Budget Cuts Strain State, County and Municipal Public Health Departments

The "invisible" infrastructure of the U.S. public health system is crumbling.

While the crises in Medicare, Medicaid, and private health insurance get most of the attention, the U.S. also faces a public health crisis. Public health is supported by our tax dollars as a service, exactly like the highways and bridges, public libraries, local water and sewage systems, public parks and national forests that we tend to take for granted.

What does public health do? Primarily it is our first line defense against the spread of communicable diseases and epidemics -- just a sample of public health work would include restaurant inspections; providing childhood or travelers' vaccinations; monitoring water samples at beaches and protecting against environmental toxins; community health education; operating public health clinics for well-babies, mental health, drug addiction, family planning and maternal health services; providing home health care for seniors; and monitoring and educating on chronic diseases, injury prevention, sexually transmitted diseases or viral threats like West Nile Virus, SARS, or monkey pox. Public health covers what the name implies -- health issues that go beyond individuals, but affect whole communities or the entire country. Public health is a public service that many of us do not even think about, but it plays a large role in the quality of life of everyone - rich or poor.

Public health departments are one part of the national "infrastructure" which has been forced to increase its workload with less funding. Only one percent of the $1.4 trillion spent by the federal government on health care in the U.S. is spent on public health. In spite of the increased threat of communicable diseases, state health agencies employ fewer epidemiologists today (1,400) than they did in 1992 (1,700).

Public health departments are now charged with new responsibilities for bio- and chemical terrorism preparedness. However, in this era of budget cuts at federal, state and community levels, any increases in funds for the new responsibilities posed by terrorist attacks are being offset by cuts in other programs. Ironically, the infusion of new federal money since 9/11 has, in many cases, weakened the public health infrastructure more than before. The availability of new federal funds for bioterrorism has become an excuse for states, desperately trying to balance their budgets, to make cuts in public health financing. Resources are being diverted from the vital core services of public health departments to the narrower (though essential) role of preparing for a terrorist threat. The costly federally mandated smallpox vaccination effort also has depleted funding.

This is likely to leave many more of us in danger. Domestic security should include not only protection from terrorist threats but also protection from communicable and chronic disease, environmental toxins, or unfit food and water -- these are not just threats, but realities.

Examples:

  • In Colorado, state statute provided for state support to local and regional health services. Currently, local public health agencies have been contributing about $10 per person, and the state has been contributing $1.30. That state support, small but vital, is being totally eliminated due to state budget shortfalls.
  • In Larimer County, Colorado, the health department gained $100,000 in federal bioterrorism funds, but lost $700,000 in state funds. It was forced to make cuts in family planning and child immunization programs. It is proposing to eliminate restaurant inspections.
  • Denver City and County, Colorado, will no longer be able to provide regional services for sexually transmitted infections.
  • Jefferson County, Colorado will not provide dental services to children or health education services to schools or senior resource centers.
  • Los Angeles received $28 million for bioterrorism preparedness, but has an $800 million deficit for the next three years. It has closed 16 health centers and school clinics and is considering shutting two of its six public hospitals. It has reduced staffing, funding for chronic disease control, and communicable disease clinic hours.
  • Several Milwaukee County, Wisconsin communities are considering sharing services, outsourcing, and merging departments because of state budget cuts.
  • The Boston Public Health Commission cut positions because of state cuts.
  • Maryland received federal funds to increase its epidemiology staff, but had to cut its state-funded food safety program.
  • The Spokane Regional Health District (Washington) recently eliminated or reduced 29 positions, cutting resources for communicable disease prevention and diminishing services to children, families and seniors.
  • In King County, Washington the amount spent per person on core public health work has dropped sharply since 1997, when $21.34 was spent per person on core public health. In 2003, only $14.35 is being spent per person-- a 33 percent drop in six years. This is in spite of vastly increased needs, including a recent and ongoing tuberculosis outbreak.
  • In Connecticut, the Governor proposed a 50 percent cut to local health departments at the same time that capacity is increasing due to preparedness for bio- or chemical terrorism.


Public health is one of the "invisible" services that we support with tax dollars. The sharp diminishment of a strong public health infrastructure, being foretold by budget cuts at the state and federal level, will soon become very visible. It is another "you don't miss the water till the well runs dry" story and waiting till the well runs dry may be too late. For more information (from which much of this article was taken) see the National Association of County and City Health Departments' website.

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