By Jazmin Orozco Rodriguez

As federal aid poured into state budgets in response to the COVID-19 pandemic, public health officials warned of a funding drought on the horizon once the emergency ended and federal grants ran out. Now, that drought has become a reality, and state governments are cutting budgets that support local health departments.

Congress has allocated more than $800 billion to support state responses to Covid, fueling a surge in public health personnel nationwide.

According to a report from the National Association of County and City Health Officials, which studied 2,512 of the nation’s approximately 3,300 local departments, staffing levels at local health departments increased by about 19% between 2019 and 2022. The same report explains that half of their revenue in 2022 came from federal sources.

But those jobs, and the safety net they provide for people in the communities they serve, are vulnerable as the money dries up, worrying public health officials, particularly in sparsely populated rural areas that already face long-standing health disparities and scarce resources.

Officials in states like Montana, California, Washington and Texas now say they are facing budget cuts and layoffs. Public health experts warn that the resulting cuts to services — like contact tracing, vaccinations, family planning, restaurant inspections and more — could plunge communities into crisis.

In California, Democratic Gov. Gavin Newsom has proposed cutting $300 million in state health funding. And Washington State’s Department of Health cut more than 350 positions late last year and plans to cut another 349 this year as the state’s federal funding for COVID-19 relief dries up.

“You can’t hire firefighters when the house is already burning,” said Brian Castrucci, president and CEO of the de Beaumont Foundation, an organization that advocates for public health policies.

In some places, pandemic money has done little more than keep small health departments afloat. The Central Montana Health District, the public health agency for five rural counties, didn’t get the same flood of money as others, but it did get enough to help staff meet increased workloads, including testing, contact tracing and the rollout of COVID vaccines.

The department filled a vacancy with a federal grant provided by the state when a staff member left during the pandemic. The federal funding allowed the department to break even, said Susan Woods, the district’s public health director.

Today, there are five full-time employees working for the health district. Woods said the team is getting by with its meager resources, but a funding cut or another public health emergency could tip the scales in the wrong direction.

“Any kind of crisis, any kind of, God forbid, another pandemic, would probably collapse us,” Woods said.

Adriane Casalotti, director of government and public affairs for the National Association of County and City Health Officials, said she expects layoffs and budget cuts to intensify at health departments. The cuts will come as health officials tackle issues that have been pushed to the back burner during the pandemic, such as rising rates of sexually transmitted diseases, suicide and substance abuse.

“There is a lot of work going on right now to address public health challenges like this,” she said. But it will be difficult to catch up with reduced resources.

Between 2018 and 2022, cases of chlamydia, gonorrhea, syphilis, and congenital syphilis increased by nearly 2% nationwide, to more than 2.5 million cases. A recent KFF report found that routine vaccination rates for preschoolers have not returned to pre-pandemic levels, while the number of families seeking exemptions has increased. Nearly three-quarters of states have not met the federal goal of 95% vaccination rates for the 2022-23 school year for measles, mumps, and rubella, increasing the risk of outbreaks.

Faced with these challenges, public health officials are clinging to the resources they have acquired in recent years.

The health district in Lubbock, Texas, a city of more than 250,000 in the state’s Panhandle, hired four sexually transmitted disease intervention specialists during the pandemic through a five-year grant from the Centers for Disease Control and Prevention.

The appointments come as syphilis cases in the state have skyrocketed beyond levels seen in the past decade and the increase in congenital syphilis is outpacing the national average, according to the CDC. State officials recorded 922 cases of congenital syphilis in 2022, with a rate of 246.8 per 100,000 live births.

But federal officials, faced with their own shrinking budget, cut the grant by two years, leaving the district scrambling to close a nearly $400,000 annual budget deficit while working to bring the outbreak under control.

“Even with the funding, it’s very difficult for these staff to keep up with the number of cases and make sure everyone is being treated,” said Katherine Wells, Lubbock’s public health director.

Wells said state officials could reallocate other federal funds from the budget to keep the program going when the grant ends in December. Wells and other state health officials are constantly asking state officials for more funding, but, Wells said, “whether or not we’re going to be able to do that in a state like Texas is very uncertain.”

Making public health a priority in the absence of a national crisis is a challenge, Castrucci said. “The ups and downs of funding reflect the attention the American public has,” he said. As the emergency fades, so has enthusiasm for public health issues.

Rural health departments, like the one in central Montana, deserve more attention, said Casalotti, who advocates for county and city health officials. That’s because they play a critical role in communities that continue to see hospital closures and lose other health services, like maternity and women’s care. Local health departments can function as a “safety net for the safety net,” she said.

Healthbeat is a nonprofit public health newsroom published by Civic News Company and KFF Health News. Sign up for its newsletters here.

Jazmin Orozco Rodriguez: [email protected], @jazmin1orozco

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF – the independent source for health policy research, polling and journalism.

Originally published: September 5, 2024 at 06:16