Online-only: Budget cuts threaten Americans’ health: More than 52,000 jobs lost since 2008
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* Teddi Dineley Johnson

In Washington state, tobacco cessation programs are struggling as funds dry up. In Maryland, budget cuts shuttered a facility for people with intellectual disabilities. In Iowa, almost all public health programs have been reduced because of budget woes.

Across the United States, ever-shrinking budgets are forcing many state and territorial health agencies to cut or drastically reduce critical programs and services aimed at protecting the public’s health. According to a recent research brief from the Association of State and Territorial Health Officials, 87 percent of state and territorial health agencies have experienced budget cuts since July 2008.

“Federal, state and local government budget cuts are jeopardizing a decade of significant gains made by state and territorial health agencies,” the brief stated. “Critical programs and services have been cut or reduced, staff positions have been eliminated and many staff have been laid off or furloughed.”

The brief, released in March, said 91 percent of all state and territorial health agencies have experienced job losses through a combination of layoffs and attrition since July 2008. About 17,800 state jobs have been lost in central, local and regional offices, affecting nearly 15,440 state employees in central offices and 2,360 state employees in local and regional offices.

But the picture grows even worse. When combined with data gathered by the National Association of County and City Health Officials, the losses add up to 52,200 state and local jobs since 2008, representing 17 percent of the state and territorial public health workforce and 22 percent of the local public health workforce.

Among the employees who remain in their jobs, furloughs loom large, with more than half, or 58 percent, of all health agencies imposing furloughs since 2010. State employees in central offices took nearly 242,000 furlough days, according to the research, which is the equivalent loss of over 1,050 full-time workers. State employees in local and regional offices took about 5,285 furlough days — the equivalent of 23 full-time workers.

Moreover, continuous budget cuts are forcing state and territorial health agencies to cut or drastically reduce many crucial programs and services aimed at protecting the public’s health, according to the brief, which found that almost half, or 46 percent, of state and territorial health agencies reduced their services in the last six months of 2011. The hardest-hit programs include public health hospitals and clinics, HIV-AIDS, sexually transmitted diseases, chronic and infectious disease, health and and nutrition, maternal and child health, prevision, tobacco prevention, immunization, family planning and services for children with special needs.

But health agencies are striking back at the budget cuts. According to the brief, numerous strategies are in place to cut expenses and reduce layoffs, including travel restrictions, delayed hiring, hiring freezes and cutting vacant positions. Other common cost-saving strategies include reducing operating expenses by cutting supplies, training, equipment and patient-related services and consolidating local health units.

To gather the data, ASTHO surveyed 59 state and territorial health agencies via an Internet-based survey fielded in November 2008, January 2009 and approximately every six months since then for a total of eight survey rounds.

For more information or to download “Budget Cuts Continue to Affect the Health of Americans,” visit [www.astho.org](http://www.astho.org).

*   Copyright The Nation’s Health, American Public Health Association