State budget cuts gut vital local health programs

December 07, 1992|By John W. Frece | John W. Frece,Staff Writer

Maryland's local health program, long a model for the nation, is in a shambles. Its deterioration has begun as quietly as the onset of cancer, and its insidious, debilitating spread remains largely invisible to most Marylanders.

But the state's seemingly endless financial calamity has gutted or eliminated invaluable local programs to head off disease or prevent epidemics.

Soon enough, the risks created by this broad governmental retrenchment will reach mainstream Marylanders, public health officers said during an informal survey,

"Clearly, we are not doing enough to adequately protect the public health," said Alan Baker, who oversees the operation of the state's 24 local health departments.

Clinics that for years have provided free or bargain-priced treatments to stave off serious illnesses and avoid staggering costs later have been discontinued or scaled back.

Among the initial victims are poor pregnant women, children with illnesses but no insurance, those who may be infected with sexually transmitted diseases or the virus that causes AIDS, paraplegics, and the elderly who are too crippled or sick to care for themselves but who have nowhere else to turn.

Already, food served in restaurants, or even the safety of everyday drinking water, is no longer routinely inspected in some parts of Maryland.

Building permits could be held up for months for lack of anyone to review required water or sewer plans.

Air-quality complaints may simply be ignored.

Swimmers could risk contracting contagious diseases from the water in public pools that no one has time to monitor.

School nurses have been eliminated in some jurisdictions as a luxury too expensive to continue.

Local health officers are shell-shocked by the loss of state subsidies that in some instances amounted to a quarter or more of their overall budgets. They say it is difficult for the public to understand the importance of what they do because if public health services are well-delivered, there is little to see.

Water safe to drink, food safe to eat, illness that is prevented, disease kept from spreading, or a child born without complications do not make the statistical lists.

"If we're doing our job," said Dr. John A. Grant, health officer for Kent and Caroline counties, "it is absolutely silent."

In Frederick County, health administrator Margo Smith puts it this way: "It's not like you can go to someone and say, 'We prevented that child from being premature.' But when [local health services are] gone and people start seeing the increases in these problems, people will start saying, 'Hey, where is the government in this?'"

What now worries health officers is that diseases the medical community once thought were controllable may get out of hand. Not long ago, says Prince George's County health officer Dr. Martin P. Wasserman, president of the state association of local health officers, there was a worldwide plan to permanently eliminate measles and tuberculosis.

"Somewhere along the line there was a reduction in support for public health. Now there is a resurgence of measles, a resurgence of tuberculosis, even more worrisome, a resurgence of a drug-resistant tuberculosis. What was once possible to eradicate completely now is a looming threat."

What happened to local health services in Maryland is the same thing that has happened to most basic governmental services since Maryland's financial problems began three years ago: their budgets have been slashed.

This has occurred in a state that is first in the nation in the incidence of cancer, near the top in infant mortality, and with a governor who says prevention programs are among his highest priorities.

State and federal governments spent a combined $54.3 million on local health services in Maryland in Fiscal Year 1991. Two years and four budget crises later, that figure has plummeted to $19.4 million.

"'Decimated' is probably not too strong a word," said Dr. Marilyn Radke, Charles County's health officer. "This is the worst I've ever seen public health be hit on the chin. We were amazed this happened."

Local health officers say they are worried the financial and policy-setting partnership they have had with the state since local health departments were set up in each jurisdiction in 1934 could be gone forever.

"It's not so much the money we're concerned about, but it appears that what they're saying is that local health is a local responsibility. That is more disturbing," said Dr. John Ryan, Talbot County's health officer.

Because efforts to stave off disease and keep the populace healthy have long been seen as one of government's most important basic functions, health departments were generally spared from the early budget cuts. But each year, the cuts went deeper: $3.3 million in the 1991 budget year, $12.5 million last year, and $20.6 million this year.

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