The recession has drained hundreds of millions of dollars and thousands of workers from the state and local health departments that are now the front line in the country’s defense against a possible swine flu pandemic.
Health officials in affected states said they had thus far been able to manage the testing and treatment of infected residents and mount vigorous public education campaigns. But many said they had been able to do so only by shifting workers from other public health priorities, and some questioned how their depleted departments might handle a pandemic.
“I’m very concerned,” said Robert M. Pestronk, executive director of the National Association of County and City Health Officials. “Local health departments are barely staffed to do the work they do on a day-to-day basis. A large increase in workload will mean that much of the other work that is being done now won’t be done. And depending on the scale of an epidemic, capacity may be exceeded.”
At a news conference on Monday, Dr. Richard E. Besser, the acting director of the federal Centers for Disease Control and Prevention, said the public health system was in “a tough situation.”
“We hear about tens of thousands of state public health workers who are going to be losing their jobs because of state budgets,” Dr. Besser said. “It is very important that we look at that resource because this outbreak was identified because of a lot of work going on around preparedness.”
Mr. Pestronk’s group estimates that local health departments lost about $300 million in financing and 7,000 workers in 2008, a year when more than half of all agencies shed employees. There were about 160,000 health department workers in 2005, according to the group. Mr. Pestronk said he expected to lose at least another 7,000 jobs this year.
State public health agencies lost an additional 1,500 workers through layoffs and attrition from July 2008 to January 2009, according to the Association of State and Territorial Health Officials. The group anticipates 2,600 job losses in the coming fiscal year.
South Carolina’s Department of Health and Environmental Control, which also staffs local health departments, has lost $30 million in state money and a third of its 6,000 employees over the last decade, said Thom W. Berry, a spokesman. The department is currently investigating several “probable” cases of swine flu.
In New York City, which has the highest concentration of confirmed flu cases, federal grants for emergency preparedness have fallen to $23 million, from $28 million a year ago, said Andrew S. Rein, the city health department’s executive deputy commissioner.
In California, which has 14 confirmed cases, the Department of Public Health recently absorbed a 10 percent budget cut ordered by Gov. Arnold Schwarzenegger to help close a huge budget gap. It did so without laying off workers, instead reducing grants to local health departments, said Dr. Bonnie Sorensen, the chief deputy director of policy and programs. During the flu scare, about 100 state health workers have been diverted from other duties, Dr. Sorensen said.
On Tuesday, Mr. Schwarzenegger declared a state of emergency that calls for all California agencies to assist the health department. It gave the department special powers to enter into contracts, suspend competitive bidding and waive certification requirements for laboratories. The federal disease control agency has shipped equipment and chemicals used to test for swine flu to California so the state can hasten its laboratory work without sending samples elsewhere.
“The bottom line is, we are prepared,” Mr. Schwarzenegger said this week.
The White House asked Congress on Tuesday to provide $1.5 billion in emergency financing to battle the swine flu outbreak, but it is not clear how that money might flow downstream.
Public health officials said Congress had missed an opportunity by excising nearly $900 million in proposed financing for pandemic flu preparation from this year’s stimulus bill. It was to be the final installment of President George W. Bush’s request for $7 billion in federal spending on vaccines, medical equipment and planning. Congress last allocated money for pandemic planning by state and local governments in 2006 — about $600 million over two years, said Dr. Paul E. Jarris, executive director of the Association of State and Territorial Health Officials.
“The entire system is lining up to decrease resources at the time we need them most,” Dr. Jarris said. “We have to realize that we’re at the starting line. The stress will come if this escalates.”
Jeffrey Levi, executive director of the Trust for America’s Health, said the financial strain made “it more important that we luck out” with a mild outbreak.
Dr. Alvin D. Jackson, the state health director in Ohio, which has one confirmed case of swine flu, said his agency’s state appropriation had declined by about $10 million over the last two years. Dr. Jackson said his budget to prepare communities and hospitals for an influenza pandemic had dropped to $34 million, from $55 million in 2004.
“Right now we’re O.K.,” he said. “We feel that we can do an excellent job protecting our citizens. But looking forward, we do understand that some additional resources would be appreciated.”
In Cleveland, Dr. Terry Allan, the Cuyahoga County health commissioner, said the decline in state and federal money had prompted a 25 percent cut in spending on pandemic preparedness over the last two years. That had cost the department at least 10 workers, Dr. Allan said, and further cuts are expected.
“Those are people we would have had available to expand and build on our plans for social distancing, for mobilizing antivirals,” Dr. Allan said. “Our plan is not adequate. It’s barely started.”New York Times Electronic Edition - 30.04.09
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