Disaster in Progress

It's mind boggling. The Illinois state budget deficit even warranted an article in the Wall Street Journal. The economics aside, my concern naturally is for the health of the people of the state. In my work with the local health departments, they are saying that county budgets have been hard hit because the state has not paid for services rendered. No one feels confident that the state will pay its bills, for services given in the past fiscal year, not to mention the current fiscal year.

From the point of view of public health, it feels like an economic disaster for which no preparedness training could help. Many county governments are making some really deep cuts into programs and services most of us have taken for granted for decades. The state funds support mostly health promotion programs and screenings for early detection and prevention. In contrast, federal dollars generally support direct clinical services, like primary care. At least in Illinois, most local health departments have gotten out of the business of providing primary care. Instead, they focus on the health promotion, disease prevention for which reimbursement does not exist.

As the programs are cut because there is no money to pay staff to do the programs, questions arise. What will happen to the health statistics for conditions like sexually transmitted diseases (STDs), breast and cervical cancer, and child abuse? How will health departments reconfigure and reconceptualize themselves in this new economic landscape? What new or old skills are needed by the remaining workforce to actualize this new reality?

I don't worry about those few organizations that are trendsetters, enlightened, prospectors (in the language of Miles and Snow) that can turn this crisis into an opportunity. But, not all organizations have that ability. Those that can't survive or adapt or morph, what will happen to the health of the people they once served?