Author’s note:This article was originally published before news broke about the first U.S. case of imported Ebola in Texas. The article has been edited from its original publication to reflect this news.
“What if there was a case of Ebola in my community?” With the growing outbreak in West Africa, public health preparedness planners across the country are mulling this question as news broke that the CDC confirmed a case of Ebola in Texas and concerns grow over the threat posed by Ebola to global health security. This question is inevitably followed up with, “Are we ready?”
These are the types of questions that keep public health preparedness planners up at night. The reason these questions are so pressing right now is not only because of the alarming symptoms and mortality rate of Ebola, but also because of the continuous funding cuts that local health departments have faced since 2007. The United States is not West Africa, and Ebola is unlikely to have sustained transmission here because of better infection control in healthcare facilities, cultural differences, and protocols put in place by the Centers for Disease Control and Prevention (CDC) to stop the spread of the disease. But while local health departments would do everything in their power to protect lives in the face of a public health emergency like Ebola, there are other consequences to a community tasked with responding to a public health emergency that are complicated by ongoing funding cuts. For example, even the containment, treatment, and contact investigation of a small number of Ebola patients would have the potential to quickly overwhelm local health department budgets, as per capita spending on public health preparedness has decreased by nearly 50 percent in just the past year . Administrative burdens often delay state and federal emergency response funding that supplements local budgets . Additionally, lack of funding has decreased the number of preparedness programs .
Local health departments have anecdotally reported to NACCHO that the programs that are cut are education and training initiatives to increase community resilience, such as instructing the community about the need to build and maintain a 72-hour emergency kit. With this in mind, preparedness planners may be asking themselves questions like, “How many would be prepared to shelter in place for three days, as was the case in Sierra Leone, to help decrease the spread of a disease like Ebola?”
More than half of local health departments rely solely on the federal government for preparedness funding . The federal government provides three sources of funding that support the preparedness capabilities of local health departments. CDC provides $640 million in Public Health Emergency Preparedness (PHEP) grants to 50 state, eight U.S. territory, and four metropolitan health departments. Although only four local health departments are funded with this money, many receive funding through subcontracts with their state health departments. These grants have been cut more than 30 percent since 2007. The Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services provides $255 million through the Hospital Preparedness Program (HPP) to help local health departments partner with hospitals and other providers to ensure that the health care system is prepared to respond to emergencies. In 2014, HPP was cut by $100 million. Lastly, the Office of the Surgeon General provides $9 million in funding to support the nation’s 1,000 Medical Reserve Corps units, and 67 percent of these units are housed within local health departments that support staff to manage volunteer coordination during disaster response. Many local health departments rely on these funding sources to support activities such as dispensing vital medications during a pandemic or other infectious disease outbreaks, conducting disease surveillance, providing accurate and up-to-date risk information to their communities, and staffing shelters for those displaced by a disaster.
These three federal funding sources work together to support local health departments, and cuts to one have a ripple effect on the preparedness capabilities of communities across the country. PHEP funding supports training and planning activities to ensure that public health departments are ready for emergencies. HPP funding supports coalitions which facilitate regional coordination of healthcare facilities, lessening the impact of emergency response by dispersing surge across multiple communities. With both PHEP and HPP cut by more than one third, many local health departments, especially rural ones, have had to cut staff and have been relying more and more on volunteers such as those in Medical Reserve Corps units to fill the gap. With federal preparedness funding subject to a reactionary cycle that is driven in part by political process, local health departments have been feeling the pinch as federal budgets shrink.
Will cuts in preparedness funding to local health departments make an Ebola outbreak in the United States more likely? The answer is no. The conditions that would limit the spread of Ebola, including better infection control in healthcare facilities and different cultural traditions, are not factors influenced by preparedness funding at local health departments. Despite funding cuts, the public health workforce stands ready to do whatever is necessary to stop Ebola from spreading. But those cuts have put deep dents in the public health shield that protects the lives of all Americans and make it more likely that local health departments faced with even a few cases of Ebola would significantly strain their already thinly stretched workforce and financial resources during the response. Please download the PDF and share NACCHO’s infographic illustrating preparedness funding cuts to raise awareness of the implications of these cuts.
For more information about the impacts of preparedness funding cuts on local health departments:
- NACCHO’s 2013 National Profile of Local Health Departments Shows Continued Funding Cuts for Preparedness (see comments section)
- NACCHO Stories from the Field: Workforce Challenges in Public Health Preparedness
- “Faces of Austerity” Report Illustrates Impact of Budget Cuts on Local Emergency Preparedness
- NACCHO. (2013). 2013 National Profile of Local Health Departments. Retrieved from: http://nacchoprofilestudy.org/reports-publications/
- NACCHO. (2013). Administrative Preparedness and the Public Health Workforce: Suggested Strategies for Health Departments. Retrieved from: http://eweb.naccho.org/eweb/DynamicPage.aspx?WebCode=ProdDetailAdd&ivd_prc_prd_key=f760ce84-eecd-4b95-adb8-f7dc919a0021&ivd_qty=1&Action=Add&site=naccho&ObjectKeyFrom=1A83491A-9853-4C87-86A4-F7D95601C2E2&DoNotSave=yes&ParentObject=CentralizedOrderEntry&ParentDataObject=Invoice%20Detail
- NACCHO. (2013). Local Health Department Job Losses and Program Cuts: Findings from the 2013 Profile Study. Retrieved from: http://naccho.org/topics/infrastructure/lhdbudget/upload/Survey-Findings-Brief-8-13-13-2.pdf
- NACCHO. (2010). 2010 National Profile of Local Health Departments. Retrieved from: http://nacchoprofilestudy.org/reports-publications/