Effect Measure

A reader sent me a link to The Salt Lake Tribune that made me do a double-take: Health department on chopping block:

Utah could become the only state in the country without a state health department.

Republican lawmakers are considering handing the duties of the health department — from tracking and responding to communicable diseases and trying to reduce obesity and cancer rates to inspecting child care facilities — to other agencies.

The proposed dismantling would save $1.7 million in administrative costs by cutting director and division director budgets. It came as a shock to David Sundwall, the department’s director, who learned of the proposal Wednesday morning.

“It would be a breathtakingly bad idea,” he said, noting Utah’s public health system is one of the reasons the state is often ranked as one of the nation’s healthiest. (Heather May, Salt Lake Tribune)

After the initial shock, I read on. Republicans in Utah are trying to cut $50 million (7.5%) out of their Human Services and Health budgets this year alone and another $102 million (15%) out of next year’s budget. And a disproportionate amount is coming from the Health side. The proposal will go all the way and submerge all of the health department’s functions into the human services agency. It’s not just reducing administrative redundancy, though. There will be major cuts in routine functions such as inspecting child care facilities. And no more unannounced inspections. Since these facilities are also feeling the economic pinch, they are under pressure to do just what the state is doing: cut corners. But in this case the result will plausibly be dead infants and toddlers. Such deaths occur even now, under more stringent inspection and will plausibly be more likely if no one is checking whether workers are properly trained and licensed and whether facilities are safe. Cuts will also affect infectious disease outbreak response, something that potentially endangers the whole community. There’s more, but it’s too depressing to detail. If you want all of it, go to the link.

I understand there is a budget problem. Not enough revenue and too many expenses. Administrative consolidation on its face seems like a reasonable way to avoid even deeper and more hurtful cuts. But I doubt very much if the proposed Republican solution will be a good one. It isn’t being proposed for humanitarian reasons. It isn’t just a consolidation but makes a statement about public health. The Mormon Church has enormous political power in the state and is not particularly sympathetic to anyone who doesn’t adhere to their life style. Their life style (no smoking or drinking) is a generally healthy one, which is good — for them. I don’t smoke and I drink very little (socially), but that doesn’t mean I want to abandon anyone who gets diseases in which smoking or drinking is a potential factor, any more than I want to abandon anyone with a disease of the uterus because I don’t have one or someone with asbestosis because I don’t work with asbestos or some one with diabetes because I don’t have it. I don’t have children in school but I still pay for schools. One could say that people with children didn’t have to have them. I think the fact is that Republicans in Utah don’t care about public health and public health functions. These functions are not only expendable but they disapprove of the regulatory functions that a public health department carries out. They are still deregulatory zealots, even as houses are being repossessed because right wing Republicans like those in Utah abandoned oversight. Some of the problem could be addressed by raising revenues. But dead infants and children are not as big a sin as raising taxes for these folks, so that’s a non-starter.

I hope an influenza pandemic doesn’t start in Utah. Because it will be around the world twice before we find out about it from a state without a full fledged health department.


  1. #1 Anne Ozment
    January 24, 2009

    I guess with Utah’s high birthrate they think they can afford to lose a few to population-based issues. So what if their immunization rates fall below the herd protection levels. A few more untested rabid bats, or whatever the vector is in Utah, won’t kill more than a few a year. Rising infant mortality statistics and declining longevity will just make life more “precious,” won’t it? If the health department is not registering births and deaths we really won’t have the date, and won’t know, will we? And then there is all of the communicable disease. Wasn’t TB fun before public health departments? I suppose there are no STDs in conservative Utah. And no people living in poverty or without health insurance that need the support of their “Health Departments.”

    Just think, it will be just like living in the old days–like the pioneers!!! What incredible fun!!!

    I had better stop–I can see I’m really on one this morning.

    Old Public Health Administrator and Nursing Director

  2. #2 Dino W. Ramzi
    January 24, 2009

    I’m not sure why it should be such a surprise. State and local health department budgets have been cut to the point that they have evolved into a figurehead, a letterhead and program to teach high school kids how to handle food at McDonald’s. I’m exaggerating, but we’re definitely moving in that direction.

  3. #3 HiveRadical
    January 24, 2009

    Funny how it’s easy to pick apart Mormons for actually trying to balance a budget.

    I think it’s interesting that no one considers the fact that liberal states like California will be the straws that break the economic back of the Nation and the World. Or are we all forgetting that California is on the brink of bankruptcy. But heck! People never die from great depressions now do they? I mean we can always print more dollars to give the hospitals and health workers, inflation smation! We don’t have any statistics of inflation killing people! So why are you worrying about it? Ponzi schemes mascara ding as publicly backed welfare programs don’t kill people do they? A whole world thrown back into a great depresion will not kill people. Households where money stress and a lack of fiscal responsibility don’t have any negative stress from such an inconsequential thing as economics don’t make people sick nor induce unhealthy living!

