As the Legislature begins planning for next year’s budget, public health leaders are calling on the state to “reverse the trend of disinvestment” in programs meant to protect the public from infectious diseases, environmental contaminants, and medical errors.
The Department of Public Health could see a small budget cut as Governor Deval Patrick looks to close a $540 million shortfall this year. Rachel Zimmerman of WBUR’s CommonHealth blog reported last week that the department could lose $2.6 million.
That will have a relatively small effect on a $519 million budget. But it adds to $70 million in cuts to the department since fiscal year 2009. The cuts came as the department was given new responsibilities, including school nutrition programs, monitoring concussions in youth sports, and, most recently, oversight of the medical marijuana program created by a ballot initiative passed last month.
In a letter to Patrick and key legislative leaders, the Massachusetts Public Health Association hints at why cuts to public health have been palatable to lawmakers. “Public health is invisible when it works, because disease, disability, or death does not happen,” Policy Director Maddie Ribble and Executive Director Toby Fisher write.
But two major public health scandals in recent months have highlighted deficiencies in the state’s public health system. A chemist at a drug lab that was operated by the Department of Public Health was accused of tampering with samples, jeopardizing thousands of convictions. And steroids produced at a Framingham compounding pharmacy have been blamed for a national fungal meningitis outbreak and 36 deaths.
The state’s public health system, “for all the wrong reasons, has been in the news,” Ribble said in an interview Monday. The letter urges lawmakers to do more than simply address the scandals. Ribble and Fisher write:
As we speak, Department of Public Health staff and others inside and outside of government are working day and night in response to the mishandling of evidence at the state drug lab and the national meningitis outbreak. Individuals – inside or outside of government – who committed criminal acts must be held accountable for their actions and the harm they have caused. At the same time, Department of Public Health must put in place new systems of accountability to ensure proper oversight is in place to safeguard the public health and safety.
Both of these activities are essential, and all signs indicate that they are being addressed aggressively. However, addressing criminal activity and gaps in oversight alone will not solve our problems.
Adequate financial resources to carry out public health programs, provide oversight of those programs, and monitor compliance with public health regulations are not currently available due to several years of dramatic cuts in state funding.
The number of inspectors to monitor food safety at restaurants and other public kitchens has been cut in half since fiscal year 2009, according to the letter, and a state report noted problems in the state food safety system even before that. The Department of Public Health’s capacity for inspecting indoor air quality at schools and other public buildings has shrunk, as has its ability to test outdoor air and water quality around nuclear facilities. Cuts have hurt the state’s ability to inspect health care facilities, according to the letter, even as staff that perform those inspections have been given new responsibilities under recent health care laws.
The letter also points to cutbacks at the Hinton State Lab, which houses the drug lab, now run by the State Police. The letter notes that Hinton also includes 17 public health labs, including those that monitor eastern equine encephalitis, infectious diseases, and food-borne illnesses. Those labs have seen staffing cuts and delays on equipment purchases in recent years, Ribble and Fisher said.
In past budget seasons there has been little talk about protecting public health infrastructure, Ribble said. “People just assumed that drugs at the pharmacy were safe, and now people are seeing that we keep those things safe by structures and people” that require adequate funding, he said. “We want to shore up these protections before we see more front page news about things going wrong.”