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Monday, 16 April 2012

Public health (non)financing: A disturbing pattern is emerging

Three unrelated funding pieces came together and reflected on 20 odd years of being involved in budget discussions.  

Preventing illness and keeping people healthy is often the first stated goal of a health organization.  Why would it not be?

Not that being first is indicative of any special position, but it does make sense to prevent illness first.  One might interpret that being the first goal could be reflective of a higher priority as well.  So when budget times roll around, open hands stretch forward and invariably a few of the highest ranked public health initiatives last through the initial rounds of budget trimming unscathed, often undebated.   Lengthy argument might ensure over various clinical issues on how limited resources should be spent or where cuts are needed to balance budgets.   Then as the finish line approaches and optimism begins to creep that public health growth is a possibility, hopes are dashed in the final days. 

Apparently this experience is not unique.

An analysis of public health funding in US speaking to the erosion and variability of public health funding in US Investing in America.   Most notable was flat public health funding at the federal level and a general cutting of funding at the state level. Contrasting this is recent announcements of significant cuts in Prevention and Public Health and CDC budgets  http://thenationshealth.aphapublications.org/content/42/3/1.2.full 

Seems the duality of public health funding in the US shares one main characteristic in Canada – it is easy for the two parties to point fingers and say “You are it”.

Speaking of cutting, gone in a slash is the National Aboriginal Health Organization that provided health planning and statistical support to Canadian First Nations.  The spin doctoring on the funding reduction is exemplary as it makes it sound like this was a good thing to lose, even though the funds are being reaped for federal budget balancing purposes NAHO funding eliminated .  It is a huge blow to the equity agenda for Aboriginal peoples, and how difficult a task it must have been to have Minister Aglukkaq to be the one to announce the cut. 

The tweet the prompted this blog was about elimination of funding from a state budget that would have gone to surveillance and public health issues related to expanded natural gas activity in Pennsylvania.  Gas drilling bill cuts public health dollars.   It was the comment on being “stripped at the last minute” that rang such a truism.  No doubt the inclusion of the activity was considered essential in the initial planning stages and minimally debated, only to suffer to the hatchet by the last of the policy folks who recognize what the downside consequences to business growth might be if there is a health implication documented.

 Surely some readers have stories they would like to share about the value of public health being espoused, only to fall flat in the finishing straight.  Post a comment, or email to drphealth@gmail.com  

addendum April 17 - a report on the APHA newswire further details some of the financing woes south of the border http://www.publichealthnewswire.org/?p=3160 .  The following quote is disturbing at the least in total, more than 52,000 state and local public health jobs have been lost since 2008 due to the elimination of positions, hiring freezes, layoffs and furloughs. This represents a loss of 17 percent of the state and territorial public health workforce and a 22 percent loss of the local public health workforce.    

1 comment:

  1. Once again you have brought to light an important issue, and trend, that should trouble even the most carefree public.

    Synonymous with short-sighted are imprudent, injudicial, unguarded, unsafe, unwary, unwise, careless, heedless, mindless; a few descriptors that have embodied the current budgetary decisions quite appropriately.
    Short term gains are being made, without consideration for the long term effects in many sectors; education cuts, health cuts, public safety at our border controls winnowed away; in favour of extravagant fighter planes.

    On the bright side, the appointment of a public health pioneer as the lead of the World Bank, I hope, is a sign of good faith in the long distance vision of governments. I try to remain optimistic, rather than to spiral into the pessimism that springs from the most recent doses of myopia.

    Thanks once again for keeping important issues in our purview.