CHARLOTTE, N.C. — Across the United States, key individuals and programs essential to safeguarding public health are being diminished. Specialists battling outbreaks like measles in Ohio or providing vaccinations via mobile clinics in North Carolina are disappearing. In Tennessee, programs offering free tests for the ill have vanished.
State and local health departments, tasked with vital yet often unseen responsibilities such as restaurant inspections, wastewater monitoring for hazardous pathogens, and outbreak response, find themselves in decline.
“You don’t want to leave a public pool with a rash or struggle to breathe normal air,” said Lori Tremmel Freeman, the head of the National Association of County and City Health Officials. However, local health officials now have limited capabilities due to significant cuts.
Experts attribute these setbacks to the drastic health budget reductions initiated during Trump’s presidency. This includes withdrawing nearly $11 billion in direct federal aid post-COVID-19 pandemic declaration and cutting 20,000 roles from national health agencies that support local health initiatives. Proposals for further cuts loom.
Public health leaders warn that the system is being weakened to a point where even basic services are in jeopardy. This is occurring amidst a rise in infectious diseases like whooping cough and a historic measles threat, alongside the looming danger of a widespread bird flu.
James Williams, county executive in Santa Clara County, California, emphasizes the fundamental role of government in preserving public health, stating it’s about ensuring access to current health information and enabling populations to thrive healthily. This responsibility transcends regular law enforcement and emergency services.
Illustrating this, a recent vaccination effort in Charlotte, North Carolina served as a model to remove obstacles for teenagers receiving overdue vaccinations. “This initiative reduces barriers for parents needing time off work,” explained nurse Kim Cristino. Such programs protect individuals and communities by preventing outbreaks through immunization.
The Mecklenburg County health department is emblematic of others nationwide, implementing programs to reduce-suicide, curb drug abuse, enhance prenatal care, and provide smoking cessation support. They also conduct educational outreach and offer medical and dental services.
Raynard Washington, director of Mecklenburg’s department, highlights the cost-effectiveness of these initiatives, noting each dollar spent on immunizations can save $11, with similar dividends seen in tobacco cessation and asthma management.
While medical interventions are celebrated, prevention work remains understated, despite its crucial role in mitigating silent health threats. “People often overlook its importance,” said Dr. Umair Shah, previously of Washington State’s health department, stressing the lack of investment in preventive measures.
Variations in funding at the state level complicate the operations of local departments, which also rely on city and county budgets. Mecklenburg County, for instance, utilizes local funds to bridge gaps left by insufficient state and federal support, yet still contends with resource shortages.
Employees frequently endure extended workdays, and the department faced obstacles like the need to tackle mpox exposures in a daycare, stretching staff thin.
The federal cuts have disrupted operations, with the Trump administration withdrawing funds without warning. This decision, led by Health Secretary Robert F. Kennedy Jr., ended vital pandemic-era grants. Thousands of layoffs at CDC further strained collaboration with local health entities.
Public health authorities argue that these decisions jeopardize the system’s integrity at a time when comprehensive responses to health threats are critical. “These measures are not abandoning public health but reforming it,” said HHS spokesperson Andrew Nixon, suggesting a reorganization aimed at improving services.
Nonetheless, the withdrawal of over $8.9 billion for essential epidemiology labs and an additional $2 billion related to immunizations destabilizes many locales. Mecklenburg County lost 11 community health workers, impacting outreach to vital communities. Mobile vaccination operations also ceased.
In Columbus, Ohio, lawsuits arise as health offices contend with significant capacity reductions amid measles surges. Kansas City, Missouri, halted its infectious disease testing plans, and Nashville ended critical testing programs.
CDC staff reductions have ripple effects, impacting programs for children with hearing loss and cutting teams for tobacco cessation support and drowning prevention.
Public health funding has fluctuated unpredictably, and the persistent cycle of emergency-based funding and subsequent reduction is unsustainable. Mecklenburg’s Washington advocates for consistent preparedness, drawing contrasts with the constant readiness of fire services.
A temporary influx of COVID-19 related funding allowed departments to bolster infrastructure, but as these funds run dry, many revert to precarious operations. Chicago’s health department, largely reliant on pandemic grants, returns to pre-COVID staffing, reducing outbreak responses and necessitating program cutbacks.
The outlook is grim as proposed budget cuts could drastically reduce CDC’s budget, potentially halving its financial support to state and local entities.
Michael Eby of Mecklenburg underscores that without adequate funding, public health departments face significant threats. Unchecked, these issues could lead to widespread harm, “risking countless lives we could otherwise save.”