WASHINGTON — While some health officials laud the Prevention and Public Health Fund as the nation’s best chance of funneling resources into chronic-disease prevention, it is not clear that the fund can survive deficit-reduction efforts unless it can quickly prove a return on investment.

HHS officials call the rise in chronic disease in the United States an “epidemic of unprecedented magnitude,” with seven out of every 10 deaths due to some form of chronic condition. Heart disease and stroke account for 50% of deaths in the U.S. annually, and nearly half of all adults have at least one chronic illness.

According to federal studies, 75% of the $2.5 trillion spent on healthcare annually is accounted for by individuals with chronic conditions. Another $1 trillion is lost annually to lost productivity due to chronic disease.

"An important tool to address chronic disease is the implementation of proven prevention programs in local communities,” said Senate Health Committee chair Tom Harkin (D-IA) at a recent hearing on the subject. “Targeted, evidence-based community prevention activities can have an enormous impact on chronic disease, while being cost-effective. A study by Trust for America's Health, titled Prevention for a Healthier America, found that investing $10 per person in proven community-based programs to increase physical activity, improve nutrition, and prevent tobacco use could save the nation about $16 billion annually within five years.”

The Prevention and Public Health fund, part of the Patient Protection and Accountable Care Act, is fundamental in making that hypothetical investment a reality, Harkin said.

According to Howard Koh, MD, assistant secretary for health, the fund is the “most-significant investment to step up and scale up preventive health measures in our nation’s history.” In FY 2010, the fund provided $500 million to state and community initiatives focused on preventing tobacco use, obesity, heart disease and cancer, as well as increasing immunizations and providing training to providers to help drive local prevention and health initiatives.

The FY 2011 budget would increase the fund to $750 million. The investment is expected to reach $16 billion over 10 years.

“One recent study in Lancet estimates that an average 1% reduction in BMI in the U.S. can prevent 2.4 cases of diabetes, 1.7 cases of cardiovascular disease and up to 127,000 cases of cancer. However, only an estimated 3% or less of healthcare dollars in the U.S. right now are dedicated to these scientific prevention strategies,” Koh told the committee members. “A new emphasis on prevention makes our country stronger and healthier, [and this] fund is a substantial accomplishment, and we’re very proud of that.”

Vulnerable Target

As Congress looks to make budget cuts, however, the fund is vulnerable. Legislators are calling for the fund to show results in its investments quickly.

“People have been using this fund as a bank,” said committee member Sen. Pat Roberts (R-KS). “[The super committee] is going to ask what each of these dollars was used for and the programmatic use of these funds.”

Koh argued that the HHS agencies have worked hard to choose programs that will provide a return and have invested in programs with an evidence base. “Those themes are aggressively pursued by NIH, CDC and the Agency for Healthcare Research and Quality (AHRQ),” Koh said. “The attention to scientific rigor is very strong, as is [the attention paid to] the cost-benefit equation.”

Koh added that there are yardsticks for judging each funded program and that no funding is given out without metrics in place to judge results.

Republicans were not the only ones to clamor for more evidence of the fund’s success. “We want an overarching integration of all of the approaches that are being taken in the Affordable Care Act, because there are those of us who believe that this will save us tremendous amounts of money over the years,” said Sen. Al Franken (D-MN). “We need to demonstrate that in a way that’s convincing and real.”

In the meantime, continued funding remains uncertain. Republicans have referred to the program as a “slush fund” that allows HHS to distribute money at its own discretion. And, last month, Democrats on the super committee announced that they have proposed cutting the fund by 50% -- $8 billion over the next 10 years.

House Republicans would go even further, having pushed to cut the fund entirely.

The Affordable Care Act’s Prevention and Public Health Fund in Your State

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