Every year about this time, when state and federal budgets are being proposed and negotiated, I visit the state Capitol in Albany as well as the U.S. Capitol in Washington, D.C., to deliver much the same message to our elected officials: “Greater investments in health care and public health infrastructure are needed.”
To make the case, I argue that rural hospitals, not only in New York state but throughout rural America, are increasingly fragile institutions, often operating with razor-thin margins or none at all. Hospitals are fragile for a variety of reasons. They are beleaguered by regulations and reporting requirements with which it is costly to comply. They are repeatedly subject to cuts to key federal sources of support. And, they incur costs of delivering care that are greater than the levels of reimbursement they receive from health insurance companies, including and especially from Medicaid and Medicare, which cover so many of our citizens.
As a result, since 2010, 120 hospitals in rural places throughout the country have closed and there are 453 additional rural hospitals considered vulnerable to closure. When a hospital closes in a rural area, rural residents lose access to acute care and often, to primary and specialty care practices associated with the hospital as well. When they lose that access, it is well documented that their health status and health outcomes deteriorate as a result. Simply put, access to care is essential to getting and staying healthy, and we need to deploy the strategies and resources that ensure that rural hospitals are there to deliver that care to our rural residents.
Similarly, the nation’s public health infrastructure is also operating under constraints that threaten to undermine its core functions, which include things like preventing and monitoring disease, developing policies and enforcing laws to protect citizens against environmental hazards, educating citizens about health issues, and ensuring a competent health workforce.
These “quiet” tasks are being performed at all times at every level of government —from our local departments of health in every New York state county, to the state’s Department of Health and Public Health and Health Planning Council, to our federal agencies like the CDC — to a greater or lesser extent, as funding allows. Unfortunately, funding has not allowed as much of this quiet work to continue as may be needed now, and in the future.
When public health and health care systems are weak, so, too, is Public Health Emergency Preparedness—or PHEP, for short. Nelson et al. defines PHEP in their April 2007 article in the American Journal of Public Health as “the capability of the public health and health care systems, communities, and individuals, to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing or unpredictability threatens to overwhelm routine capabilities.” Is there anything about this definition that sounds important, right here, right now? PHEP is exactly that thing upon which we are all currently relying, at the local, state and federal levels, to ensure that we don’t get swallowed whole by the current Coronavirus epidemic.
And that is why the proposed budget of the United States government, fiscal year 2021, released on Feb. 10, is so mystifying, and also potentially so damaging, because it proposes to cut $25 million from the Office of Public Health Preparedness and Response. That office is housed within the Centers for Disease Control and Prevention (the “CDC” that we’ve been hearing from so often of late), and is charged with responding to public health emergencies. It also coordinates public health responses with partners in this country and beyond, and manages the Strategic National Stockpile, which accumulates critical medical supplies for use in emergencies.
Similarly, the administration also proposed to cut $18 million from the Hospital Preparedness Program, which aims to ready hospitals for emergency surges of patients, such as might be accompanied by, say, an outbreak of a communicable disease. And lastly, the administration asked for over $85 million in cuts to the Emerging and Zoonotic Infectious Diseases program, which conducts research on diseases like the coronavirus.
The administration’s proposed cuts to public health emergency preparedness programs were short-sighted — so short-sighted, in fact, that though it was released in February, it apparently did not contemplate widespread infection from a communicable disease in the United States, though, as of this writing, the coronavirus is in nearly all states, just a mere month later. And though one might argue that something novel and new like the coronavirus could not have been predicted, something like widespread infection from the flu is all too predictable, from one year to the next.
There is nothing like an outbreak, and all the disruption it can cause to our work and family lives, to show the strengths and weaknesses of our formal systems for preparedness and response. There is also nothing like an outbreak to prove the point that investments in health care and public health systems are essential to ensure that they are sufficiently robust to effectively prepare for and respond to public health emergencies when they occur.
The Healthcare Consortium is a non-profit organization with a mission of improving access to healthcare and supporting the health and well-being of the residents in our rural community. The agency is located at 325 Columbia St. in Hudson. For more information, visit www.columbiahealthnet.org or call 518-822-8820.