Health Department Budget Cuts: Kanawha-Charleston Health Department, West Virginia
Budget cuts are taking their toll on many local and state health departments. Kanawha County in West Virginia is one of them. As the sole public health department for West Virginia’s largest county and city, Kanawha County Health Department (KCHD) is the public health department for approximately 11 percent of the state’s total population. The population also increases significantly as individuals commute to work in Charleston, the state Capitol. Additionally, KCHD experienced several funding reductions in federal grants through the West Virginia Department of Health & Human Resources. The largest of these cuts was the 13 percent reduction in funding to the KCHD’s Public Health Emergency Preparedness Grant during fiscal year 2012-2013. This is an especially significant cut since it affects the department’s ability to prepare for emergencies in a jurisdiction that includes the state Capitol as well as several chemical plants and coal mines. KCHD has also experienced funding decreases to clinical programs including the HIV/AIDS testing and counseling and tuberculosis surveillance and control.
So far, KCHD has been able to absorb the majority of the funding cuts by not filling vacant positions, decreasing expenses and cutting certain programs in environmental health. However, with additional cuts in funding anticipated and with increases in expenses, Rahul Gupta, MD, MPH, the Health Officer and Executive Director of Kanawha-Charleston Health Department, says the Health Department will have no choice than to cut more services in the coming year.
NewPublicHealth spoke with Rahul Gupta, MD, MPH, about the recent cuts. Dr. Gupta is also on the board of directors of the National Association of County and City Health Officials.
NewPublicHealth: Tell us about the nature of some of the budget cuts you’ve faced.
Dr. Gupta: The issue for us is not just the size of the cuts, though they have been steep, but some have also been sudden cuts, and some have been almost unexpected. In the 2011-2012 fiscal year, the city of Charleston cut financial support by half—that had not happened before and was a direct impact of the financial difficulties that they’re in. We are a City/County Health Department and for the 2011-2012 fiscal year we also saw a budget cut by 12.5 percent by the county. The same cuts have persisted for 2012-2013 and we’re just glad they didn’t cut any further.
NPH: Why are these cuts so critical right now?
Dr. Gupta: These cuts come at time when the needs of our community continue to grow and the Appalachia region is seeing the worst health indicators of all of the country. The data reflect that higher rates of obesity and diabetes are reported in more than eighty percent of counties within our region. Some factors that contribute to these statistics include fewer health care programs, lack of access to health services, unemployment, no health coverage, poverty, illiteracy, limited education, poor health practices, little or no preventative care, and limited social and recreational opportunities often due to the rural and mountainous terrain. The department works across all sectors to directly or indirectly influence all of these factors. And the solution is a multi-sector approach to impact the communities.
NPH: Where have the largest cuts for your department been?
Dr. Gupta: Environmental health programs are probably the ones that get impacted disproportionately. Environmental health is an area of local health department that not only provides prevention efforts but also enforcement efforts in the area of water, sanitation, food establishments, clean indoor air, mine safety and emergency preparedness. Such significant cuts impact our programs negatively. Just a few days ago, we had a mercury spill in town that our staff responded to. It is these kinds of events that our ability to prepare for and respond to suffers when significant funding cuts occur. Another responsibility that falls under environmental health division is the closing of meth labs in motels. Meth labs operating in hotels and motels have become an increasing public health hazard in our state and across the nation. It requires a lot of effort and collaboration with various law enforcement and other agencies each time there’s a meth lab bust. We also have more wait times for many of our services now.
NPH: You’re operating at 65 percent of your staff capacity in environmental health. Does that mean that fewer restaurants and other sites are inspected or that it takes longer?
Dr. Gupta: We began implementing a new rating system for restaurants starting August 1, 2012, and that was at the same time that some of our outdoor fairs and festivals began. We have to give less attention to those temporary food events just because we don’t have the manpower. Sometimes food establishments such as restaurants that are being shut down for critical food code violations may have to delay re-opening since enough inspectors may not be available to conduct a re-inspection as quickly as that business would like us to.
NPH: Have clinical services changed since the budget cuts began?
Dr. Gupta: The clinical services actually have changed somewhat. In fact, the good news here is we have been able to do more with less, meaning that despite the budget cuts, what we did was we reorganized our clinical services so we, in addition to full-time RNs, also employed more medical assistants and licensed practical nurses, in order to compensate while maintaining the high quality of clinical services.
NPH: What are other examples of how you’re making due with less?
Dr. Gupta: Clean indoor air is one example. We have had the most comprehensive clean indoor air regulations across the state. West Virginia does not have a statewide law and only 18 of its 55 counties currently have comprehensive indoor air regulations. We conduct close to 5,000 inspections per year just for clean indoor air regulations. We have documented lower smoking rates, and we published a study last year in Preventing Chronic Diseases, which showed a 37 percent reduction in admissions for heart attacks over the last eight years in the presence of a comprehensive clean indoor air regulation enforced by KCHD. We believe the reduction in secondhand smoke in our community significantly contributed to this benefit. However, it bothers me greatly that while we implement a great clean indoor air regulation, we are not able to offer any tobacco cessation services to those in need.
Additionally, we used to have a weekly TB clinic. We saw people from our county and surrounding counties. We have to reduce that down to once a month now from once a week. Finally, we have to increase fees including ones for clinical services as well as permit fees due to the budget shortfall. So we’re depending more on revenues being generated from fees now because of these cuts. This means more financial burden on the public, which we never wanted.
NPH: So, how have the cuts galvanized you?
Dr. Gupta: In an ideal world, we should be doing more programs and be funded to do even more programs that can be effective and efficient; however, the reality on the ground is that we’re faced with cuts. We have to start prioritizing public health, and while it is sad, it does give us a chance to align services as well as find creative and innovative ways to perhaps make services more efficient as well as become creative. And so we’re finding ways to develop new partnerships with elected leaders, educators, business community, faith-based community, emergency management folks and others, to be able to work on innovation. Of course, when these cuts are constant and they cut across, it does impact negatively. There’s no argument about that. But the fact is when you are given that mandate; you still have to work through them.
NPH: Are you working with policy-makers to communicate the value of public health?
Dr. Gupta: Yes. We worked with Senator Rockefeller and Congresswoman Shelly Moore Capito on the transportation bill recently. This is something you wouldn’t normally think is important to public health, but the Cardin-Cochran Amendment in there basically talks about having dual use bicycle lanes and how it’s important to keep built environment and public safety in the bill. While not perfect, the Congress passed the bill which was signed into law on July 6, 2012, and I’m glad to report that public health played a role. Similarly, the City of Charleston is working on a 20-year comprehensive plan to make the city walkable again. We’re working very closely with them to have a health in all policies concept.
And what we are really trying to do is to change the culture of the way that people think. Typically, all the arguments and discussions in Congress and state legislatures have been about the fiscal notes—what is it going to cost? We know in just about all state legislatures, they’re required to have with every bill a fiscal note. What I argue is why not also have a health note? Perhaps we should now have a health note to every bill, every policy and say, well, if this is not going to improve the health, perhaps we should think about enacting it in a way that it does improve health. In the next 20 years, health expenditures at state and national levels will be the main driver of cost and I believe we need to understand that quickly. I think that is the future in which we are heading.