Local health officials from across Maryland say this year's state budget will lock in crippling cuts that will weaken food inspections, pregnancy clinics, chronic disease prevention and other services provided by front-line workers.
"We're very concerned about the viability of local health departments," said Dr. Barbara Brookmyer, president of the Maryland Association of County Health Officers and a Frederick County employee.
The spending plan that lawmakers are poised to adopt this week contains $37 million in state funds for local health departments - about the same amount they received in 1997. As recently as two years ago, the local departments got $73 million in state money for their operations. Local governments also contribute to local health departments, which are technically state agencies.
County officials are concerned about more than this year's dollar amount. The state budget, they say, creates a new baseline for their funding that is to continue for several years, meaning they might not benefit if the economy improves.
The reductions "will be permanent," Brookmyer said in a telephone interview. In the past two years, state funding for public health dropped more than 40 percent and 416 jobs were eliminated, Brookmyer said.
Lawmakers and state officials say they've had to make tough decisions in many areas as they've filled a $2 billion gap between revenues and expenses in the $13 billion state operating budget.
"We had to reduce many things we deeply care about," said Del. Mary-Dulany James, a Harford County Democrat who heads the House Appropriations Committee health subcommittee.
She and other officials say they are hopeful that the national health insurance overhaul recently signed by President Barack Obama could help fill gaps soon, and that the economy will improve.
"We think there's going to be a new way of financing health care," James said.
The funding reductions mean less people and services for efforts at combating cancer and tuberculosis, fewer locations, shorter hours and more people turned away who need help, said Brookmyer, the state association head. Over the past two years, county health offices have shed 416 full-time jobs.
At the same time, rising costs, caps on fees and state requirements for mandated services could mean even more cuts down the road.
"Local public health doesn't benefit from organized advocacy groups or strong political interest the way some other government services benefit," Brookmyer said. The agencies provide a range of services, she said, often to people who are "struggling in many spheres of their lives and are therefore focused on their survival," and not budget machinations in Annapolis.
Cuts to county health programs affect more than the poor, said Dr. Peter L. Beilenson, Howard County's health officer.
"The next round of cuts will be food inspections," Beilenson said. That could mean two reviews per year of restaurants and food stores instead of the three the state requires.
His department has lost 25 percent of staff in the past two years, he said, despite extra financial support from Howard County government. Howard has eliminated a maternity clinic that served up to 400 pregnant women a year, cut dental care, and reduced and privatized AIDS services.
When serious health emergencies such as H1N1 occur, "you really need to respond, and we just don't have the depth," he said.
Local health departments will also need to play an important role in educating the public as the national health care insurance changes take effect, he said.
More layoffs are looming, Beilenson said, when federal stimulus funds run out June 30.
"We've been fortunate with H1N1 that the federal government stepped forward," said Douglas L. Hart, the interim health officer in Anne Arundel County.
He hired about 10 temporary workers, including eight nurses, and bought supplies, but that will end soon. "It's not the same as having the infrastructure in place" for a health emergency, he said.
He has cut hours and locations but tried to avoid eliminating services, though a therapeutic summer camp for disabled children has been ended. Anne Arundel County provided money to continue some cancer screenings, he said, but money for tobacco-cessation classes and combating cancer have been cut up to 90 percent in the past few years.
"Right now, it's not looking good for public health," Hart said.
Baltimore's health department appears the exception, faring better because the prevalence of poverty and health problems means more state and federal money, according to Olivia Farrow, interim commissioner, and Pat Horsey, chief financial officer.
The department has lost $3 million in state funds since last year, Farrow said, but city government replaced the state funds. "There have been no major reductions in our funding," Horsey said.
State Health Secretary John M. Colmers had little more than encouragement to offer Tuesday in a telephone interview.
"These are not easy times to be secretary of health and mental hygiene," he said. "My role at this point is to live with those [reductions] once those decisions have been made," he added. "We'll get out of this," he said, as state revenues grow and as the national health care initiative gets under way.
Del. Guy J. Guzzone, a Howard County Democrat on the House Appropriations Committee, said lawmakers needed to alter the funding formulas for health care spending, because automatic increases were outstripping tax revenues.
But he questioned the assertion of critics who say local offices will be crippled forever.
"Nothing is permanent," he said, because the change in the budget "only has the force of law for one year."