State, local public health officials grapple with fallout from funding, job cuts

"It's been highly disruptive to our work," MDH Commissioner Brooke Cunningham, MD, PhD, says. "Many of our projects continue to go forward, but at a reduced pace because we just don't have the same teams here. There are a number of areas, particularly in infectious diseases as well as in our health equity bureau, that are operating at a reduced capacity."

In a recent episode of The Nation's Health podcast from the American Public Health Association, City of Minneapolis Health Department Commissioner Damon Chaplin, MBA, said that while previous funding cuts from the CDC have affected specific programs, the current cuts—should they go through—will affect the whole department. "We're looking at potentially whole functions within health departments not being able to do what they were designed to do because of these cuts," he said.

'The bill will come due'

Cunningham is also worried that the Trump administration will be looking for others way to reduce or cut funding to state and local health departments. Recent reporting by NPR indicates that CDC grants to state and local health departments haven't been showing up on schedule, leading to programs in some states to be abruptly halted. And the fiscal year 2026 budget blueprint released by the Trump administration in May calls for an additional $3.6 billion in funding cuts for the CDC.

For Cunningham and other state and local health officials, the funding cuts are a reminder of a reality she says she didn't fully understand until she came to MDH—that the country's public health infrastructure relies on a strong and reliable federal partner.

"That is the system we have built over time," she says. "Should the federal government pivot away from that obligation? States do not have the resources."

Part of the problem, says Brian Castrucci, DrPH, president and CEO of the de Beaumont Foundation, is that the fund reductions are being framed as a health department issue, and most Americans simply don't spend much time thinking about their state and local health departments. Average citizens might get upset when teachers are laid off or police budgets are cut because they understand what the impact could be, he argues. But there's not much awareness of how cuts to public health departments might affect them, until there's a public health emergency.

"People don’t really know what the impact is" when public health professionals are laid off, Castrucci says.

ASTHO's Harris agrees.

"When you don't hear anything about public health, that's because things are working really well," he says. "You can go out to eat and not worry about getting sick, you can turn on the faucet and drink the water, or you can send your kid to school and not worry about them catching some unusual illness."

Castrucci believes we're in a time of peril, and most people aren't seeing it.

"That lack of awareness is going to set the country up for a real fall," he says. "We may be able to get along without these health programs for a while, but the bill will come due."

Loss of federal expertise

While the cuts in federal funding will have a crippling impact on the ability of state and local health departments to respond to public health emergencies, experts warn that the layoffs and early retirements at agencies under the HHS umbrella, including the CDC and the Food and Drug Administration (FDA), could also hamper response. 

An example was provided this spring, when the Milwaukee Health Department sought epidemiologic and analytic support from the CDC to help deal with high lead levels in the city's public schools. The request was denied because all the staffers with the CDC's Childhood Lead Poisoning Program had been placed on administrative leave.

"This is a pretty unprecedented scenario to not have somebody to turn to at the CDC," Milwaukee Health Department Commissioner Mike Totoraitis, PhD, said at an April 14 press conference, the Wisconsin Examiner reported. The entire CDC lead team was reinstated on June 11, but it's unclear if members of the team have been deployed to the city.

In many instances of infection-related or foodborne disease outbreaks, CDC and FDA investigators work with state and local department investigators to identify the source of the outbreak and help get it under control. While expertise exists at the state and local levels, collaboration with federal experts is often needed in places where health departments may not have the capacity to handle a growing public health problem. 

"There's a lot of coordination," says Alex Sundermann, DrPH, MPH, an assistant professor of epidemiology at the University of Pittsburgh. Sundermann says he's worried that a scenario similar to what happened in Milwaukee could play out elsewhere and with different types of outbreaks.

"We could see a hospital have a very distinct outbreak or unique type of outbreak where federal expertise could be very helpful, but it might not be available," he says. 

"Virtually no state has the subject matter expertise that resides in the federal government, CDC in particular," says Harris, adding that in states like Alabama, the expertise provided by the CDC is critical.

"We rely on the federal government to give us guidance, to provide subject matter experts, to have people who can answer questions that we have, and to help us develop strategy," he says.

Although some critical workers at the CDC who were laid off in the spring have been reinstated, and others are in limbo pending legal challenges, the reductions in force at HHS continue. Earlier this week, following a Supreme Court ruling on July 8 that said the Trump administration could continue with its efforts to reduce the federal workforce while challenges play out in lower courts, the department sent out dismissal notices to many of the 10,000 employees it announced it would be cutting on March 27.

Castrucci said less help from the CDC and other federal health agencies will be a challenge that will likely force state and local health departments to look elsewhere to supplement their expertise.

"We might need to look to universities, or to other health departments, to fill that gap," he says. "We're going to have to make some hard choices in our health departments, but I know we will have a response."

An uncertain future

There's also concern about how this is affecting the people who've devoted their professional lives to protecting public health, especially in the wake of the COVID-19 pandemic, which saw many Americans turn against public health institutions at all levels. Between the public backlash and the fear of losing a job because of federal funding cuts, many in public health might simply decide it's no longer worth it. 

"I think people like to be in public health because they feel like it's a job that lets them make a difference…but it can become an unpleasant enough environment that people just choose to do something else," Harris says. "I wouldn't be surprised by that." 

In addition, college students who might at one time have considered a career in public health may no longer be interested if there are fewer jobs available. 

This all contributes to a prominent theme that emerges from conversations with public health professionals: Even if the White House and Congress are controlled in the future by people who are more supportive of public health, rebuilding gutted state and local departments will be difficult.

"It's really easy to break stuff. You can do that real quick," Cunningham says. "It's hard to build it back."

"We're going to lose people, we're going to lose experience," says Castrucci. "And all of that is going to place our nation in considerable uncertainty."

But for Castrucci, the uncertainty might provide public health professionals with an opportunity to rethink how the country's public health infrastructure is funded. "We've lamented the boom-and-bust funding cycle for decades but never changed it," he says. 

Changing that cycle, Castrucci argues, can't simply rely on a new president. It will require better communication from state and local public health leaders, not only to counter misinformation but also to promote the idea that communities are better off with strong public health institutions. He suggests every public health commissioner should have an email list with school officials, religious leaders, and business leaders who they can turn to for support with this messaging.

Castrucci says public health leaders probably should have started doing this years ago. But he thinks the urgency of the moment could provide the spark for creating "value that people understand and demand." 

"Don't get me wrong—we are going to refund public health," he says. "The question is how many people have to die before we do it?"