Boom, now bust: Budget cuts and layoffs take hold in public health

Even as federal aid poured into state budgets in response to the COVID-19 pandemic, public health leaders warned of a boom-and-bust funding cycle on the horizon as the emergency ended and federal grants sunsetted. Now, that drought has become reality and state governments are slashing budgets that feed local health departments. Congress allotted more than $800 billion to support states’ COVID responses, fueling a surge in the public health workforce nationwide. Local health department staffing grew by about 19% from 2019 to 2022, according to a report from the National Association of County and City Health Officials that studied 2,512 of the nation’s roughly 3,300 local departments. That same report explained that half of their revenue in 2022 came from federal sources.

But those jobs, and the safety net they provide for the people in the communities served, are vulnerable as the money dries up, worrying public health leaders — particularly in sparsely populated, rural areas, which already faced long-standing health disparities and meager resources. Officials in such states as Montana, California, Washington, and Texas now say they face budget cuts and layoffs. Public health experts warn the accompanying service cuts — functions like contact tracing, immunizations, family planning, restaurant inspections, and more — could send communities into crisis. In California, Democratic Gov. Gavin Newsom proposed cutting the state’s public health funding by $300 million.

And the Washington Department of Health slashed more than 350 positions at the end of last year and anticipated cutting 349 more this year as the state’s federal COVID funding runs dry. “You cannot hire firefighters when the house is already burning,” said Brian Castrucci, president and CEO of the de Beaumont Foundation, an organization that advocates for public health policy. In some places, that pandemic cash did little more than keep small health departments afloat. The Central Montana Health District, the public health agency for five rural counties, did not receive the same flood of money others saw but did get enough to help the staff respond to an increased workload, including testing, contact tracing, and rolling out COVID vaccines. The department filled a vacancy with a federal grant funneled through the state when a staffer left during the pandemic.

The federal funding allowed the department to break even, said Susan Woods, the district’s public health director. Now, there are five full-time employees working for the health district. Woods said the team is getting by with its slim resources, but a funding dip or another public health emergency could tip the balance in the wrong direction. “Any kind of crisis, any kind of, God forbid, another pandemic, would probably send us crashing,” Woods said. Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials, said she expects to see layoffs and health department budget cuts intensify.