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Americans endangered by cuts to local health departments

Imagine the public protests if federal, state and local government budget cuts forced fire departments across the United States to eliminate the jobs of nearly 52,000 firefighters. Millions of Americans would be worried about the safety of their families – for good reason.   

Now stop imagining. Instead, consider a similarly severe – but real – threat to the health and safety of the American people. Without sparking widespread public attention, the jobs of 51,700 health professionals have been gradually eliminated in county, city, metropolitan, district and tribal health departments across the United States since 2008.  

{mosads}The cuts were documented in a survey of local health departments  published in June that was conducted by the National Association of County and City Health Officials, where I serve as executive director.

The elimination of the almost 52,000 jobs in local health departments has had a big impact, increasing the likelihood of more illnesses, injuries and deaths among the American people.  

Unsung champions of population health, local health departments do many things on a daily basis that too often go unnoticed. They focus on preparing for, preventing and responding to illnesses and injuries caused by a variety of factors, including: infectious disease outbreaks; unhealthy behaviors like smoking and substance abuse; natural disasters; mass casualty attacks by terrorists and other criminals; and catastrophic accidents like airliner crashes and train derailments. 

Among other duties, local health departments collaborate with community and private-sector partners to ensure the safety of the water we drink, the food we eat and the air we breathe. They educate the public about smoking and obesity. They vaccinate people against diseases like hepatitis A and B, flu, measles and whooping cough. They provide substance abuse treatment and conduct screening for conditions like high blood pressure, diabetes, tuberculosis and HIV.  

Local health department touch the lives of more than 200 million Americans every day. Most of the 2,800 local health departments in the United States have been weakened by funding and staffing cuts – particularly the largest health departments, which each serve more than 500,000 people and collectively serve nearly half the U.S. population.

The funding cuts have come about because of millions of dollars in reductions in federal, state and local government assistance for local health departments since 2008 – even though the U.S. population and the cost of providing healthcare grew every year.  

Like fires, public health emergencies can strike without warning and with devastating consequences. For example, Ebola, Lassa fever, dengue fever and Middle East respiratory syndrome (MERS) have together killed thousands of people and sickened thousands more around the world in recent months. Thankfully, there have been no widespread outbreaks of these deadly diseases in the U.S. – but that doesn’t mean our population is somehow invulnerable.  

In addition to diseases, our country is regularly hit by tornadoes, hurricanes, flooding and earthquakes. Attacks by terrorists, criminals and the mentally ill have taken place as well, killing innocent victims and often leaving many others in need of emergency medical help and long-term care and assistance. The 2013 Boston Marathon bombings, for example, sent more than 260 people to local hospitals – including 16 who lost limbs – in addition to killing three people. Tragically, we must be ready for more such attacks in the future.  

While we must always hope for the best, we need to be prepared for a broad range of public health emergencies, because all require a rapid response in the same manner as a fire burning out of control. Communities don’t wait until a big fire breaks out to hire all the firefighters they need and buy new fire engines. In the same way, we can’t afford to leave our local health departments dangerously understaffed, underfunded, and without adequate public health infrastructure until a horrific epidemic, disaster or outbreak of violence strikes.  

Just as we need adequately staffed fire departments to protect us, America needs adequately staffed local health departments to serve as the frontline public health responders to outbreaks of disease and disasters.  

Our elected representatives in Congress and in state and local governments should work together to provide needed funds to allow local health departments to stop cutting staff and instead start hiring thousands more health professionals to strengthen their programs, protect more people and save more lives. I can’t think of many higher priorities for government than this investment in a healthier future for all Americans. 

Hasbrouck is executive director of the National Association of County and City Health Officials (NACCHO). He earlier headed the Illinois Department of Public Health, and the Ulster County (N.Y.) Department of Health and Mental Health. He also was an official with the U.S. Centers for Disease Control and Prevention, and the World Health Organization.


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