Sequestering Public Health

What we stand to lose

Published on March 4, 2013by Abdul El-Sayed

After a bitter fiscal impasse between President Obama and congressional republicans over the past several months, a budget sequester signed on Friday evening will make deep, across-the-board cuts to major federal programs.

The cuts include $28.7 billion, nearly 5 percent, in domestic discretionary spending. Discretionary spending, allocated annually by congress for non-military programs, includes funding for public health at home and abroad, as well as for health research.

These newest cuts come upon the heels of deep budget reductions over the past two years that have already had negative consequences for our nation’s public health infrastructure. Since the 2010 fiscal year, public health spending has already decreased by about $2.5 billion, nearly 8 percent. Sequestration doubles that total to nearly 16 percent, with potentially more cuts to come in the next several years.

Unless Congress acts quickly to undo the cuts that have already been set in motion, they will have massive implications for the public’s health into the next several decades.

The health implications will be felt immediately both at home and abroad. Sequestration means that $350 million in Centers for Disease Control and Prevention (CDC) funding is lost. The Coalition for Health Funding estimates that this means between 210,000 and 840,000 children and adults will be left without vaccination for deadly diseases, such as hepatitis B, measles, pertussis, and influenza.

In a Senate report, Senator Tom Harkin (D-Iowa) estimated that reductions in CDC funding for HIV prevention will deny nearly 700,000 Americans access to HIV testing, potentiating the spread of this deadly virus. Moreover, nearly 12,000 HIV-positive Americans will lose access to life-prolonging treatments they now count on.

Similarly, nearly 34,000 women will lose access to breast and cervical cancer screening, which will result in hundreds of cancers being missed.

The American Public Health Association (APHA) estimates that nearly 150 food-borne outbreaks will go unidentified as a result of the sequester—leaving them to fester unabated, increasing their morbidity and mortality and associated costs. The APHA estimates, for example, that as a result of cuts, the number of deadly E. Coli O157 infections, which result from infected, undercooked beef, will increase by 40 percent.

As nearly two-thirds of the CDC’s budget supports state and local health departments, the pain will extend beyond the federal level. Nearly 2,500 local public health workers, for example, will go without necessary training in epidemiology, laboratory methods, and outbreak investigation.

The Women, Infants, and Children (WIC) program, which provides support for low-income mothers and their children and has been demonstrated to reduce the healthcare costs associated with prematurity, will be particularly hard hit. That program will be forced to cut nearly 750,000 women, as well as their dependent children.

Outside our borders, the global health implications are also massive. Sequestration will rob global health programs fighting HIV/AIDS and other diseases abroad of nearly $600 million in funds through cuts to the Department of State and USAID. These cuts could force nearly 200,000 people off their HIV/AIDS treatments, causing 37,000 deaths and leaving nearly 74,000 children without parents, according to a spokesperson for the ONE campaign. Secretary of State John Kerry, in a letter to the Committee on Appropriations detailing the potential fallout of the sequester, estimated that nearly $200 million in aid cuts to Syria, the Horn of Africa, and the Sahel region would disrupt food availability among nearly 2 million people.

Worse than the short-term impacts of sequestration on public health at home and abroad may be the lasting implications sequestration’s cuts will have for the future of public health. If unabated, these cuts will extend through fiscal year 2021, crippling our public health infrastructure by starving critical organizations, such as the CDC and the Food and Drug Administration (FDA), of the funds they need to carry out even their most basic operations.

At the core of public health is the responsibility of shepherding limited resources for maximal benefit—very similar to the responsibilities of our government representatives. Unfortunately, our leaders have chosen to put their partisan goals above their responsibilities by slashing important public health budgets. And for that, we’ll all suffer.

Edited by Karestan Koenen.