Who needs public health?
AS THE Legislature and Governor Patrick confront a budget deficit for next year, they will need to find new revenues as well as decide which state programs will survive and which programs will be cut beyond recognition. They should not gut public health. We all need it.
The state is grappling with a new public health threat: swine flu. The strain that has killed over 150 people in Mexico, and is affecting several US states, has the potential to unleash a pandemic. Does the state have the capacity to organize preventive measures - and a response if swine flu breaks out here?
What is needed to respond to this threat are strong state and local health departments with the staffing and systems essential to a coordinated response and with the ability to reach people at the community level.
State and local health departments must be able to communicate with healthcare providers regarding possible cases, symptoms to watch for, and recommended treatments. There also needs to be a state laboratory with the equipment and staff to test the samples that come in to determine whether swine flu has landed here. Trained public health nurses with community relationships should identify people with symptoms, talk to those who may be infected to help them get treatment, find out where they have been and who else they may have infected, and help them make arrangements to stay home. Local health departments need to support schools and businesses that may need to close down as a precaution. Public health workers must also distribute anti-flu medications - and, if necessary, implement quarantines. For tasks such as setting up vaccine distribution centers, there needs to be community partners, whose roles must be coordinated by health departments.
These tasks will be especially challenging in communities with only a part-time or volunteer board of health. Many smaller towns lean heavily on the work of the state health department and regional coalitions for help. Emergency preparedness funds have helped to strengthen local planning and coordination, but it's not enough. The budget cuts that have eroded local and state health department capacity have diminished our preparedness.
Some consider public health "easy" to cut, compared with more visible services with clearly defined populations. And indeed, both the governor's budget and the House Ways and Means budget cut public health disproportionately. The town of Amesbury eliminated its health department and the City of Worcester left its health department a skeleton. This kind of thinking is shortsighted. Cuts to public health will put every resident at risk. Consider who is actually affected by the programs and services of public health - and what is at stake in cutting them almost 25 percent, as proposed by the House Ways and Means Committee.
The mother preparing breakfast for her children needs public health to ensure that the public water supply she relies on is clean -- so that her kids' oatmeal and hot chocolate are uncontaminated.
How about the businessperson hosting clients for lunch? Public-health funding ensures that the restaurant has been inspected and complies with health codes and anti-smoking laws - and that there is follow-up on reports of food-borne illness.
People at risk for cancer, stroke and heart disease, diabetes, addiction, HIV, and Hepatitis C need information to prevent these diseases, to get screened, and to find out where to go for treatment. Community health workers, funded by public health, provide information to members of their communities and connect them to services.
Who needs public health? We all do. Every resident of the Commonwealth - whether aware of it or not - relies on a strong, functioning public health system - a system that is greatly endangered. Without public health, there is no way for the Commonwealth to succeed in education, economic growth, environmental innovation, or civic engagement. In this time of new strains of viruses and costly public health problems like obesity and diabetes, the Legislature - and administration - should think twice before cutting our public health system so deeply that it puts us all at grave risk.
Valerie Bassett is executive director of the Massachusetts Public Health Association and chair of United We Stand for Public Health.