Concerns mount that budget cuts could worsen public health crisis

Gainesville —- On a recent morning, the public health department here gave immunizations, examined obstetrical patients, checked the health and teeth of children, screened for sexually transmitted diseases and taught new mothers about portion size.

The stream of patients included Gainesville resident Samantha Romero, 22, who received birth control. She and her husband were both out of work, and she said they couldn’t afford the prescription cost at a pharmacy. So she came to Hall County’s public health department. “This place is a lifesaver,” Romero said.

Across Georgia, public health employees offer a range of such medical services. County by county, these workers also inspect restaurants, sewage and water systems, and plan for natural disasters and other emergencies.

It’s a vital part of the health care safety net, says Dr. James Curran, dean of Emory’s Rollins School of Public Health.

But recent budget cuts to public health have frayed that net in Georgia, according to health professionals. Their concerns follow a 2007 report from a legislative committee that concluded Georgia’s public health system was in a state of crisis, hampered by inadequate funding and a shrinking pool of nurses amid growing demands for services.

That crisis has grown worse, public health officials say. They predict this fall’s state budget cutbacks of at least 6 percent —- driven by the state’s current $1.6 billion shortfall —- will create longer wait times for medical appointments. Because of delays in patients seeing a nurse, said Dr. Doug Skelton, president of the Georgia Public Health Association, “there will be an increase in infectious diseases such as TB, meningitis, hepatitis and HIV.”

Other predictions include more patient visits to emergency rooms, increases in infant mortality and strokes, and lower immunization rates.

The Department of Human Resources, the agency that oversees public health in Georgia, says the state has not had any dramatic loss of services.

“There are cuts and shortages everywhere; we’re no different than other states,” said Dr. Sandra Ford, the acting state director of public health. “We’ve managed to find savings and continue to provide services.”

Still, public health experts cite the state’s $7.5 million reduction for family planning services, which include abstinence education and birth control, as an example of the fallout from cutbacks.

“We’ll end up with thousands of unwanted and unplanned pregnancies,” said Russ Toal, president-elect of the Public Health Association. The public health system, he said, “is in serious jeopardy.”

The public health cutbacks will affect metro Atlanta counties as well as other areas in Georgia, public health officials say. “At a time of economic distress and greater needs, we’re less able to serve the public,” said Dr. Alpha Fowler Bryan, public health director in Clayton County.

A plan to restructure the Department of Human Resources, though, may give more attention to public health, which, in the proposed redesign, will move to a new Department of Health.

Ford says she’s optimistic about the switch. “We’ll be able to leverage our resources better and share the wealth better,” she said.

Toal said the agency move “can’t happen soon enough.”

“It doesn’t appear that public health has been a priority within DHR,” he said. “We’re not able to do a lot of preventive services that public health has always done.

“When public health does its job, nothing happens,” he said. “We don’t have outbreaks. We don’t have restaurants serving bad food.”

Skelton says public health infrastructure is being dismantled at a time when Georgia needs improvement in health services.

Georgia ranked 40th among states in a 2007 health rating by the United Health Foundation. The private group cited Georgia’s high immunization rate as a strength, but that’s countered by high rates of infectious disease, infant mortality and deaths from cardiovascular disease.

Gov. Sonny Perdue would like Georgia to boost its ranking into the 30s, Ford says. Focusing on problem areas of the state could help, she adds.

Public health officials, though, fear Georgia’s ranking will slip. They point to the state’s dwindling work force.

Nurses are the backbone of public health, and Georgia has seen a 16 percent decline in their number over the past six years, from 1,816 in fiscal year 2002 to 1,526. The nursing vacancy rate hovers at about 20 percent.

Recruitment is difficult, and a lack of money often prevents hiring. “Locally, I have nursing positions on the books, but I don’t have funding to fill those positions,” said Betty Dixon, public health nursing director for eight coastal Georgia counties.

Already, public health nurses face a major pay gap: Starting salaries are $36,700, compared with about $61,000 in the private sector.

Then there are the furloughs. The state’s tight budget has caused the Department of Human Resources to require many employees to take one day off without pay every month. Nurses see it as a 5 percent pay cut that lowers morale and productivity.

“You don’t get paid a whole lot to begin with,” said Angie Hanes, nursing director for 13 counties in the Gainesville public health district. “We’re having to do more with less. You definitely don’t feel appreciated.”

Ford, the acting public health chief, says the furloughs have not had a major effect on services. “I don’t think anyone would enjoy losing a day’s pay,” she said, adding, “Furloughs were done to avoid layoffs.”

In Hall County, though, a revenue decline and projections of further state cuts led to elimination of 13 public health jobs this summer. The wait time for women’s health appointments now stretches to four months, and the health department shut down a once-a-week clinic in a Gainesville public housing project.

“This is the worst I’ve ever seen it,” Hanes said.

PUBLIC HEALTH DUTIES INCLUDE:

Conducting family planning appointments

Screening for STDs and tuberculosis

Giving health checkups to children

Holding flu shot clinics

Inspecting restaurants

Conducting cancer screenings

Inspecting sewage systems and testing well water

Administering shots and medication for travelers

Staffing shelters during natural disasters

Investigating animal complaints

Promoting good nutrition

Monitoring disease outbreaks