Vantage Point: Public health budget cuts could cripple progress

Marilyn Winkleby

The recent outbreak of illness from contaminated spinach and the looming threat of pandemic flu make clear the need for a strong public health system. Yet Santa Clara County is considering budget cuts that could dismantle decades of progress.

Not long ago children were crippled by polio, mothers died in childbirth, cars lacked seatbelts and fatal diseases were carried by food and water. At a national level, the public health system can take credit for reversing these trends. But the root of public health begins at the county level.

While each of Santa Clara County's 15 cities has a police and fire department, none has a health department. The Santa Clara County Public Health Department is the watchdog for the health of all county residents and is crucial to the prevention and control of disease, and emergency response. What if there is an outbreak of meningitis, a food-borne illness, a contamination of our water supply, a flu pandemic or a destructive earthquake?

Huge budget cuts are being proposed by the Santa Clara County Board of Supervisors that will hobble the public health department and severely compromise the health and well-being of our communities. The proposed $19.5 million cut amounts to a 48 percent reduction in the health department's general funds. This comes on top of the $18 million cuts imposed in recent years. Thirty percent of the health department's workforce, or 154 full-time people, will lose their jobs. And this is in one of the wealthiest counties in the nation.

In the short term, the poor will suffer the most. The South County and West Valley public health offices will be eliminated, cutting services to more than 4,500 needy children and their families. STD clinics like the Crane Center will disappear. The Violence Prevention Program will be eliminated in 57 schools, with 25,000 students affected. Our corps of public health nurses—already the smallest number per-capita in the state—will be cut to a fraction of its current size.

In the long term, we will all suffer. When children are not vaccinated, when a multi-drug-resistant tuberculosis is not contained or when a flu pandemic hits, every one of us is at risk. Uncontained diseases and sudden disasters pay no attention to where we live or who we are.

What can we do?

We must all work together to find alternatives. The supervisors face the thankless task of addressing a $238 million deficit for fiscal year 2007-08, and have many tough choices to make. We urge the supervisors to explore alternatives such as spreading the cuts more equitably among the county departments, seeking emergency state funding, or phasing in the cuts over time.

In the future, we must think hard about how to pay for essential public health services. Perhaps we should reconsider a half-cent sales tax increase, such as was proposed by Measure A that was defeated in 2006 at the polls. A small tax such as this could raise $170 million yearly to support our public health department, our county hospital and clinics, health insurance for needy children, mental health care and other critical services. Perhaps a stronger partnership between the county health department and our county's hospitals, insurance carriers and health-care providers should be created to generate a collaborative response to the crisis. If an ounce of prevention is worth a pound of cure, then sustained investments could translate into fewer health care crises and save lives and dollars.

To imagine a public health emergency, recall the images of New Orleans during Hurricane Katrina and the thousands of people stranded in the storm-ravaged Superdome. When the "Katrina" of California hits our county, will we be ready? We may have a grand new football stadium to house the victims when the hospitals are full and neighborhoods are in ruin, but who will organize the public health response?

Stanford community members and Santa Clara County residents are encouraged to write to the county board of supervisors and testify at the meeting of the board's health and hospital committee on June 6 at 2:30 p.m. at 70 W. Hedding in San Jose. More information about board meetings and workshops can be found at

This article was originally published in the May 6 San Jose Mercury News. Marilyn Winkleby, PhD, is a professor of medicine at the Stanford Prevention Research Center and faculty director of the medical school's Office of Community Health. Ann Banchoff, MPH, MSW, is the program director of the Office of Community Health.