Chronic disease isn’t going away, but a national center devoted to its prevention may be, a prospect that is alarming agency insiders and public health officials across the country.

The Department of Health and Human Services’ budget for 2026, released Friday, proposed $14 billion in discretionary funding for programs that aim to reverse the chronic disease epidemic, but it would also abolish the CDC’s National Center for Chronic Disease Prevention and Health Promotion.

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“If this center is eliminated, state and local departments lose core prevention funds. And they lose the workforce for schools, chronic disease prevention, data collection, surveillance systems,” a senior official at the CDC chronic disease center told STAT on condition of anonymity for fear of retribution. “If folks care about kids, schools rely on this.”

Federal health leaders want to fold the chronic disease center into the Administration for a Healthy America, a new entity within HHS that will also bring other centers under its umbrella: the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Office of the Assistant Secretary for Health, and the National Institute of Environmental Health Sciences. The proposal asserts these moves will strengthen the response to chronic illness.

“AHA will administer $14.0 billion in discretionary funding for programs that aim to reverse the chronic disease epidemic,” the proposal reads. “It will prioritize prevention — a missing piece in the American health system — primary care, maternal and child health, mental health, substance use prevention and treatment, environmental health, HIV/AIDS, workforce development, and policy, research, and oversight.”

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That leaves the current chronic disease center in limbo, its budget diminished, its workforce disbanded by layoffs contested in court, and its location to be determined as its surviving programs are scattered. The president’s funding requests tend to undergo big changes before Congress passes a budget, but for now, public health experts are expressing puzzlement about how this proposal might harmonize with health secretary Robert F. Kennedy Jr.’s Make America Healthy Again agenda.

“It looks pretty devastating for chronic disease when they’re saying that they’re really interested in prioritizing chronic disease,” Philip Huang, a physician and director of Dallas County Health and Human Services, told STAT. “And then that MAHA report that came out — I mean, it’s a very limited agenda that they’re talking about in terms of how to address chronic disease.”

Moving prevention to AHA may give rise to more problems than it solves, Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials, told STAT. Part of that is uncertainty about which programs may survive.

“That other agency does not exist right now,” she said. “You’re not just shifting the work. That would be something that has to get built up. So we’re losing the people who do the work right now. We don’t really know where the programs would pop up again when, and who will do the work.”

A spokesperson from HHS defended the decision, saying complex, duplicative health programs have led to fragmented efforts that dilute taxpayer resources and their impact on Americans. Some CDC programs will continue under AHA, the message emailed Tuesday also said, adding, “We must end this wasteful and inefficient model of health programming in favor of strategic, coordinated approaches. The creation of AHA does not eliminate priorities or functions; instead, it unites previously independent programs to work together to Make America Healthy Again.”

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Not visible on the AHA agenda: the CDC’s program to encourage smoking cessation, which has already fallen to the budget ax, a decision that makes no sense to Huang, who, years ago in his role as chronic disease director for Texas, traveled the state to urge restaurants to go smoke-free.

“For them to have eliminated the Office on Smoking and Health is absolutely insane if you say you’re trying to address chronic disease,” he said. Among preventable causes of chronic disease, “tobacco is the most blatant.”

The CDC official also called smoking cessation one of public health’s most effective interventions, “like smallpox elimination for chronic disease.”

A new generation of young people, exposed to pitches selling e-cigarettes and tobacco pouches, might hear messages only from advertisers and not campaigns foundational to preventing heart disease, stroke, and cancer, the CDC official added.

Huang was struck by Kennedy’s answer when asked to name the leading preventable cause of death among Americans.

“What he’s saying are the primary drivers of chronic disease are ultra-processed foods, environmental toxins, technology, and medications, including vaccines,” Huang said. “They may be factors, but we know a lot of what causes these chronic diseases. Tobacco is the No. 1 preventable cause of disease, and he couldn’t even identify that during his hearing.”

Conservative voices have been calling for the CDC to return to its roots, narrowing its scope to infectious diseases like the one that inspired its creation and its location in the southeastern United States: malaria.

Since its founding in 1946, the CDC’s expertise and activities have grown deeper and wider, as the “prevention” in its name implies, to include a multitude of diseases, studying their origin, treatment, prevention, and prevalence. The agency’s knowledge, standards, and investigations are shared around the world and in all U.S. states and territories.

The list of noncommunicable diseases is long, including cancer, heart disease, diabetes, maternal mortality, obesity, mental illness, epilepsy, and dementia. So is the tally of causes in addition to tobacco: high blood pressure, unhealthy diet, limited physical activity, poor access to cancer screening.

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If the CDC’s footprint shrinks to communicable disease outbreaks, the chronic disease center’s program will be splintered. The pain would be felt far from headquarters in Atlanta, the CDC official said. That’s because 80% of the dollars funding the center at CDC now flow to state, territorial, and local health departments.

“Prevention as a whole is being deprioritized, so that will put pressure on clinics in the health care delivery system to do what they’re not doing now: prevention outside the clinic, in neighborhoods, to prevent heart disease, diabetes, cancer.”

The budget plan would provide $500 million “to tackle priority activities to Make America Healthy Again,” of which $260 million would fight chronic illness by addressing nutrition and environmental impacts.

That would include $119 million for a new Prevention Innovation Program, which the proposal said would improve the health of Americans through reliable broadband technology integration, “ensuring access to nutrition services and physical activity venues, and reducing dependence on medication.”

A May 22 letter from 29 U.S. senators in response to President Trump’s budget proposal urged lawmakers to protect robust funding for the CDC as a whole while singling out its chronic disease center.

“The elimination of the CDC’s chronic disease prevention office also contradicts the Administration’s stated goal of addressing the chronic disease epidemic in our country,” the letter said. “These cuts will not make Americans healthy.”

One of the national center’s major roles is to provide the comprehensive data collection and analysis to public health departments across the country, a division of labor that allows small staffs to do more.

Jason Orcena, public health commissioner for Union County, Ohio, said there’s a valuable synergy between the CDC and his office, which serves 70,000 people in a county that includes both suburban and rural areas with differing health needs.

“There’s a heavy reliance on those national surveillance tools to help frame the work we do locally as part of our local community health assessments and community health improvement plan,” he said. “That’s one of the things the center and CDC in general does and the state does as well. We rely on them through that economy of scale to have truly experts in these areas because I can’t afford to have someone be an expert in all things.”

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Asked what disease or condition concerns him the most, Orcena said, “the one I don’t know about yet.”

Georges Benjamin, executive director of the American Public Health Association, pointed out that there are 3,300 departments across the country, some with hundreds of employees and some with just two.

“We’re the gap filler for people to make sure that even within the traditional medical system, things don’t fall through the cracks,” he said about individual public health systems. “If you start seeing a new cancer developing, that’s going to be picked up by the chronic disease center.”

Case in point: HIV was initially recognized after a rare cancer related to the infection began showing up in men who had sex with men, later linked to the disease that became an epidemic.

“This is the division that’s going to figure that out. It’s not NIH,” Benjamin said about the chronic disease center at CDC.

At the state and local level, public health officials are facing confusing messages on funding for individual projects. Earlier this year they weathered the loss of money to pay for Covid-19 programs, many of which had pivoted to cover health needs beyond Covid.

Because chronic disease has long been underfunded and underappreciated, partnerships between local health departments and a national system is crucial, NACCHO’s Casalotti said.

“Bringing all these parts together could move us towards a place so we can focus more on these diseases,” she said. “Right now, what they’re seeing and experiencing is actually pulling back from this work, not necessarily pushing it forward. And so I think that’s where the field needs to go: We need to be pushing forward together.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.