Governing
WASHINGTON — After years of cutting public health, states are falling behind on vaccinating their residents and guarding against the possibility of disease outbreaks, food-borne illness and other threats, a new study released Tuesday concluded.
The Trust for America’s Health and the Robert Wood Johnson Foundation rated states on 10 measures, including public health spending in recent years, the percentage of their populations receiving vaccinations for preventable diseases, how recently they’ve tested their emergency plans, whether they have the capacity to handle a surge in testing and whether they require medical facilities to report infections that arise from patients during their treatment.
Among the report’s findings:
- Two-thirds of states have decreased public health funding over the last two fiscal years, significantly impacting workforces and lab capacity. In total, 40,000 public health jobs have vanished in the last five years.
- Only one quarter of states vaccinate at least half of their residents against the flu, despite Centers for Disease Control and Prevention recommendations that nearly all Americans get vaccinated.
- More than half of public health departments didn’t test emergency plans to deal with food-borne illness, an outbreak or biological weapon attack last year
- Fewer than half of states require human papillomavirus vaccinations (HPV), education about the vaccine or funding for it, despite risks of cancer and scientific consensus against the conclusion that it increases sexual activity among the young adolescents who receive it.
- Only two states and the District of Columbia meet the U.S. Department of Health and Human Services benchmark of providing whooping cough vaccinations to at least 90 percent of preschool children.
“There’s been a widespread mistaken belief that we have... infectious diseases under control, and I think this has led to not just complacency but letting our guard down,” said Tom Inglesby, director of the UPMC Center for Health Security.
The risks are real, the report’s authors conclude. Food-borne and water-borne illnesses result in 128,000 hospitalizations and around 3,000 deaths each year, for example. Diseases that were considered either eradicated or no threat to the U.S., such as dengue fever and tuberculosis, which racked up nearly 10,000 cases in the U.S. last year, have been rebounding. And each year more than two million Americans develop antibiotic-resistant infections to diseases like Salmonella, and at least 23,000 die. Jeffrey Levi, the executive director of Trust for America’s Health, put the cost of infectious diseases to taxpayers at $120 billion a year.
States received a point for meeting each objective measured. On a ten-point scale, a majority of states scored five or lower. New Hampshire performed the highest at eight. Seven states, including New York, North Carolina and Oregon, scored seven points. A total of 15 states scored five points, the most of any category. Georgia, Nebraska and New Jersey scored the lowest at two points.
The budget picture for public health in recent years has been bleak. A total of 33 states cut funding for public health over the past two fiscal years, some by as much as 30 percent. Sixty percent of state programs have laid off staff and more than 90 percent have lost staff through attrition. The report notes that public health is funded on a year-by-year basis, so it’s especially vulnerable to the kinds of cuts that have been a staple of the years following the Great Recession. State public health departments also depend on funding from the federal government and the CDC, and both sources have decreased in recent years.
A recent National Association of State Budget Officers study put revenue growth at less than one percent in the next fiscal year. State spending is expected to increase 3.8 percent, and with so many competing demands following years of cuts, carving out space for public health is far from a given.
States should still take a hard look at their current levels of spending, ask what more they can do and whether they’re spending existing support in the most efficient way, Levi said. For instance, providing vaccinations is now the responsibility of insurers under the Affordable Care Act, which frees up money in local health departments for other initiatives.
“Some of the delivery dollars that have been spent in the past can be reoriented to educate the public to take advantage,” he said.
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