2015 marks the 20th anniversary of APHA coordinating National Public Health Week and the accomplishments of the public health community over the last two decades are significant, such as a 70 percent reduction in HIV/AIDS-related deaths. What an amazing fact! While this progress is laudable, we must continue the focus that brought us here. This reduction is the direct result of concerted advocacy for ARV development and of a federally-funded public health program developed around the whole individual.
The Ryan White Treatment and Modernization Act (originally the Comprehensive AIDS Resources Emergency (CARE) Act) was first enacted by Congress in 1990. Ryan White supports PLWHA at each stage of their illness, helping them to remain in care, take their medications and stay healthy. It has become the gold standard of comprehensive, holistic care for people living with severe and chronic disease, mostly because in the age of healthcare reform, Ryan White was the first program to recognize the vital role of structural interventions, like housing, transportation and especially access to nutritious food, as key determinants of health.
Given the strong research and practice evidence in support of the need for and benefits of medically informed food and nutrition services, it is surprising that when the Affordable Care Act (ACA) was passed in 2010, it contained no comprehensive coverage of medically-tailored food for any severe disease population. Medicaid and private insurance provided through the new exchanges do not provide the structural supports that help deliver lower healthcare costs and positive health outcomes. Furthermore, only a little more than half the states in the nation have opted to expand Medicaid. This is a major concern, since the expansion of insurance coverage provided through the ACA has been proposed as a rationale for discontinuing Ryan White. This is a short-sighted view.
If we are going to achieve a more coordinated national response to our epidemic of chronic and severe illness, including continued success with PLWHA, and accomplish our quest to reduce healthcare spending nationwide, we need to learn a lesson from the success of Ryan White. Medically tailored food and nutrition services must be included in all healthcare reform efforts. This is a success we can build on.