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.

"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.

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."

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

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/)

HEALTH & SCIENCE