Anna M. Buchanan, MPH IOM Committee on HIV Screening & Access to Care September 30, 2010
The national nonprofit organization representing the public health agencies of the United States, the U.S. Territories, and the District of Columbia, as well as the 120,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to assuring excellence in state-based public health practice.
By just about any measure, the last two years have been the most difficult fiscal period for states since the depression State revenues are continuing to deteriorate, as most states are witnessing actual monthly totals lower than their recent forecasts States foresee fiscal year 2011 to be the most difficult to date, and few see fiscal year 2012 much better. State Fiscal Update (February 2010), the National Governors Association and the National Association of State Budget Officers. In the last six months of 2009, nearly half of LHDs (46%) lost the skilled people needed to protect the health of their communities as 8,000 LHD jobs were lost. When combined with previous NACCHO findings, this results in a cumulative 23,000 jobs lost from 2008 2009, approximately 15 percent of the LHD workforce in the country. Local Health Department Job Losses and Program Cuts: Overview of Survey Findings from January/February 2010 Survey (March 2010), National Association of County and City Health Officials.
Instrument: Web-based survey (zoomerang and Qualtrics) Population surveyed: All 57 ASTHO member agencies (50 states, six territories and the District of Columbia). Response: Nov/Dec 2008 survey - 78.9% response rate Jan/Feb 2009 survey 38.5% response rate Jul/Aug 2009 survey 80.7% response rate Jan/Feb 2010 survey 70.1% response rate
Average Proportions for State Public Health Agency Revenue (FY09) Other 17% State 34% Federal 49% ASTHO s Budget Cuts Survey (November 2009)
Extent of Respondents Budget Reductions 83% of health departments suffered job losses since July 2008. 1,564 state employees in central offices were lost 651 state employees assigned to local/regional offices were lost 76% of state/territorial health departments made cuts to the FY09 budget during FY09.
Extent of Respondents Budget Reductions 55% reported a FY10 budget that is smaller than FY09. A third of states with larger budgets in fiscal year 2010 compared to fiscal year 2009, indicated that this is the result of federal stimulus and H1N1 funds and that their state general funds actually decreased. 28% reported a FY09 budget that was smaller than FY08. At least 23% expect further cuts in FY10.
Percent of State Health Agencies experiencing job losses and program reduction FY09: N= 49, FY10: N= 40, FY09 & FY10: N= 52
Examples of State Health Agency Actions Resulting from Budget Cuts: State A -Eliminated its HIV prevention program. Cut its health inspections staff by 58% and reduced public health nursing, immunization and vital records process. State B -Suspended Diabetes prevention and eliminated Hepatitis C and Valley Fever prevention, crisis intervention, women s and children health services and local nutrition program. Slowed down its vital records process, and reduced epidemiological investigations, laboratory tests, children s vaccines, and oversight of WIC. State C -Reduced HIV medication purchases, immunization, early intervention program, women and children s health services, minority health, chronic disease services, Sickle Cell services, oral health, WIC, Evaluation & Accreditation of Local Health Departments, purchase of Medical Care for Kidney, Epilepsy, Cystic Fibrosis, and Cancer, Tobacco Cessation activities. State D -Reduced vaccine purchase and distribution by $6 million, cut the public hospital budget by over $2.4 million, reduced a homeless services contract by 10%, cut $8 million from substance abuse services, reduced tobacco control activities, limited HIV/AIDS services, cut environmental studies, reduced an early intervention program for at-risk children, and cut back nurses scholarships, EMS services, oral health and school health services for children, suicide prevention, stroke monitoring, youth violence, teen pregnancy prevention, and regulation of health care quality and safety.
Programs Disease-specific programs (e.g. Heart disease, Parkinson s, Alzheimer s, Tuberculosis, Cystic Fibrosis, Asthma, Epilepsy) Number of States/Territories Already Making Cuts to the Programs 14 HIV, AIDS and STDs 12 Public health hospitals and clinics 12 Tobacco prevention and control 12 Workforce and quality improvement 12 Immunization 11 Teen pregnancy prevention 10 Cancer programs 9 Family health and nutrition (e.g. WIC) 9 Laboratory services 9 Prevention Programs (e.g. health education & promotion) 9 Epidemiological investigations and surveillance 8 Maternal and child health programs 8 Oral health services 8 Emergency Medical Services 7 Inspections (e.g. Health care facility, food safety, nursing home, pharmacy; day care center) Minority Health 7 7
1. The fiscal crisis continues to have a negative impact on State/Territorial Health Agencies and their work to protect the public s health. 2. Future studies include data on other levels of government (federal and local). ASTHO s coordinated approach to survey design and data harmonization this year with NACCHO and NALBOH will allow for more comparable data, and produce a more complete view of the public health system as a whole. What does this mean for implementation of universal HIV screening?
http://www.astho.org/programs/health-reform/ } Prevention & Wellness Fund provided substantial funds to states to be administered over the course of six years } Some HIV funding provided already } Necessity of public health infrastructure } Significant questions remain: additional HIV funding? true impact of expanded insurance coverage?
Questions?