“Because there is no clear, current scope of services defining what a health depart- ment should do, public health infrastructure is vulnerable to any changes in policy and funding.”
can use for any public health function, such as maintaining an STD clinic or hir- ing an epidemiologist. Funding reductions should never
threaten a local health department’s ability to provide essential services, Dr. Riggins says.
“I believe that if public health agencies continue to be funded to be the safety net for clinical, communicable, indi- gent health care rather than to be the complementary system that proactively synergizes the health care system toward healthier populations, we will see com- munities struggle,” Dr. Riggins said. “Public health funding is and will con- tinue to be a complex issue,” said DSHS Commissioner David Lakey, MD. “With the geographic and population diversity of Texas, there likely is no clear funding model to fully address every need. We will continue working collaboratively with our health department partners to develop a sustainable approach to fund- ing core public health services.”
reductions in federal funding for family planning. Dr. Morgan says public health agencies that provide clinical family planning services likely will feel the im- pact of the two-thirds drop in available state funding.
On top of that, local health depart- ments in Texas experienced a 16-per- cent reduction in federal Public Health Emergency Preparedness (PHEP) base funds for FY 2012. Eight health service regions that carry out local public health functions for areas not served by a lo- cal health department or district took an 18-percent reduction, and the DSHS central office preparedness program
dropped 22 percent. Dr. Morgan says the reductions were necessary to limit local health department and district re- ductions to only 16 percent. As a whole in FY 2012, reductions to the PHEP base grant for Texas total $6 million, leaving the state with about $31 million. The Cameron County Health Depart- ment uses PHEP funds for a dengue fe- ver project focused on educating health care professionals about reporting dis- eases to the local or state health depart- ment. Other departments use the funds in a variety of ways, from outreach to Medical Reserve Corps projects. The federal preventive health servic- es block grant funded approximately 19 percent — about $1.4 million — of the local public health services grants to lo- cal health departments and districts. Dr. Morgan says these funds are absent from President Obama’s budget and the Sen- ate budget and likely “won’t be contin- ued.” State funding for preventive health services for FY 2012 is about $6 million. Dr. Morgan says the preventive health
David Lakey, MD
Mark Guidry, MD, MPH
42 TEXAS MEDICINE February 2012
services block grant provides flexible funding that local health departments
Committee to examine funding In the wake of a grim economy and dwindling public health funding, local and state health officials hope a new committee established this past legis- lative session under Senate Bill 969 by Sen. Jane Nelson (R-Flower Mound) will help local health departments and DSHS develop new policies and funding mechanisms to improve support for the public health system.
SB 969 amends the Health and Safe- ty Code to establish the Public Health Funding and Policy Committee within DSHS. The committee’s first charge is to define the core public health services a local entity should provide to establish a common definition for what should be funded. In 1999, Texas became the first state to codify into law 10 essential public health services to provide a working definition for local public health sys- tems. (See “10 Essential Public Health Services,” opposite page.) Dr. Riggins says despite Texas’ early adoption of the essential services, many disparate defini- tions of public health exist. “Recent events suggest that our public health policy, especially as it pertains to
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