Public health systems across the United States are entering troubling times, as federal funds designated for pandemic relief begin to dry up. What seemed like a stable boost during the COVID-19 pandemic has now morphed from boom to bust, leaving many local health departments scrambling to maintain their operations. The National Association of County and City Health Officials found local health department staffing increased by approximately 19% from 2019 to 2022, reflecting the surge of federal aid. But now, with budgets being cut, this staffing boom is teetering on the edge of collapse.
Throughout the peak of the pandemic, more than $800 billion flowed from Congress to assist states with their COVID-19 responses, which significantly fortified the public health workforce. But as these federal grants sunset, states are tightening their belts, directly impacting local health departments. Brian Castrucci, president, and CEO of the de Beaumont Foundation, bluntly remarked, "You cannot hire firefighters when the house is already burning."
The effects of the drying up of financial resources are already evident. States such as California, Montana, and Texas are reporting significant budget cuts. California's Democratic Governor Gavin Newsom suggested a staggering $300 million cut to the state's public health funding, and the Washington Department of Health announced more than 350 job cuts amid similar deficits.
For communities, particularly vulnerable ones—especially those situated in rural areas—these budget cuts could spell disaster. Officials fear service cuts will follow, meaning local health departments may no longer be able to offer programs like contact tracing, immunizations, and family planning. Without these programs, experts warn some communities may find themselves facing health crises.
Health departments, particularly those serving rural populations, operate as safety nets, especially as many HOSPITALS continue to close. According to Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials, the lack of sustainable funding for local health officials is particularly alarming. She noted communities are already grappling with not only the fallout of COVID-19 but also other persistent public health challenges, such as rising rates of sexually transmitted diseases, suicide, and substance misuse.
Even as some states witness cuts, others are grappling with the ramifications of this funding crisis indirectly. For example, Love Columbia, a nonprofit based out of Missouri, has announced it has exhausted its pandemic-related funds for rent assistance. Their average rent is steep, with one-bedroom apartments going for around $861—meaning many residents now lack access to important services just when the need for resources is highest.
The group claims to have helped 2,049 households and prevented 712 evictions using these funds. Now without federal assistance, they are calling for public donations to refill their depleted coffers. Strains on rental assistance programs offer just one glimpse of the far-reaching consequences the public health funding crisis may have on housing and social services.
Meanwhile, Florida's budget outlook reflects similar caution. Budget leaders anticipate deficits as federal coronavirus aid dwindles. House Appropriations Chairman Tom Leek expressed hope for the state to maintain revenue surpluses but acknowledged local departments might soon feel strain as available federal funds are quickly allocated. 2023 saw significant shortfalls reported: potential budget deficits of over $2 billion were projected for 2026 and nearly $7 billion for 2027 if current spending continues.
The connection between public health and financial stability was highlighted recently when representatives discussed Florida's long-term financial outlook. With increasing retirements from the Baby Boomer generation, healthcare costs are expected to surge. This rise, paired with dwindling federal aid, places immense pressure on health services now more than ever.
Compounding matters is the long-term debt many small businesses incurred from COVID-19 Economic Injury Disaster Loans (EIDL) programs, which are not forgivable and must be repaid. Some businesses, strong on revenue but burdened by this debt, are now considering their futures, with many facing similar hardships. Companies like Greenlight Creative, which applied for nearly $500,000, have expressed how this outstanding debt hangs over them like a cloud. These loans initially provided lifelines—but they now present serious concerns about long-term viability and operational flexibility.
Lubbock, Texas, presents another stark example of public health challenges. The city's health department received funding for disease intervention specialists focused on rising syphilis and congenital syphilis cases. Despite federal grants to assist, the funding is set to expire, and officials are left scrambling without adequate resources to combat alarming upward trends. Katherine Wells, director of public health, expressed her fear about the sustainability of these funds, stating, "Even with the funding, it’s very hard for those staff to keep up with cases …“ without the necessary resources.
Across various states, local public health departments are slowly becoming casualties of the post-pandemic funding crunch. The National Association of County and City Health Officials reports staggering increases of nearly 2% nationwide for sexually transmitted diseases from 2018-2022. With alarming rates of chlamydia, gonorrhea, and syphilis rising, public health departments are not only facing staff shortages but also the overwhelming challenge of restoring preventative services to prior levels.
Data from the KFF reveals another chilling trend: routine vaccination rates for children have not bounced back since the pandemic; almost three-quarters of states did not meet the federal vaccination target for diseases like measles and mumps. With more families claiming exemptions from vaccinations, communities are at risk of preventable outbreaks of vaccine-preventable diseases.
It all leads to the bigger conversation about the sustainability of public health funding. Analysts such as Adriane Casalotti stress the need for prioritizing public health roles within legislative budgets, especially as many rural areas continue facing healthcare provider shortages. Fulfilling tax-supported funding commitments could stave off several more public health crises.
Many believe addressing the public health challenges we face goes beyond addressing current deficits. This sentiment resonates strongly within areas previously underserved before the pandemic. For the Central Montana Health District, which serves five rural counties, funds provided throughout the pandemic aided their limited staffing capabilities. Although they managed to maintain operations during COVID-19, Susan Woods, the public health director for the district, emphasized the precariousness of their situation moving forward.
“Any kind of crisis, any kind of, God forbid, another pandemic, would probably send us crashing,” Woods articulated, illuminating the fears many health officials share currently.
Despite the challenges on the horizon, public health leaders stress the importance of maintaining their roles, combating issues thought to have slipped entirely through the cracks during COVID-19—namely increases of unmet healthcare needs, particularly after experiencing these cuts.
The reality is, communities have been charged with recovering from COVID-19’s economic and health fallout just as they face winding down of surety—from federal assistance to resources available to maintain the very systems established to serve them. Public health systems act like lifelines, which local authorities must keep afloat to serve their communities, especially those already facing illusions of security.
Looking to the future, it remains unclear how severe the fallout from these cuts will be. Public health remains at risk as state lawmakers navigate their budgets amid mounting economic pressures. The pressing question looms: will we prioritize fostering the health of our communities, or are we resigned to watch as the public health infrastructure potentially collapses under the weight of fiscal responsibility?
