Drop in federal funds squeezes public health

The state budget recently delivered good news for Georgia public health: an overall increase in funding.

But behind those numbers are other numbers that have alarmed public health officials.

Dr. Georges Benjamin
Dr. Georges Benjamin

About 70 percent of the overall budget for the Department of Public Health comes from federal grants. And that federal money has seen significant reductions.

From fiscal 2012 to fiscal 2013, across all programs, Public Health lost about $25 million in federal money. And that drop has continued.

Almost all Health and Human Services and Homeland Security grants have been cut, said Dr. Patrick O’Neal, director of health protection for the Georgia Department of Public Health.

“It looks like we’re going to see ongoing [federal] cuts,’’ O’Neal told GHN in a recent interview. “It keeps us up at night.”

All states have suffered federal reductions to public health programs, according to the American Public Health Association.

But some states, such as Georgia, that are much more dependent on federal dollars have been hit hardest.

O’Neal says state programs affected include those for emergency preparedness, immunizations, laboratory services, epidemiology, disease surveillance and health promotion.

The federal budget cuts began about four years ago, said Dr. Georges Benjamin, executive director of the American Public Health Association. The budget deal struck last year moderated these reductions somewhat, but eventually “we go back to fairly draconian cuts,’’ Benjamin told GHN on Friday.

The nation has lost about 42,000 jobs in government public health over the last five years as a result of reductions in federal and local spending, Benjamin added.

The impact has hit vaccinations, infrastructure for local health departments, programs targeting chronic diseases, and research projects, he said.

Public health departments have become less able to respond quickly to outbreaks of food-borne illness, he said.

What about the future impact of federal reductions?

“I’m very pessimistic about it,’’ Benjamin said.

“Public health folks are not very good at yelling and screaming,” he said. “They just suck it up and do the job.”

Fears about HIV patients

Despite some gains from the Affordable Care Act, Benjamin said, “you’ll still need a very robust public health system. Medical doctors don’t do restaurant inspections, air quality tests.”

Water contamination issues

Public health officials are the responders to infectious disease outbreaks, he added, and oversee safety for all citizens, such as protecting water quality.

“Public health is for everybody; it’s not just for the underserved,” Benjamin said.

In recent years, the individual states’ budget actions – partly a result of the recession – haven’t helped the situation. From fiscal 2008 to 2012, the median per capita state spending on public health decreased from $33.71 to $27.40. This represents a cut of more than $1.15 billion, based on the states’ total combined budgets from those years, according to the Trust for America’s Health.

In Georgia, the creation of the Department of Public Health helped stanch that bleeding, along with the agency’s strong leadership.

But O’Neal notes that as federal budget cuts occur, public health employees’ benefits costs keep rising.

The CDC recently removed about $3.7 million in HIV prevention funding from the state, and transferred that amount plus $800,000 to Fulton and DeKalb counties’  health departments. That switch was intended to focus more resources on where the disease is hitting hardest, in metro Atlanta.

“We certainly have had some complaints from rural counties, but overall I don’t think we’ve seen a tremendous impact,” O’Neal said.

Yet he added that he is worried about federal funding for HIV/AIDS, which comes through the Ryan White program.

(White was a young Indiana hemophiliac who contracted HIV through a transfusion and became a symbol of the national AIDS epidemic in the 1980s. He died in 1990.)

The money from the program, among other things, funds the ADAP program – providing prescription drug assistance and other help for people with HIV. At one time, Georgia had the longest waiting list for the ADAP program in the United States, but eliminated that waiting list in 2012.

Jeff Graham of Georgia Equality said that with the state not expanding its Medicaid program, the majority of Georgians with HIV will remain reliant on Ryan White funding for their medical care. Under the ACA, states get extra federal funding for expanding Medicaid to cover more low-income people, but Gov. Nathan Deal and legislative leaders say it would still be too expensive for Georgia.

“It is difficult to say what will happen three or four years down the road,” Graham said. “Should Congress begin to shift funds from Ryan White to other programs or cut Ryan White funding, then the state would be expected to fill that gap.”

He added, “While the state has had a commitment to stable funding for its share of ADAP, it is extremely unlikely that they would come up with the tens of millions needed to replace Ryan White funds.”