the Medical Reserve Corps volunteer program.
Despite funding constraints, Dr. Rig- gins says WCCHD is fortunate. Years ago, the district consolidated most of its clini- cal services with its community health center partner, Lone Star Circle of Care. While the health district does provide some immunizations, the community health center provides the bulk of clini- cal services, such as prenatal care and well child care. “WCCHD was relatively spared from some of the larger reductions that af- fected health departments that provide more clinical safety net services,” Dr. Riggins said.
Safety net services refer to clinical
services public health agencies provide as part of the health care system. These could include preventive services such as prenatal care, well child exams, family planning, and immunizations. Consoli- dating clinical services allows WCCHD to focus on providing essential services while building and maintaining collabo- rations that allow a full-service health department to function effectively, Dr. Riggins says. Dr. Guidry says his district has wit- nessed a reduction in funding. State and federal funds for FY 2010 totaled $3.9 million. The district received only $3.14
million for FY 2011 and about $2.8 mil- lion for FY 2012. GCHD’s public health improvement grant had a reduction of $60,000, while emergency preparedness funds dropped $25,800 and WIC funds went down $55,600 for FY 2012. GCHD’s public health improvement grant focuses on wellness initiatives that promote healthy eating and exercise, and other activities. The outlook for public health depart- ment funding — both federal and state — is fuzzy at this point, according to Dr. Guidry.
“In today’s economy and with all the uncertainty about health system reform being implemented, tweaked, or re- pealed, it’s hard to know what’s going to happen. The general sense is that public health needs to be on alert,” he said. Dr. Guidry says virtually all public health funding is on the table, whether for disaster preparedness, infectious dis- ease surveillance, or other key activities. And the future of health system reform will shape much of what happens. “If health system reform is implement- ed the way it’s currently written, most people will have health insurance. That could affect the services public health departments provide and associated funding levels. For example, immuniza- tions provided by a local health depart-
ment could disappear completely or significantly downsize because the need for health departments to provide them could decrease as more individuals have insurance to pay for them,” he said. In the face of uncertainty, Dr. Guidry
says all public health departments “need to be vigilant about changes and plan ahead.”
Decoding public health funding Trying to break down public health fund- ing to local health departments in Texas is no easy task. Dr. Morgan says the department funds local health departments in two ways: noncompetitive contracts re- newed annually and competitive grants for which local health departments and other entities, such as community health centers, apply.
Adding to the complexity of how the state funds local health departments is the way money comes to DSHS, Dr. Mor- gan says. “We have funding that comes from
DSHS Public Health Funding and Policy Committee members
Craig Blakely, PhD, MPH, College Station Sandra Guerra, MD, MPH, San Antonio Mark Guidry, MD, MPH, Galveston Richard Kurz, PhD, Fort Worth Deb McCullough, FNP, Andrews Paul McGaha, DO, MP, Tyler William S. “Chip” Riggins, MD, MPH, Georgetown Stephen Williams, Houston Victoria Yeatts, MSN, RN, Garland
44 TEXAS MEDICINE February 2012
different federal sources, as well as state funding that goes to programs within DSHS. They all have different require- ments for the use of funds,” he said. The legislature doesn’t include a line item that spells out a specific appropria- tion for local health departments. “We don’t have a block grant of fund- ing to local health departments that cov- ers all necessary public health services and activities,” Dr. Morgan said. “We have programs that contract with local health departments individually, such as money for STD and TB services and obe- sity prevention.”
He says DSHS doles out funding to local health departments based on the need to conduct essential public health services, based on a formula, or based on sets of contracts awarded to entities. Dr. Riggins says Williamson County and its cities have the distinction of be- ing one of the healthiest Texas regions, which “probably works against us in terms of funding based on formulas. The better job we do in public health, the less disease happens and unfortunately, the less funding we may see until the next outbreak.” Dr. Guidry knows all too well the
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