Guest Commentary: Oppose proposed budget cuts to the Yolo County Health Department

RE: Oppose proposed budget cuts to the Yolo County Health Department

Dear Chairwoman Thomson and Members of the Board,

We the Yolo County Health Council write to express our deep concerns about the proposed cuts in the Health Department. These are not ordinary times and there are great pressures on you to be financially responsible with greatly diminished funds. However, the need for drastic budget reductions can lead to decisions that over time prove to be unsound fiscally. We believe that the proposed cuts to the Health Department are in fact penny wise but pound foolish.

For example, any reduction to the immunization program could save some funds this fiscal year, but set County residents up for a medical disaster in the future. Such program cuts will have their greatest impact on those with the fewest financial resources, and sick un-immunized kids can have a profound effect on the health of our entire community.

An inevitable truism of medicine and public health is that people who are sicker when they present themselves to a clinic, doctor, or hospital, cost more to care for than if funds are spent to either prevent their illness or intervene early. This is true for a large number of conditions including immunizations, HIV, pregnancy prevention, fetal infant mortality review (looking for reversible trends in infant hospitalizations and/ or deaths) and the list goes on and on. As one example, the prevention of a single case of HIV saves a minimum of $65,000 in downstream life-time HIV-related health care costs.

Cutting the position of County Health Director (Dr. Joseph Iser) to save $240,000 makes little sense given the complexities of the county’s health needs. With less to spend on vital services, coordination, leadership, and judgment are going to be even more important. Those skills, attributes, and actions come from the top. The Health Council strongly believes that eliminating the Health Director is a recipe for disaster. Further, Dr. Iser is already filling not one, but two leadership positions (Public Health Officer and Public Health Administrator). We strongly oppose the elimination or reduction in his position.

We currently have a first class health department that has a strong track record of providing valuable to services to our community. Dismantling these services might seem attractive in delivering a quick fix by cutting the health department’s budgets, eliminating programs, and terminating the employees. However, it is important to note that if certain programs are cut the County will lose enough State and Federal matching funds that the budget reduction will cost the County more in revenue than it saves in cost, making the County’s deficit worse not better. If we reduce or eliminate Health Department provided laboratory services, we will need to contract with outside labs to do the mandated tests. Imagine if you will, going through another flu pandemic. Each suspected influenza test sent to an outside lab would cost more, would take longer to get results, and in many cases would mean the costs of treating the patients would increase substantially. In short, the dedication and quality of service provided would not be there.

There is no question that the Board of Supervisors has some difficult decisions to make. We, your Health Council that you have selected to advise you on matters related to health, urge you to remember when you make these difficult choices that the health department programs (described below) provide important services. Should they be eliminated our citizens will suffer, and it will take a generation to grow these back to current levels. Further, we risk creating a third world enviromnent in the backyard of Sacramento – the capital of California – the world’s seventh largest economy!

In closing we would like to accentuate the positive by noting that Yolo County’s Health Department has as its goals the early detection of disease, the prevention of disease, and the mitigation of long-term chronic disease. The Health Department increases access to care, reduces health care disparities, and improves the health of the public.

In 2009 the Health Department worked hard to prevent epidemics (e.g., HINI), diminish the spread of disease, protect against environmental hazards, prevent injuries, promote and encourage positive health behaviors, and respond to disasters and assist communities in recovery. We also depend on our health department to coordinate a myriad of community health care providers, some in arranged in units (Woodland Healthcare, Kaiser, and Sutter) and others who are solo or small group providers. In some cases the health department assures the quality and accessibility of health services by serving as a healthcare safety net for example by providing immunization services. When these services are cut, people delay care and present with much more serious and costly illnesses at the emergency rooms and clinics of our local healthcare providers. This places a much more expensive and ultimately unsustainable burden on our local health care partners and affects the care of everyone in our community.

Our health department is committed to:

• Providing immunizations to prevent childhood diseases
• Providing counseling, guidance, and services to women, infants, and children (WIC)
• Promoting physical activity and nutrition to prevent obesity and other chronic diseases such as diabetes, hypertension, etc.
• Preventing teen pregnancy
• Preventing teen suicide
• Preventing, managing, and treating HIV, Hepatitis C
• Providing health education and prevention (car seats, syringe exchange programs, tobacco youth coalitions, GET READY programs)
• Addressing local priorities through community health councils
• Preparing for emergency situations of disasters or threats in communities
• Providing public health nursing (FIMR, immunizations; home nursing, and health care provider education)
• Providing high level lab services to the health department

As you look at all of the above, it is important to remember that the Health Department has already suffered the loss of both personnel and programs in the most recent round of budget cuts. Following the example of Dr. Iser, the remaining personnel have doubled up the jobs they are doing. We are certain that further cuts represent not ‘fat trimming’ but the elimination of the equivalent of bone and vital organs. As we said at the outset, that will be penny wise, but pound foolish. We strongly advise against further cuts to the Department of Public Health Budget.

Sincerely

Roger Clarkson
Chair
Yolo County Health Council