    You see people this approach from one angle is what’s been killing us. To give a de facto cold shoulder to the raw economics is what got us into this mess, not soley de-regulatory measures. In fact the whole housing problems were ENABLED by regulation seeking to enforce a disregard for economic reality, it was a regulating of liberality.

    But you can all continue to curse out the LDS Church. Keep your narrow view on things, because that’s what enables you to keep worshiping your own sacred cows. Those evil Mormons trying to balance the totality of the picture and not trying to defy the laws of physics through inflationary debt based fiscal policy!!! How dare they actually try to deal with hard issues and how dare they not see the world as you do!!!

  4. #4 Gindy
    January 24, 2009

    Hive, not one poster nor Revere said ANYthing about Mormons or the LDS.
    All that was mentioned was Republicans.
    By the way, there are more Mormons in California than there are in Utah.
    “In fact the whole housing problems were ENABLED by regulation seeking to enforce a disregard for economic reality, it was a regulating of liberality.”
    You sure have drunk deeply of the Koolaid, haven’t you.
    The main reason the housing market busted was because deregulation allowed HUMAN GREED to run unchecked.

  5. #5 Anonymous
    January 24, 2009

    Yes, we are in for rough times ahead. Cuts will have to happen everywhere. But this is not just cuts, this is eliminating infrastructure. This is de-development. Public health is infrastructure just as much as roads or power lines or water. It may not always be managed well, but at least the framework is there. It may be easy to make that framework disappear in lean times in the name of balancing a budget. But, it will be much harder to rebuild when we realize how much we need it. Have we learned nothing from history?

    Plus, are we not already reaping the long-term consequences of focusing too much on short-term gains? Why do we think that we can solve the problem with the same thinking that got us here in the first place?

  6. #6 Tracy Hall Jr
    January 24, 2009

    Gindy wrote,”not one poster nor Revere said ANYthing about Mormons or the LDS.”

    Revere wrote, in fact, “The Mormon Church has enormous political power in the state and is not particularly sympathetic to anyone who doesn’t adhere to their life style.”

    I invite you and Revere to put aside your prejudices and meet some real Latter-day Saints. Please worship with us tomorrow — visitors are always welcome.

    You can learn the location and time of the services nearest to your home at http://mormon.org/mormonorg/eng/worship-with-us.


  7. #7 Gwen
    January 24, 2009

    Coming from someone who actually works at Utah’s State Health Department and is also a Mormon I can tell you that it is a fallacy to associate everything that happens in Utah with the Mormon church. Yes, the church is influential, but its reach extends to only so many matters. The Mormon church does not dictate what matters the health department can and cannot tackle. Likewise, there are many people who work at the Health Department who are not Mormon but who make important decisions. Like many other public health professionals, I am appalled that Utah is considering nixing the health department and hope that Utah’s many problems – STDs, prescription drugs abuse, meth addiction, will continue to be addressed.

  8. #8 crf
    January 24, 2009

    The federal government should be quickly working to provide an option to loan money to states.

    These and similar cuts are only being suggested because of sudden gaping shortfalls in state budgets, due to the sudden unforseen cratering of the economic tax base. These budgets are often, like Utah’s, required to be balanced every year. So those budget holes are real and must legally be dealt with, but they are also being used as an excuse to cut those government functions, popular with the public, but which Rebulicans are often ideologically against.

    If the state instead had, for certain programs, the option of borrowing the money from the federal government, (at zero interest say, and for a long period), then the public would demand they do that, rather than continue with these cuts as if they had no choice. They could pay the loan back with tax increases once the economy recovers.

    This economic slowdown shows just how economically incoherent is the republican and libertarian balanced budget mania. They should run surpluses and pay down debt when times are good. When times are bad, they should maintain or increase government spending, not raise taxes, or temporarily reduce them, and run a deficit.

    But Utah’s children’s future shouldn’t be sacrificed just because the adults in charge there don’t even understand the bare basics of economics. The federal government needs to step in to provide the option of protecting certain essential state services with loans.

  9. #9 Lea
    January 24, 2009

    Let’s mention that Mormon’s are good people. I’m not one of them and I live in Utah. Nine times out of 10 Mormon’s have treated me with respect and kindness, there are many of them that I like very much. And to be fair there are many that I’d like to slap around for being so manipulated, anyway …… .

    West Valley area of Utah just opened a new clinic for VA Vets. Just saw a quick blurb about that on the news last night.

  10. #10 revere
    January 24, 2009

    I went to med school with quite a few Mormons and I will second what Lea said. Individual Mormons have always (at least as far as I know) treated me with respect, as I hope I have treated them with respect. We are just human beings. That is not the issue I raised. First, the LDS Church has tremendous political influence especially on Republicans in Utah and this is a Republican initiative. Second, the LDS Church as an institution is a narrow minded, prejudiced and reactionary institution. The Church has no respect for my religious views (I’m an atheist) and it has said so in various ways and has shown its narrow mindedness most recently in California. You all know what I’m talking about. Third, if Utah was so far sighted fiscally compared to California as one commenter implied, why do they have to slash their budget so drastically? If you want to pay attention to economics, then raise revenues.

