Testimony of New York State Association of County Health Officials

Transcription

1 Testimony of New York State Association of County Health Officials By Cynthia Morrow, MD, MPH NYSACHO President and Commissioner of Health, Onondaga County Before the Senate Finance Committee Hearing on the Executive Proposal To Reduce the Estimated Budget Deficit For the State Fiscal Year October 27, 2009 Page 1

2 NYSACHO TESTIMONY BEFE Senate Finance Committee October 27, 2009 My name is Dr. Cynthia Morrow. I am the Commissioner of Health for Onondaga County and am currently President of the New York State Association of County Health Officials, also known as NYSACHO ( I would like to thank Senator Carl Kruger, Vice-Chair Senator Liz Krueger, and all the distinguished committee members for the opportunity to present NYSACHO s concerns about the Executive Proposal to reduce the estimated budget deficit for the State Fiscal Year. NYSACHO is the voice of the State s local public health system, representing all 58 local health departments. Together with local health officials and the New York State Department of Health (NYSDOH), NYSACHO works for all New Yorkers to prevent disease and disability, promote health and safety, and protect against environmental hazards. On behalf of the 58 local health departments across the state, NYSACHO first wishes to recognize and thank Governor Paterson for exempting from his Deficit Reduction Proposal (DRP), all mandated Article 6 state aid funding for public health services. This funding covers a portion of eligible costs of local programs such as those that prevent lead poisoning, reduce the incidence of vaccine-preventable childhood diseases, ensure healthy birth outcomes, prevent and treat rabies, and protect the quality and safety of the food we eat, the water we drink and the air we breathe programs that directly protect and improve the lives and health of New Yorkers. While we are thankful that this funding is exempt, it is important to remember that Article 6 funding only partially supports programs that are needed to ensure public health at the community level and that local governments bear the vast majority of the costs associated with mandated services. NYSACHO also applauds the Governor for preserving state aid for services and administration of the Early Intervention Program, or EI, for children under age 3 with special needs. However, NYSACHO once again urges the Executive and Legislative branches to close loopholes that have permitted the commercial insurance industry to unfairly shift EI costs to state and local taxpayers, a practice that has occurred over the last 15 years. The fiscal imperative to close these loopholes has never been greater as this federally mandated program is growing exponentially. Page 2

3 Along those same lines, NYSACHO appreciates the fact that cuts in reimbursement for the Preschool Special Education program were not included in the DRP. In addition, NYSACHO urges the Executive and Legislative branches to adopt the Governor s Temporary Task Force on Preschool Special Education November 2007 recommendation that counties be removed from fiscal, administrative and programmatic responsibility for preschool special education by Currently, county health departments outside NYC are responsible for paying for pre-k programs even though school districts determine eligibility and configuration of services. We believe that a closer alignment of fiscal accountability with programmatic decisionmaking will significantly increase overall accountability for the program.. I now turn to our grave concerns about the current Executive budget proposal for an across-the-board reduction of 10% or more in grants that fund essential public health services and activities. Quite simply, these cuts will hurt communities throughout New York State that depend on a wide range of crucial public health services. The grants on the chopping block have, for decades, provided core support for essential public health and life preservation services that local health departments provide to residents of New York every single day. Activities funded by these grants run the gamut from ensuring the safety of drinking water to controlling sexually transmitted diseases; from ensuring the safety of bathing beaches to investigating and treating cases of tuberculosis; from screening for and detecting cancers early to strengthening efforts to prevent lead poisoning; from reducing vaccine-preventable childhood diseases to ensuring access to sound nutrition and healthful food to low-income pregnant women and infants. These are programs that the State has deemed so important as to provide additional support beyond the supplemental support provided by Article 6. For years, these grants have not been given cost-of-living increases, effectively reducing local public health funding year after year, long before any explicit cuts were put forward. The proposed 10% slash in these programs will further cripple an already strained public health infrastructure. Local health departments, partnering with the NYSDOH, apply a population-based approach to building robust communities that provide their residents with a healthful quality of life. Local health departments emphasize health promotion and disease prevention through a combination of regulatory enforcement, development and implementation of local policies supporting public health efforts, education, oversight, quality assurance, and direct services. Evidence-based health promotion and disease prevention strategies are investments in the future Page 3

