tobacco companies are constantly developing new products like nicotine pouches. “It would cost more money to bring the Genie back into the bottle,” she said.
The CDC Chronic Disease Center works with the community and academic centers to promote effective programs and lead congregation athletics and nutrition classes, from resignation to reach young Iowans in rural areas to training members of Black churches in Columbia, South Carolina.
In rural Missouri, dozens of walking trails have been developed in “boot heels” in the southeastern part of the state. This is an area with a high rate of obesity and diabetes, says Ross Brownson, a public health researcher at Washington University in St. Louis, is working with the CDCC to direct the Center for Prevention Research.
“There is strong evidence that changing the walkingability of a community can help people gain more physical activity,” Dr. Brownson said. “There are no health clubs in the countryside, but they have the ability to have nature and walks, and the land is relatively inexpensive.”
In Rochester, New York, CDC support trains deaf and listeners to lead exercise and wellness programs for other deaf people who are not easily involved in other gym classes.
In San Diego, researchers are testing ways to protect farm workers from exposure to ultraviolet and heat-related diseases.
“If they get up and start, they're community-driven and they're not dependent on government,” said Allison Bey, who recently lost his job managing such projects at the CDC.
The CDC reorganization also eliminated the lead poisoning program. Lead poisoning is also “one of our biggest public health threats in Cleveland,” said Dr. David Margolius, the city's director of public health.
The CDC does not directly fund the Cleveland lead program. The funds come from the state. “But we just have federal expertise to call on us to lead us to a lead-free future. So it's going to have a huge impact on us,” he said.
