by revere, cross-posted from Effect Measure

There is a good summary by Robert Roos at CIDRAP News about the $420 billion spending bill signed by President Obama this week to cover the next six months. The good news edges out the bad news, so the net is positive, a welcome change from the kind of deeply depressing budget news to which we became accustomed during the Bush years. Bush took a teetering public health system whose decline started with Reagan and continued through Clinton and put it on life support. Now a couple of items in the spending bill have upped the oxygen slightly but don’t increase the circulation in all the critical organ systems. In particular, it didn’t restore any of the $900 million in aid to state and local public health that was zeroed out of the stimulus bill. The new spending bill includes no pandemic money for them, either, an incredible omission. It will be the state and local public sector people that will bear the brunt of a pandemic. Much better to fund local public health than $40 million for countermeasures for HHS staff and contractors or $700 million for pandemic planning at HHS. Too much of that planning is wheel spinning at this point. Better to give more money to state and local health departments to implement plans and build badly depleted capacity. But there is also some badly needed money for important purposes.

Yesterday we wrote about a paper looking at the prevalence of viral genetic material in a hospital emergency room during flu season. The new bill includes $3 million for badly needed research by National Institute of Occupational Safety and Health (NIOSH) on this subject, fulfilling a recommendation of the Institute of Medicine in 2008 for more information on airborne transmission and effectie ways to protect health care workers. $3 million dollars is a pittance for such important work, but it is a lot better than zero. Zero is the amount NIOSH got in the stimulus bill, after another pittance, $40 million was stripped out. CDC also got little in the stimulus bill (some building projects only) but will get a little under 3% more than last year for its pandemic activities. $425 million is going to increase vaccine production capacity. I’m not clear on exactly what this means. The technology is evolving very quickly, so what kind of capacity this is I don’t know.

The bottom line here is that public health once again came ahead, but just barely, and nowhere near where it needs to be to get our communities ready to cope with a pandemic. As one of my colleagues points out, no Senator ever championed an agency because his wife didn’t get breast cancer or no Congresswoman because her children were born healthy. The old adage, when public health works, nothing happens, means that curing disease has many proponents but preventing it in the first place very few. The new monies allocated to public health and pandemic preparation is welcome but no cause for great joy.

Bridges and dams aren’t the only items of neglected infrastructure that badly need fixing. State and local public health are still gasping for breath. If they don’t make it back to where they need to be, neither will many of the rest of us when the time comes.

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