2009 Public Health Budget

King County is facing a serious budget crisis. In response, Public Health – Seattle and King County has proposed measures to reduce expenditures in our 2009 budget by approximately $19 million dollars. This includes more than $11 million dollars in new efficiencies and restructured programs that will take effect December 31, 2008. It also includes an additional $8 million dollars in a second set of reductions – reductions that will have especially serious impacts on the health of our community, affecting key programs and services that serve the general public and our most vulnerable residents.

Executive Sims’ proposed budget includes six months of funding to prevent this second set of $8 million dollar reductions for six months -- time to use to find alternate resources including a dedicated, long term funding source for Public Health. But, without another funding source, this second round of additional, very serious reductions will go into effect June 30, 2009.

As proposed, 70 current employees (for the equivalent of 41 full-time positions) will be affected by the changes scheduled to go into effect December 31, 2008. And an additional 69 current employees (for the equivalent of 72 full-time positions) would be reduced on June 30, 2009 if no stable, long-term funding solution is found. Because some of the specifics of this budget information are new to some agencies, for consistency and accuracy, all departments have been asked to wait until Tuesday to notify the specific individuals in positions affected by these changes. At that time, budget and staff reduction information will be added to the proposed budget descriptions on the Public Health website.

Public Health has been dealing with a chronic budget shortage for years, and we constantly search for better ways of doing business to be more efficient with fewer resources. In this tough economic climate and budget year, we are proposing administrative cuts and restructuring of more than two dozen of our programs to reduce our expenditures by $11.5 million dollars.

Some of these changes are primarily internal to the workings of our department. Even though we have already made substantial administrative reductions, we are further reducing our administrative costs in proportion to reductions in program. This includes staffing, contracts, and budgets for services and supplies in the Office of the Director, Finance and Accounting, Business Standards and Accountability, Contracting and Procurement and Management Information Services. In addition, we are centralizing more business operations in order to improve the efficiency of how we deliver crucial public health clinical services to people in our community who need it most.

Some of the changes we propose in response to the serious budget problems we are facing will be felt more directly by the people who receive services. In the HIV/AIDS program, for example, we have shifted resources away from outreach strategies, such as the hotline, that no longer match the needs of the community we serve. We are proposing to increase Environmental Health permit fees to cover the full cost of inspections. And we have identified less expensive ways to provide key aspects of our services. For example:

• Maternity Support Services program will reduce home visits but increase office visits.
• Full-time immunization clinics in all our Public Health Centers will be replaced by a smaller number of part-time services in remaining sites spread geographically across the county.
• While we are ending services for pregnant mothers with HIV/AIDS at Northwest Family Center, we are referring these clients to one of five programs that have expertise in serving families.
• The clients of MOMs Plus, a program that conducts street outreach with pregnant women involved in substance abuse will continue to be identified through the jail, homeless shelters and by referral from community agencies, so that services to women and their families would be maintained.

While some of these changes may create new limitations in accessing and receiving services, in this tough economic climate and in a difficult budget year, these changes are necessary. We will do everything possible to reduce the risk that these changes will not affect our core capacity to serve our mission. See specific list and description of the program changes.

The budget crisis facing Public Health is so large that the efficiencies and changes in business models described above are not enough to meet our budget reduction targets. Eight million dollars in additional reductions, affecting dozens of programs are proposed, with especially serious effects on the health and safety of our whole community and the most vulnerable. In order to reduce King County General Fund, we must cut the programs where most of these dollars are invested, like communicable disease control and public health clinical services to vulnerable populations. These grim financial circumstances force us to propose cuts that are at the very heart of the public health mission.

To avoid an immediate catastrophe, Executive Sims’ proposed budget includes six months of funding for this second set of critical program reductions in hopes that this time will allow time for King County to work on solutions for the budget crisis, particularly with the state legislature to identify stable, long-term sources of public health funding. In the absence of a funding solution, these reductions will go into effect on June 30, 2009.

Some of these serious reductions are to programs that serve all 1.9 million residents of King County. These include the elimination of the Zoonotic Disease program and the Drinking Water Program. These also include reductions in Public Health Laboratory services, Communicable Disease Program investigation and control activities, Tuberculosis Program prevention activities, Child Care Health Program services, Emergency Medical Services, and investigators in the Medical Examiner’s Office.

Other cuts are proposed to programs that provide essential health services to the most vulnerable people in King County, where the burden of illness and premature death falls disproportionately on low income and communities of color. The cuts are wide-ranging, including:

• Closure of family planning clinics at White Center, North and Columbia Public Health Centers, and closure of the Northshore Public Health Center;
  
• Elimination of preventive Oral Health Program screenings and sealants in King County outside of Seattle, eight Child and Family Commission programs serving high risk youth and parents, funding for a Chronic Disease and Injury Prevention program that serves low-income older adults, and sexually transmitted disease services at the Division of Youth Services.
  
• Reduction in safety net funding to community health centers and other safety net clinics; residual capacity to provide immunization services; Jail Health services at the Regional Justice Center, and core business operations programs.

See list and more complete description of these program changes.

These substantial proposed cuts will affect people of all ages and incomes, and the people least able to find other options will be hurt the most. They will also have economic impacts, today and in the future, in the form for higher costs for emergency rather than preventive health care, and more criminal justice system expenditures. Our mission to fix the funding problem is our biggest priority, because it is essential that we find a new and stable source of funding, including new local options.

Without such longer term funding, the intensifying perfect storm of federal, state and local funding cutbacks will only continue to make our budget challenges worse, resulting in even deeper program cuts in the years ahead.