Monday, October 7, 2013

The Shutdown: How Cuts Weaken Public Health

We are into the sixth day of the government shutdown of October 2013. Is it affecting the Mid-Michigan District Health Department?  Yes, it is.  We’ll begin the day on Monday morning by working on contingency plans (Instead of doing the work our clients and staff want us to be doing!). If this goes on a couple of more weeks, the State may have to stop reimbursing us for some services. Without that reimbursement we will not be able to pay staff to deliver those services, so the Federal layoffs will start turning into state and local layoffs.  Furthermore, our employees eat and shop locally, and our clients spend their benefits in local stores, so local businesses will soon feel it, too. 

But today I am not going to blog about how bad the consequences of this way of making policy are for the public interest.  Plenty of other writers have got that covered. In this post I do want to make two points:  First, the shutdown is just another in a long series of blows to the ability of American communities to protect the health of the public. Second, these blows have had a cumulative affect that is profound in certain ways. One of the more profound effects of the long decline is that, over time, it causes us to set goals that are more and more limited, and to use strategies for achieving those goals that are less and less effective. Oddly, we are doing this without really acknowledging that it is happening.

To the first point: here is a great slide, first used by my predecessor, Kim Singh. We have continued to update it. It shows funding for what is called Essential Local Public Health Services (ELPHS) in Michigan.

These are funds the State pays local health departments to provide mandated services.  It shows that ELPHS today is 3 million dollars less that it was a decade ago.  But it also shows that funding is 13 million dollars less than would be needed to provide the same level of service, adjusted for inflation!  In other words we only have two-thirds of the inflation-adjusted ELPHS dollars we did a decade ago.  Of course the services are still mandated.

Other cuts, like the sequester, the shutdown, reductions in local funding and the loss of grant funds have had their impact, too. Since 2008, 44,000 local public health jobs have been lost according to our professional organization, the National Association of County and City Health Officials. A dozen of those positions were at MMDHD.

As a local health department loses resources, its ability to carry out its mission is compromised. By this I mean it is forced to set more limited goals, and to use strategies that are less and less effective.  I am going to write about this tomorrow. I’ll be taking as my example the use of social media to educate and inform the community about health issues, in which health departments are settling for what may be fairly ineffective communications strategies that happen to be free. 

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