State cuts accelerate public health funding shortfall

Mar 1, 2010 (CIDRAP News) – Over the past 5 years public health has seen federal funding remain flat, but $392 million in recession-driven state funding cuts this past year are further impairing the ability of many communities to deliver basic disease prevention and emergency health preparedness services, according to a report today from two nonprofit groups.

Though current healthcare reform proposals in Congress include measures that could transform the public health landscape, the report said the amount still isn't enough to close gaps in public health funding.

The 36-page report, from nonprofit health advocacy group Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation, provides a detailed look at how each sates spends its public health dollars.

The deep level of state cuts wasn't offset by $1 billion in funds that public health received in the Obama Administration's economic stimulus package, because the measure represented one-time funding—not the ideal sustained funding—that won't be fully disbursed through this year and into 2011. "Overall, the economic situation has drastically hurt public health departments across the country," the report said.

Public health job cuts
Today's report detailing how cash-strapped state budgets are affecting the big public health picture comes on the same day that national health officials released new information on local health department job cuts for 2009. The National Association of County and City Health Officials (NACCHO) said today in a statement that the departments cut 16,000 jobs last year.

Combined with 7,000 jobs lost in 2008 through budget cuts, position attrition, and layoffs, NACCHO estimates that 15% of the local public health workforce has disappeared over the last 2 years.

Robert Pestronk, executive director of NACCHO, said in the statement that over the past year local health departments have shouldered the burden of responding to the H1N1 pandemic while conducting their routine activities such as restaurant inspections. "While local health departments will do the best job they can with the resources available to them to protect Americans from public health threats, these data sound a warning," he said.

Midwest low on funding ladder
As in past years, the TFAH report found that state shares of Centers for Disease Control and Prevention (CDC) funds varied widely from state to state, averaging $19.23 per person in fiscal year 2009.

Midwestern states received the least federal support for public health, about $16.50 per person, in fiscal year 2009. Meanwhile, Northeastern states received the highest amount at $19.80 per person. On an individual basis, the amount ranges from a per capita low of $13.33 in Virginia to a high of $58.65 in Alaska.

States seeing double-digit percentage drops in state public health budgets between fiscal years 2008 and 2009 include California, Florida, South Carolina, Kansas, North Carolina, Arizona, Indiana, and Mississippi. TFAH's experts point out that not all states structure and fund their public health departments the same way.

States got supplemental funds to help them respond to the H1N1 flu pandemic, but state and local health departments were stretched severely amid stagnant federal funding and state cutbacks, the TFAH report said. For example, to help staff H1N1 vaccination clinics, public health nurses in Los Angeles County were pulled from clinics that screen for tuberculosis, treat teens for sexually transmitted diseases, and vaccinate children. In Maine, home visits from public health nurses were cut back, and three-fourths of the staff was reassigned to H1N1 work.

Modernizing public health
Jeffrey Levi, PhD, executive director of TFAH, said in the statement that chronic underfunding for public health, rising healthcare costs, and erosion of the public health workforce puts the nation at a competitive disadvantage. "If we are going to improve the health of Americans, we need to fundamentally rethink our approach to funding and managing public health and disease prevention in the United States," he said.

Such wide variations in how different states and localities fund and structure public health make it difficult to establish health goals and standards and make it particularly hard to analyze how efficiently dollars are being used to improve community health markers, the report said.

Health reform bills passed by the House and Senate in 2009 include measures that could revamp public health and infuse it with significant new funding, the report said. Both include public health investment funds, school-based health centers, obesity prevention programs, and public health workforce enhancements.

In addition, the Senate's version would establish a Ready Reserves Corps, expand epidemiology lab capacity, and boost public health fellowship training, which includes expanding the Epidemic Intelligence Service.

The Obama Administration has recently signaled that it may attempt to pass a healthcare reform bill through reconciliation, in a move to avoid filibuster that would block the legislation.

Regardless of increased funding or new legislation, the TFAH report said the nation urgently needs to modernize the public health system. It also calls for a national prevention strategy that would help prioritize and address the nation's greatest health problems. The strategy would help set realistic goals for improving health and assess the health impact of policies across federal government.

The national prevention strategy, which is included in the Senate's healthcare reform bill, should also move the nation toward a higher level of preparedness to respond to health threats such as infectious diseases, foodborne illness outbreaks, natural disasters, and bioterrorism, the report said.

"The current default policy is to provide emergency supplemental resources in times of emergencies instead of being prepared ahead of time," the authors wrote. "This approach is costly in the long term and leaves Americans needlessly at risk."

The report also called for more accountability to improve health outcomes to ensure that public health funding is spent effectively and in ways that improve the nation's health and safety.

See also:

Mar 1 TFAH press release

Mar 1 TFAH report on public health funding

Mar 1 NACCHO press release

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