Can Local Health Departments Survive the Current Fiscal Crisis?

Abstract

r D S we witness the largest reduction to human service budgets ever perpetrated on a civilized people, I am compelled to ask: "Will local health departments survive the fiscal crisis?" Pessimists are encouraged to send flowers. But I am not a pessimist. I respond to the sentiments ,qzbe MQexpressed in an old New Yorker cartoon which depicts two scrawny prisoners chained, spread-eagled, halfway up a very long, very narrow dungeon wall. A window at the top of the wall is extremely small and barred; on the floor is a tiny drain, also covered. "Listen," says one to the other, "I have a plan." Without that prisoner's spirit, without hope, we shall certainly perish. Public health professionals, especially those working for state or local health units, may see themselves in the same plight as those prisoners. Things look pretty grim. Even so, now may be the time for a plan, for ideas, maybe even for action. The present crisis presents many dangers to those who work in public health systems, and for those who are served by the public sector. However, the situation may also represent an opportunity for those willing to be innovative to look further down the road than the next hill, or curve, or pothole. Health departments traditionally perform four functions: 1. They conduct a variety of preventive activities in the community, including food and housing sanitation and other aspects of environmental control, communicable disease surveillance and epidemic investigation, health assessment of the population (or segments of it), and communitywide immunization of children and other susceptibles. 2. Health departments have also provided an increasing variety of direct medical services and clinical care. From the earliest periods in American public health (i), these services have included home care, public health