Truthout - March 17, 2020

Himmelstein said hospitals in lower-income areas and communities of color are more likely to be underfunded and overburdened, because their patients tend to be covered by insurance that provides less profit for providers, if they are covered at all. Lower-income areas may not have enough health care providers to begin with, and these are often the same areas where politicians cut spending on public health.

“Instead of saying ‘let’s build hospitals where they are needed,’ we build them where they are profitable,” Himmelstein said.

Years of austerity at all levels of government, combined with profiteering in the health care sector and the Trump administration’s bungled response, have severely weakened the nation’s ability to combat the coronavirus outbreak and is putting public health workers on the front lines of the crisis in danger, according to experts and labor advocates.

Underfunded and overworked public health departments are tasked with tracking and stopping the spread of the disease. Hospitals and emergency rooms are struggling to respond to coronavirus cases, amid a lack of key workplace protections and shortages of protective equipment for nurses and health workers. Our health care system has gaping holes that leave millions uninsured and many wary of seeking medical treatment. Tens of millions of workers are without paid sick leave.

These are just a few of the systemic problems boiling up to the surface as COVID-19, the disease caused by the novel coronavirus, continues to spread nationwide and balloon into a public health crisis that is claiming lives and significantly altering daily life for millions.

President Trump, whose preoccupation with the economic fallout of the crisis initially encouraged the spread of misinformation, has certainly hampered the government’s response. However, while public health experts and unions representing service workers on the front lines of the outbreak agree that Trump certainly bears responsibility, they also point to countless austerity-minded politicians who came before him.

And while Congress is now mulling a sweeping relief package meant to fill critical gaps in the nation’s coronavirus response, critics say the legislation would not do enough to contain the virus and prevent future pandemics.

Consider the state and municipal public health departments that are currently overwhelmed by outbreaks of COVID-19, including significant community spread, in areas across the country. Thanks to budget cuts going back nearly two decades, public health departments nationwide have eliminated 50,000 positions since 2008, according to David Himmelstein, M.D., a professor of public health at the City University of New York at Hunter College.

“Those missing 50,000 public health workers are why our response has been so inadequate,” Himmelstein said in an interview.

Employees of public health departments are the “front line” public health workers who are “trained to mobilize” and fight epidemics, Himmelstein said. They also work hand-in-hand with federal authorities, implementing Centers for Disease Control (CDC) initiatives at the state and local level.

“They are the folks who actually go out and when someone is sick with an infectious disease … they track down the people who might be exposed and treat them in the case of treatable things like STDs or hepatitis, or isolate them in the case of COVID-19,” Himmelstein said.

Yet funding for public health has been declining for years. Health departments took a big hit during the Great Recession, when state governments cut spending to make up for losses in tax revenue. However, in many states this funding was never restored even as the economy recovered — along with positions formerly held by public health workers who combat the spread of disease.

When adjusted for inflation, state public health spending was actually lower in 2016 and 2017 than it was in 2008 and 2009 when the recession first took hold, according to the Trust for America’s Health, a nonpartisan research and advocacy group. From 2015 to 2017, 31 states made cuts to their public health budgets, often because conservatives controlled their legislatures. Only 19 states maintained or increased their budgets during the same time period. ...
Read full report at Truthout