As if we haven't had enough bad news about the economy and the impact on state and local budgets, here's another tough pill to swallow.

More than $32.7 million in public health services is being cut across all 35 local health jurisdictions in Washington. That's the equivalent of cutting more than 250 full-time jobs!

In the wake of these cuts, numerous public health services will be lost or dramatically reduced. These will include crucial services ranging from maternal and child health home visits to communicable disease investigations to inspections to ensure drinking water quality, public health codes in restaurants, on-site septic systems and control of waste, both hazardous and solids.

The effect of these cuts will be an increased burden and cost to health care, criminal justice and social welfare systems due to the failure to provide effective services that prevent these substantial downstream costs.

To add insult to injury, so to speak, indications are that more cuts are coming in 2009 and 2010. As things stand, local counties have limited capacity to allocate additional funds to public health. Across the state, 71 percent of county expenditures go to public safety, leaving 29 percent for everything else, including public health. This situation suggests that counties will need new local revenue sources, assuming both counties and cities agree that public health is a local funding priority. This is likely to be a very unpopular suggestion, especially given the enormous amount of money already in the overall health care system.



What's the solution?

Dr. Tom Locke, our county health officer, promotes a reunification of public health and medical care and illustrates how they interact and support each other.

Dr. Locke says, "The focus of public health is on promoting health and preventing illness through the use of proven nutrition, exercise, risk behavior modification, environmental health protection, and communicable disease control and prevention. Public health interventions are targeted at whole communities or groups within

those communities."

On the other hand, "the focus of the medical care system is dealing with evaluation and treatment of illness and injury for individuals," he says.

"In an integrated health care system, health care workers would provide both public health and medical care services based on the needs of their patients and the community at large."



How do we get there?

We start with the fact that about 1 percent of health care dollars are invested in public health, while the bulk of the money goes into the medical care system. Just how this vast sum is spent is another topic entirely. But this inequity is severely crippling the public health component.

And we find that health departments are cutting core services while they are needed more than ever.

We, as community members, need to engage our state and federal legislators to, first, understand the enormity of this issue and, second, to find the means to adequately support the need. The means are already available, but there needs to be a very deliberate reallocation of funds to achieve the desired outcome.