4 and provide the foundation for a strong health care system. An important part of maintaining this foundation is the assurance of sustained and adequate funding for local public health activities by the State. The key role of local health departments in addressing the current H1N1 pandemic is an example of the critical importance of continued support for a strong and reliable public health infrastructure in New York State. Ironically, an enormous reduction in state funding for public health emergency preparedness in this fiscal year threatened to severely limit our ability to respond. In the State Fiscal Year, local health departments across the State felt the impact of the $12 million reduction in emergency preparedness funding. In 2008, in recognition of a cumulative 40% reduction to its CDC grant for emergency preparedness, the State allocated funding for local health department emergency preparedness to keep them whole despite the loss of federal revenue, recognizing that all emergency response will occur first and foremost at the local level and that local health departments preparedness activities are a crucial component of New York s overall ability to respond. Yet in State Fiscal Year , state support for public health preparedness was eliminated. In light of this elimination, our capacity to respond to this novel threat was rescued only with a last-minute federal appropriation after the World Health Organization declared a global flu pandemic. However, restricted one-time funding cannot replace long-term, sustained funding. Without sustained resources, we will soon be forced to make unacceptable choices about which public health services will have to be delayed or even eliminated. As we face what for many of us is the greatest public health challenge of our careers, I, and my colleagues throughout the state, are already struggling to maintain the local public health infrastructure in the wake of local and state budget cuts. While having necessary clinical staff or supplies is very important, there is also a critical need for epidemiologists, health educators, sanitarians and engineers to provide the data, logistical, and fiscal support necessary to respond. Knowing that emergency response occurs at the local level, federal and state governments require the same level of response, preparedness and reporting of every county, regardless of its size or resources. For some of our smaller counties, this burden can be unbearable in the face of recent budget cuts. Just as our firefighters rely on funds to maintain trucks, hoses, and staffing to respond to emergency calls, the public health system must have sustained funding for the staffing and Page 4

5 equipment infrastructure that allows us to recognize and respond to emerging public health threats in an effective and timely manner. Public health workers are first responders in our communities. Right now, our departments are struggling to maintain our capacity to provide everyday public health services even without the overwhelming challenges of responding to the H1N1 pandemic. As we ask our staffs to work harder than ever, with fewer resources to protect our citizens in this pandemic, many wonder if they will be employed come the New Year, or if they will face furloughs or erosions in pay and benefits. In addition to the current threat of pandemic influenza, the public health system is facing a longstanding challenge of a shrinking public health workforce. At this very time, local health departments are experiencing attrition, layoffs, and position reductions. A 2008 survey by the National Association of City and County Health Officials (NACCHO) found that 53% of local health departments in New York State lost positions in 2008 due to lay-offs. Given the current fiscal crisis, we expect that percentage to further increase. This is especially troubling when coupled with the fact that the average age of our public health workforce is fifty-three years. Local health departments were already facing a significant loss of experienced personnel prior to the fiscal crisis and now we are greatly constrained in our ability to hire the next generation of our workforce. Unless New York State appropriately funds local health departments, we will be forced to make difficult choices that affect our ability to protect the health of the State s citizens, but also our ability to respond to the myriad of emerging health challenges of the 21 st century. As these challenges arise in our communities, local health departments will be faced with unthinkable choices because preparedness also encompasses our being ready to meet every day challenges that local health departments face rabid wild animals in the yards or homes of our residents and farmers; outbreaks of hepatitis at a supermarket such as one faced in Erie County; nationwide foodborne outbreaks such as the salmonella contamination in peanut products earlier this year, or exposures to vaccine-preventable diseases such as mumps in camps. To illustrate the potential impact of choices, many counties provided NYSACHO with information about what a $1 million dollar cut could mean to them. Every $1 million cut from public health may translate into the loss of essential services that protect the health, life and safety of New Yorkers. Examples of these service cuts, all of which have potentially deadly consequences, include: Page 5

6 $1 million cut = 52,310 FEWER children immunized against diseases 7,660 FEWER home visits to new mothers and their babies 12,920 FEWER visits to ensure that tuberculosis patients take their medications 9,146 FEWER restaurant inspections to make sure food is safe to eat 1,030 FEWER people treated who have been exposed to rabies, a fatal disease Local public health expenditures are a small part of the overall health care expenditures in New York State, but they provide crucial services needed by every New Yorker. Whatever the current economic situation, one thing we can be certain of is that disease and other natural and man-made health hazards will continue to threaten the health and well-being of our citizens. Our best defense is a strong public health infrastructure. We recognize and respect that this fiscal crisis requires difficult choices and shared sacrifice. We believe that one of the essential roles of government is the protection of its residents from harm. To meet our shared obligation to protect the people of New York State, we urge this Legislature to preserve local public health. On behalf of all of NYSACHO s members the State s local public health officials I thank you for this opportunity to share our concerns about the impact of the proposed cuts to local public health within the Executive proposal to reduce the estimated budget deficit for the state fiscal year. I also look forward to your ongoing support of the Public Health System in New York State that works everyday to protect our citizens and keep our communities safe and healthy. Page 6