  11. #11 California Epi
    January 24, 2009

    Utah is doing in one huge step what other states and local jurisdictions have been doing piecemeal for years. Our local Chronic Disease Division (notice that it isn’t even at Branch level) primarily manages contracts and has only has a handful of staff people. They lost their sole Epidemiologist about 6 years ago during the last economic downturn. We serve over 3 million people, but with Republican politicians Public Health is constantly being whittled away. Except of course for Bioterrorism…

  12. #12 Anonymous
    January 24, 2009

    “Second, the LDS Church as an institution is a narrow minded, prejudiced and reactionary institution.”

    Pot, meet kettle. Sometimes, reveres (whichever one you are this time), the opinions you express are as ridiculous as the ones you oppose.

    “First, the LDS Church has tremendous political influence especially on Republicans in Utah and this is a Republican initiative.”

    There is such an incredible logical fallacy in this statement, I don’t even know where to start. Usually I enjoy the reasoned discussion here, but lately it’s become as ideological in the other direction as the politics I have despised (and hope are changing). Can we focus on the issue at hand? You do absolutely no service this important issue to imply that this is somehow unique to Utah. Apparently your narrow minded prejudice is getting in the way of reason. Shame on you.

  13. #13 revere
    January 24, 2009

    Anonymous: Tell it to your gay brothers and sisters in California. As to the “logical” fallacy, it isn’t a matter of logic. It’s an empirical question. If you want to refute it with some evidence, go ahead. And Utah is no different than most other states (so much for the vaunted financial responsibility) except that it is poised to become the first state without a state health department. Is Utah the worst? Probably not. There are all those southern states. You are now in their league. But you are making a statement, that’s for sure.

  14. #14 Lea
    January 24, 2009

    They raised taxes on cigarettes by two dollars so there’s some of your revenue.

    And we have State Liquor stores, tremendous amount of revenue there. (you can get beer at convenience stores, just not hard liquor).

  15. #15 Anonymous
    January 24, 2009

    I’m not from Utah. And I was not referring to the issue itself, but the logical construct of your statement. I am as disappointed by this development as you, but I have grown incredible wary of ideology in all forms over the past 8 years. I believe you do just as much of a disservice to rational thought and the hope for a future of reasoned decisions if you can’t frame your arguments better.

  16. #16 Phila
    January 24, 2009

    the logical construct of your statement.

    If there’s a huge logical problem here, you should be able to state clearly what it is.

  17. #17 revere
    January 24, 2009

    Anonymous: Why don’t you frame it for me as you see it. I don’t know what you are driving at.

  18. #18 MoM
    January 24, 2009

    It would be interesting to see how big a hit the Utah Department of Tourism or the Utah Correctional Industries (who compete with private industry with labor that draws 6ยข and hour) take.

  19. #19 MoM
    January 24, 2009

    And for perspective, when I started with our State’s Health Department, we were a Division of the Department of Social Services. It was the vogue at the time to have “super agencies” that covered everything that could possibly be related. The result was that the other things DSS did (Family Services, Children’s Services, Aged Services etc) got first pick at the budget and Public health got the leavings. When we finally got a separate, stand-alone Department of Health, things improved. Looks to me like Utah is headed back the other way. My experience says it is a bad idea. (But you already knew that…)

  20. #20 HiveRadical
    January 25, 2009


    You are correct they didn’t say ‘Mormon,’ but they were referencing the influence of the Mormon Church as part and parcel to the cause of the problem they perceive.

    And you are incorrect. It was not deregulation that so empowered greed, it was regulation, it was the government fostering fanny mae and freddy mac and the reason greed was enabled was because the foundations of the mortgage industry were led to believe that they were ‘too big to fail’–and all of that because of the forced, and government fostered, liberalization to the point of absurdity. This wasn’t the government restraining markets, this was the government putting a cattle prod to the markets. Either way it was government meddling that FOSTERED, ENCOURAGED AND ENABLED the unbridled greed that swept through the housing markets. Even the liberal writters at SNL can see this, why won’t you?

  21. #21 MissFifi
    January 25, 2009

    “Even the liberal writters at SNL can see this, why won’t you?”
    It is this kind if name calling that gets us in a pickle. So, let us work together to tackle the issue at hand, Public Health funds should not be getting cut, so we all need to think out of the box to help local/state/federal governments see why public health is crucial. They need to understand that when they saddle other overworked agencies with trying to reduce obesity, tracking infectious disease, etc, it is leaving way too much much room for errors and consequences that they might not be ready to bear.

  22. #22 Pierce R. Butler
    January 25, 2009

    Would it help to shame the Utah legislature out of its reckless tendencies if this initiative were to be called the promotion of social Darwinism?

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