Public health funding: Feds giveth but the states taketh away
Public health officials didn't expect budget cuts after government
promises to shore up the system following the World Trade Center and
anthrax attacks.
By
Victoria Stagg Elliott, AMNews staff. Oct. 28, 2002.
Additional information
Public health departments throughout the country are experiencing an
infusion of federal funds for bioterrorism preparedness. But in an
unexpected twist, that new money may have made it easier for some
cash-strapped state and local governments to slash their public health
budgets.
In many cases, the state and local cuts are completely overwhelming the
benefit of the federal funds, leaving public health departments in worse
shape.
For example, in rural Larimer County, Colo., the Dept. of Health and
Environment will gain 1.4 positions because of the new bioterrorism funds
but will eliminate 15 positions because of state cuts, said Adrienne
LeBailly, MD, MPH, the department's director. Her $6 million annual budget
will receive $100,000 in federal money but lost $700,000 in state funding.
"We're eliminating dollars for public health programs that ... will
impact more lives and prevent more deaths and injuries and diseases than
will ever happen from bioterrorism in our state," she said.
The county will hold a referendum later this year to try to raise money
to replace the lost state funds, and, if it passes, the cuts will be
reversed. But for the time being, the department has just reduced the
family planning and childhood immunization programs. More than 200 women
will not have access to birth control. One thousand children will not be
able to get immunized at the public clinic.
Public health systems in other areas are hurting as well. In Los
Angeles County, officials already have closed 11 health centers and four
school-based clinics this year and are talking about closing two of their
six public hospitals. In Illinois' DuPage County, a suburban area west of
Chicago, a substance abuse program for women and an abstinence education
program for the schools have been chopped.
$1.1 billion in grants to state and local health departments target
bioterrorism preparedness.
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"A lot of our members are reporting that they are experiencing cuts. It
reflects overall budget conditions at the state and local level, although
it seems anomalous in the face of increased federal resources directed to
public health," said Patrick Libbey, executive director of the National
Assn. of County and City Health Officials.
It wasn't supposed to be this way.
In January, the U.S. Dept. of Health and Human Services announced $1.1
billion in grants to state and local health departments for bioterrorism
preparedness -- money above and beyond what was already granted for other
services.
President Bush's proposed 2003 budget includes $940 million for state
and local health departments to improve laboratory capacity, epidemiology,
disease surveillance, training and communication infrastructure.
HHS Secretary Tommy Thompson said the money would rebuild the
long-neglected U.S. public health infrastructure so that it could respond
to more common public health crises, such as West Nile or influenza, and
that local health departments were a vital part of that system.
"If we never have another bioterrorism attack, as [Thompson] often
says, the silver lining of the 9/11 attacks is that we have the
opportunity to build a public health infrastructure second to none," said
HHS spokesman Bill Pierce. "Local health departments are critical to
this."
Lean times drain resources
The reasons public health departments are still taking a financial hit
are varied, although most are linked to the bleak economy. Tax revenues
are down, and nearly every state is struggling with deficits.
During lean times, the public health budget is frequently the first in
line for the chopping block, but public health officials say this year is
worse than others. They say the promised windfall from the federal
government has facilitated many states' decisions to cut their funding.
A weak economy is draining state public health budgets.
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In addition to budget cuts, an increased demand for services is taking
a toll on health departments. The weak economy has created a greater need
for services as people lose health insurance along with their jobs.
"We've done some really good things with the money for bioterrorism
preparedness. We've updated our public health lab and bought vaccines,"
said John Wallace, director of intergovernmental relations at the Los
Angeles County Dept. of Health Services. "But at the same time, we have an
overwhelming number of uninsured who need to access our system on a daily
basis, and there's just no funding stream to support indigent care in this
country."
The L.A. County health department is looking at an $800 million deficit
over the next three years and has an annual budget of $3 billion. It
received more than $28 million for bioterrorism response.
Public health officials also say the money granted for bioterrorism
does not quite cover what they are expected to do with it, and this is
creating another strain on the system.
"We have bioterrorism activities all the time, but I'm contributing
several times more in staff time than I'm getting in return," said Leland
Lewis, executive director of the DuPage County Health Dept. "At my level,
I'm not seeing a lot of money. I do see some, but I would've hoped that
there would have been more."
His department received $300,000 for bioterrorism response from the
federal government. He blames his department's struggles on rising costs
and a $38 million budget that hasn't increased in years.
Despite tough times, officials say they'll cope. They're raising fees
and trying to squeeze a little bit more out of what they've got. Public
health has traditionally been underfunded, and they're used to working
this way. But they warn that the system will not be able to respond to
bioterrorism if this continues.
"I try to run a pretty lean group here, because I want the taxpayer to
feel comfortable that every dollar they're sending us is being used
wisely," Lewis said. "We'll get through this. The economy will turn
around, and some of the funding we've lost will be restored. But it's a
strange time to be cutting funding ... when we're asked to do so much
more."
And public health officials say this is not what they expected to
happen after Sept. 11, 2001, and the ensuing anthrax attacks.
"It would have been nice to have the bioterrorism money to enhance the
services that we used to have," Dr. LeBailly said. "At this point, I feel
like we've been hurt more. I certainly wasn't expecting to have a weaker
public health infrastructure than we had before 9/11."
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ADDITIONAL INFORMATION:
Federal funding snapshot
Amounts that some states and cities have received from the Health and
Human Services Dept. for bioterrorism preparedness in 2002:
California: $70,779,150
Texas: $59,749,890
New York state: $33,917,260
Michigan: $31,225,867
Illinois: $30,140,755
Los Angeles: $28,250,343
New York City: $26,181,040
Arizona: $18,659,807
Colorado: $16,492,100
Chicago: $12,819,246
Delaware: $7,298,076
Wyoming: $6,540,590
Source: Dept. of Health and Human Services
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Weblink
HHS
announcement of bioterrorism preparedness grants to states
(http://www.hhs.gov/news/press/2002pres/20020131b.html)
NACCHO, the National Assn. of
County and City Health Officials (http://www.naccho.org/)
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Copyright 2002 American Medical Association. All
rights reserved.
