December 1, 2009

County and City Health Departments: The Need for Sustainable Funding and the Potential Effect of Health Care Reform on their Operations

This brief was written by Jack Meyer, PhD., Principal, Washington, D.C. Office of Health Management Associates, and Lori Weiselberg, MPH, Senior Consultant, Chicago office of Health Management Associates. With the health care reform, health departments (LHDs) and state health departments (SHDs) will not diminish. Keeping people healthy is an important goal in itself. It also improves worker productivity, student learning and the national defense. The local and state health departments are unique among American institutions in protecting and improving the health of all residents of a community. Continuing waves of federal, state, and local budget cuts are threatening their survival. As the nation continues to struggle with the adverse effects of the deep recession, it is critical that that nation preserves and shores up the widespread network of local and state public health departments. Public health is what the society can do collectively to assure the conditions in which people can be healthy.

This report will focus on local health departments. The authors acknowledge that many of the findings and recommendations also apply to state health departments, and make a number of further references to these departments in the report. The main emphasis is on LHDs, but this in no way diminishes the importance of assuring adequate support for both state and local health departments.