Trump Proposes Slashing Domestic Spending to Historic Lows

“Most Americans suffer from some form of chronic illness,” stated Dr. Matifha Frathschwei Davis, health director for the city of St. Louis.

Addressing the proposed cuts, she asked, “How do you reconcile this with an effort to make America healthy again?”

Last month, the Federal Health Administration eliminated 2,400 jobs at the CDC. The Chronic Disease Center, which handles the largest budget within the CDC, was particularly impacted.

In a reorganization last month, programs focused on lead poisoning, smoking cessation, and reproductive health were discontinued.

The proposed budget would slash CDC funding to around $4 billion, down from $9.2 billion in 2024.

Moreover, the budget plan does not account for the $1.2 billion Prevention and Public Health Fund, suggesting that the cuts could surpass what Trump has proposed.

Programs targeting injury prevention, including those related to firearms, along with HIV surveillance and public health emergency preparedness grants, would also be affected.

According to the budget proposal, reductions aim to eliminate “duplicate, DEI, or simply unnecessary programs.” While Congress will formulate a federal budget, it remains uncertain how Trump’s proposal will evolve given the Republican majority and his allegiance to Trump.

CDC officials have been informed that the functions of the Chronic Disease Center will be relocated to a new entity within the health department called Management for a Healthy America.

Additionally, the proposal released on Friday seems to allocate $500 million to the Health Secretary for initiatives focusing on “nutrition, physical activity, healthy lifestyle choices, medications, and treatments.”

Yet, the Chronic Disease Center’s budget at the CDC was nearly tripled. Even if some chronic disease centers are revived under AHA, it’s unlikely that CDC scientists, who have relocated from Atlanta, will be involved.

“The actual subject matter experts managing the program may no longer be at the CDC,” remarked Dr. Scott Harris, Alabama’s state health officer. “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.

The CDC’s Chronic Disease Center has launched programs aimed at the prevention of cancer, heart disease, diabetes, epilepsy, and Alzheimer’s disease. However, it also supports initiatives beyond traditional boundaries, like developing walking trails and ensuring healthy food options are available in airports.

Dr. Davis from St. Louis indicated that her department has already been impacted by cuts that affect smoking cessation programs, lead poisoning initiatives, and health equity efforts, with a loss of over $11 billion in funding that the CDC previously provided to the state’s health department.

“I’m going to see the impacts of COVID-19 reflected in our current situation,” Dr. Davis emphasized.

In the proposed budget, the administration claims that discontinued programs could be more effectively managed at the state level. However, the state’s health department already oversees most chronic disease initiatives, with approximately three-quarters of the CDC Center’s funding dedicated to these programs.

Dr. Harris expressed that the funding loss is “devastating for us.”

Alabama has one of the highest chronic disease rates nationwide, with upwards of 84% of the Department of Public Health’s budget sourced from the CDC, Dr. Harris noted. Approximately $6 million is estimated to support chronic disease initiatives, including blood pressure screenings, diabetes education, and promoting physical activity.

If these funds are cut, he added, “I have no idea now where the funding will come from.” “No one truly seems to know what to expect, and we are not solicited for input on these matters.”

The Minnesota health department has already terminated 140 positions, with hundreds more potentially at risk if CDC funding reductions continue. Cuts to chronic disease prevention have direct repercussions on nursing homes, vaccination clinics, and public health efforts for Native Americans in the region.

“Federal decisions have left us unsupported in a fragile situation without a safety net,” stated Dr. Brooke Cunningham, the state health commissioner.

Dr. Cunningham noted that until recently, there seemed to be a shared understanding at all levels of government regarding the importance of investing in health.

The impact of the CDC Chronic Disease Center is felt in many surprising facets of American life.

In Prairie Village, Kansas, Stephanie Barr learned about the center when she worked as a waitress without health insurance and discovered a lump in her breast 15 years ago.

Thanks to the CDC’s National Early Breast and Cervical Cancer Detection Program, she received mammograms and ultrasounds, with staff assisting her in registering for Medicaid for treatment after a biopsy revealed the mass was cancerous, Barr recounted.

“It was caught just in time,” said Barr, now 45 and cancer-free.

Since its inception in 1991, the program has provided over 16.3 million screenings for more than 6.3 million individuals, with no other affordable options available.

The organization 530 Health has circulated a petition urging lawmakers to reject the proposed HHS budget, which could cut discretionary funding by approximately one-third. The signers contend that these cuts would “effectively devastate” the nation’s research and public health infrastructure.

The budget also suggests dismantling the disease registry and surveillance system.

“Without collecting data or maintaining these surveillance systems, we lose sight of trends,” mentioned Dr. Philip Fan, director of Dallas County Health and Human Services in Texas.

“You’re losing all historical context,” he explained.

In a previous role as Director of Chronic Diseases in Texas, Dr. Huang worked closely with CDC specialists who effectively decreased tobacco use among Americans.

“Abolishing smoking cessation efforts is utterly irrational if you aim to address chronic illnesses,” he stated.

Smoking remains a top contributor to preventable deaths in the United States, leading to over 480,000 deaths each year, per CDC data.

More than one in ten Americans smoke regularly; however, rates vary significantly by region, and CDC monitoring is crucial for targeting areas where cessation programs are most necessary.

“While smoking rates have declined, if the federal government eases regulations, tobacco companies are poised to regain ground,” cautioned Erica Seward, vice president of advocacy for the American Lung Association.

She highlighted that tobacco firms continually innovate new products, such as nicotine pouches. Usage among teenagers doubled last year. “It would be significantly more challenging to reverse this trend,” she added.

The CDC Chronic Disease Center collaborates with both community and academic organizations to promote effective programs, ranging from engaging youth in rural areas of Iowa to training members of Black churches in Columbia, South Carolina.

In rural Missouri, numerous walking trails have been established in the Bootheel region, an area with high obesity and diabetes rates, as noted by Ross Brownson, a public health researcher at Washington University in St. Louis, who is partnering with the CDCC to lead the Center for Prevention Research.

“Research indicates that enhancing walkability in a community can significantly increase physical activity levels,” Dr. Brownson commented. “Though there may be no fitness centers in rural areas, residents can enjoy nature and outdoor walking, and land is relatively affordable.”

In Rochester, New York, CDC support is training both deaf and hearing individuals to lead exercise and wellness programs targeted at others who are deaf and often excluded from mainstream fitness classes.

In San Diego, investigators are exploring strategies to shield farmworkers from ultraviolet and heat-related health issues.

“When they initiate these efforts from the ground up, they’re community-driven and not reliant on government support,” commented Allison Bey, who recently lost her position overseeing such initiatives at the CDC.

The CDC’s reorganization has also resulted in the termination of the lead poisoning program. Lead poisoning is “among our most significant public health challenges in Cleveland,” pointed out Dr. David Margolius, the city’s public health director.

While the CDC does not directly fund Cleveland’s lead program, the state provides the necessary resources. “We rely on federal expertise to guide us toward a lead-free future, so this will have a profound impact on us,” he stated.