Public Health Cuts Threaten Preparedness, Preventive Health Services

Continuing cuts to local public health departments' budgets and staff, as well as proposed cuts to the US Prevention and Public Health Fund, are leading to reduced local preventive services and straining the ability of departments to respond to emerging crises, public health leaders and advocates say.

A new report from the National Association of County and City Health Officials (NACCHO) found that nearly half of local public health departments cut staff in the first half of 2011 and more than half cut programs during the past year (http://tiny.cc/snu7t). The cuts compound previous losses to such agencies that have occurred in the years since the economic crisis began. Moreover, proposed cuts to the $15 billion in expected funding for prevention efforts included in the health care reform bill may further dampen planned prevention activities, warn more than 100 organizations, including clinician organizations and public interest groups.

Local public health departments continue to take a substantial hit as states and municipal governments face ongoing budget crises.

Between July 2010 and June 2011, 55% of local public health departments reduced or eliminated at least 1 program (11% eliminated a program entirely), according to the NACCHO report. The programs hardest hit have been services for women and children, which have been cut at 21% of the departments surveyed by NACCHO. Other individual health services will also likely be cut, along with emergency preparedness efforts, both of which already had been reduced at 20% of the departments.

Additionally, 44% of departments lost at least 1 employee during the first half of 2011, and more than half experienced such a staff loss, reduced working hours, or furloughs during this period, according to the report. These cutbacks compound those faced by strapped departments over the past few years, adding up to the loss of 34 400 positions through layoffs or attrition since 2008.

“We are not going to see a significant improvement for another year or 2 at the local level,” said Robert Pestronk, MPH, executive director of NACCHO.

Pestronk explained that because of the cuts, many services usually provided by public health departments are becoming less accessible. Departments, he noted, are reducing the hours or days that services are offered. The cuts are also forcing departments to be more creative and to work more closely with other service providers in the community.

“[Departments] must think more carefully about what they can continue to do and what others in the community can do,” he said. But if no other service providers are available, “those services disappear.”

A much needed new revenue stream, included in health care reform, appears to be on the chopping block as well, according to Richard Hamburg, MPA, deputy director of the advocacy group Trust for America's Health (TFAH).

The health reform legislation included $15 billion in funding for public health prevention efforts over 10 years. Hamburg explained that public health departments have been taking on more and more responsibilities due to increased emergency preparedness efforts since the September 11, 2001, terrorist attacks, the emergence of pandemic flu, and the ongoing obesity epidemic. Yet funding has not kept up.

“[Public health] is chronically underfunded,” he said. “The dedicated funding stream in the Affordable Care Act was so needed.”

However, deficit reduction efforts have identified this new funding as a potential target for cuts, a move opposed by Hamburg's organization and more than 100 other groups, including the American Academy of Pediatrics, the Infectious Diseases Society of America, and the American Nurses Association, who sent a letter (http://tiny.cc/fyfxq) to the Joint Select Committee on Deficit Reduction in October.

The letter emphasized that money spent on preventive health services yields a good return on investment. It cited a report by TFAH that estimated that a $3 billion per year investment in public health—approximately $10 per person—could save more than $15.6 billion annually within 5 years. Moreover, Hamburg noted, such an investment can “impact quality of life, reduce diseases [and] injuries, and may also have the result of saving money in the short and long term.”

Pestronk noted that one of the difficulties facing public health departments' efforts to secure adequate funding is that the work they do is often invisible in their communities. For example, such programs as immunization, preventive health services, or emergency preparedness may not be noticeable until they are no longer available.

“Ultimately, over time people will discover they want those protections,” Pestronk said.