This Statement was written by Kelly Colopy, MPP, the Director of the Long Beach Department of Health & Human Services and Kim Saruwatari, MPH, the Director of the Riverside University Health System-Public Health. Both serve as the Co-Chairs of the Public Health Alliance of Southern California, a coalition of 8 Southern California Local Health Departments.
People know what it means to go to the doctor when they get sick, yet many are unaware of a less visible workforce protecting their health before a trip to the doctor is needed. When all is well, public health professionals are largely invisible. Now, amid COVID-19, many people are learning about the essential services public health provides for the first time. But as COVID-19 cases are surging, California’s budget deal signed by the Governor on Monday reduces the state’s current $3.4 billion public health budget to $3.2 billion – a 6.3% decrease. Budget decisions like these severely hinder our ability to respond to and prepare for current and future public health emergencies like COVID-19. This makes no sense.
Over the past decade alone, local and state health departments lost 20% of their workforce, and local health department budgets shrank by as much as 24%. Consider one example: Over the past 15 years, 11 local public health labs closed in California, which hampered our ability to test for COVID-19, a key criterion for safely re-opening businesses, schools, and other gatherings. Almost all funding sources for local health departments have been declining at the same time that public health threats are growing – such as natural disasters, Zika, Ebola and now COVID-19.
Local health departments serve important functions, including COVID-19 testing and follow-up, collecting critical data on health outcomes, ensuring food access for individuals most in need, and building relationships with community partners to improve health for all. They also address the social factors that touch our lives, such as access to housing and good jobs.
It is essential to recognize that budget choices made today will have lasting implications on the public’s health and our ability to advance healthier, equitable communities tomorrow. What we need during COVID-19 and beyond is funding to rebuild and strengthen our public health infrastructure at all levels, but especially at the local level where city and county health departments are working on the frontlines. Without a strong public health infrastructure, the ability to quickly respond to novel diseases or other public health emergencies is severely hampered.
State and federal governments should be increasing, not cutting, funding for local health departments in their budgets, with the flexibility and nimbleness we need to address this current pandemic and the root causes of health inequities. Local governments also need to step up and fill the gaps left by the state and federal government for local health departments within their jurisdictions. In the U.S., only 3 cents of every health dollar goes to public health, while 97 cents goes to medical care. We need to shift this paradigm and prepare ourselves for future challenges by investing in prevention.
At the core of public health is a mission to advance health equity in partnership with our community members most impacted by racial and economic inequities. Local health departments identify and address the neighborhood-level factors that drive unjust differences in a person’s health outcomes based on where they live. Local health departments work to address and correct these differences with community-based prevention practices such as maintaining healthy, safe and affordable housing, partnering with workforce development programs and our community members on job creation, and identifying communities in need of green space. Local health department funding should be made with these social factors in mind.
With the COVID-19 pandemic, it’s clear that our local health departments are at a critical juncture. Our decisions today will affect us not just in moments of crisis but for generations to come. We must support a comprehensive public health system to protect our society from the threat we currently face with COVID-19, as well as take steps to prevent the disproportionate impacts of the next public health emergency before it occurs.
Funding a sustainable, equitable, and resilient local health department infrastructure is needed to protect our residents most impacted by health inequities and keep everyone safe and healthy. When we invest in public health, we are not just investing in local health departments. We are investing in a future where everyone can live to their full potential, where people have stability and security in their work, homes, schools, and environment to enjoy life, and where we come together to ensure no one is left behind.