How Budget Cuts Continue to Make Us Sicker, Poorer and Less Secure


Local Department of Health Doing Less with Less

Featuring: Phil Maytubby, Director of Public Health Protection, Oklahoma City/County Health Department, Oklahoma City, Oklahoma

Photo Featuring Phil Maytubby (The Oklahoman)


Health security is efforts on the part of government at all levels to keep people safe from all external threats that have a health impact. After the 9/11 terrorist attacks, the federal government recognized the unique role of public health professionals in emergency response and recovery. In 2002, the Public Health Emergency Preparedness (PHEP) program at the Centers for Disease Control and Prevention (CDC) was created. In the same year, the National Bioterrorism Hospital Preparedness Program—later Hospital Preparedness Program (HPP)—was established to enhance hospitals’ ability to respond to a biological attack. These complementary programs serve different purposes, funding health departments at the state and local level to carry out public health preparedness and coordinate health care system readiness to respond to emergencies.

City and county health departments are on-call 24 hours a day, seven days a week to protect their communities from public health emergencies. They help communities respond to and recover from disease outbreaks, natural and human-caused disasters, and terrorist attacks. More than half of local health departments rely solely on federal funding, including the PHEP and HPP programs, to prepare for and respond to public health emergencies.

At its highest point in 2003, PHEP funding was nearly $1 billion. Since 9/11, state and local health professionals have used this funding to, for example, implement an Incident Command System with pre-assigned roles that help health departments to respond quickly to emergencies. Local health departments have also become a hub for storage and distribution of medicines and supplies that could be needed in an emergency. Public health and health care providers have strengthened existing partnerships and built new ones through the HPP program that can help ensure that people get the care they need in an emergency.

Despite the progress made since these early investments, austerity has taken its toll. For the past several years, funding for PHEP has been stagnant at $660 million, and this year President Trump proposed cutting it to $551 million. HPP was cut by one-third to $255 million in 2014, and funding has stayed level at $255 million annually. The President’s fiscal year (FY) 2018 budget proposed cutting it to $227 million, further reducing capacity.

Public Health Emergency Preparedness and Hospital Preparedness Funding Over Time
(in Millions of 2018 Dollars)

Source: National Association of County and City Health Officials

Emergency Preparedness in Oklahoma City/County

The Oklahoma City-County Health Department (OCCHD) oversees the health and safety of more than 1.25 million people in the metropolitan area. The region has recently experienced several emergencies including severe weather, earthquakes, wildfires, and infectious disease outbreaks. The staff of OCCHD, like their counterparts nationally, are trained to investigate disease outbreaks and contain them by advising local leaders when to close schools and other public places. They develop plans and hold preparedness drills to make sure that everyone knows their role in an emergency and educate the public about how to protect themselves in an emergency, such as by creating emergency kits, wearing masks, drinking bottled water, and staying indoors.

Local Impact of Cuts

According to Phil Maytubby, OCCHD Director of Public Health Protection, the health department has reduced their preparedness staff by about 20 percent through attrition and a lack of available funding to hire new staff. This has led to people doing multiple jobs which may or may not require similar skills. For example, the same staff person may be serving as volunteer coordinator and preparedness planner, simply out of necessity.

Phil emphasizes that the HPP “is our #1 partner.” Because of cuts to HPP, tasks are going undone and there is no one to pick up the slack. Partnerships between the public health and health care sectors need to be continuously maintained and improved or response time in an emergency can suffer.

Phil worries about the impact on the community if OCCHD is not able to focus on capacity building. He explains:

“A strong community is one that is able to bounce back after an emergency. Unfortunately, it is difficult for preparedness staff to interact with the community in an optimal way. For example, I would like to attend community association meetings to talk about what people should do to be safe in an emergency. But there just isn’t time with all the competing demands on my staff.”

To demonstrate the benefits of investing in PHEP and HPP, Phil points to the recent outbreaks of Ebola and Zika virus. A successful response to these threats was only possible because of the foundation built by PHEP and HPP. Phil explains that with the uncertainty of whether and how much PHEP funds will be cut:

“It is difficult for preparedness staff to take on new projects. Reductions in funding make it hard to maintain what the program has achieved so far, let alone take on additional response and recovery roles and efforts.”

Fortunately, while paid staff has been reduced, the Oklahoma Medical Reserve Corps (MRC) has seen continued growth. Oklahoma County has the largest MRC unit in the state, with over 1,700 volunteers (nearly 700 with a medical license) and over 1,000 members for public health support. Even with this cadre of volunteers to backfill the holes in capacity, budget limitations affect even this volunteer program through restrictions on purchasing necessary supplies and limited funding available to cover volunteers’ training.

Phil worries about what would happen without the capabilities that PHEP and HPP have provided his community. In light of current challenges and budgetary pressures, he says what keeps his staff going is responding to emergencies and seeing the benefit of the investments in protecting people and keeping them safe. However, he says, in a continued environment of austerity:

“You’re not going to know what you’re missing until you don’t have it. And then you’ll say ‘wow what did we do?’”