7.8 Public Funding for Public Health
Boston Public Health Commission programs and initiatives are supported by federal, state, city and foundation funding. Reimbursement from third-party payers (including health insurers) is also used to offset the costs of providing medical care at clinics and school-based health centers. In many instances, the Commission works in partnership with other health care providers and community-based organizations to develop and implement comprehensive approaches to public health issues. Unfortunately, efforts that have integrated funding streams are most at risk in times of funding reductions. Combining funding from a variety sources has a synergistic effect — so much so that eliminating just one source of money may make it impossible for the service to continue.
During difficult economic times there is a tendency to focus attention on “critical care” services. However, budget cuts that eliminate funding for prevention-oriented approaches to health often lead to increases in preventable diseases and, therefore to expensive medical care. Public health, with its primary focus on prevention, has tended to be both misunderstood and undervalued. As such, recent state budget cuts have disproportionately affected public health services. Funding reductions in the state Department of Public Health budget, local aid cuts, and reductions in Mass Health coverage have resulted in the dismantling of many core public health services: surveillance, communicable disease tracking, counseling for teens, screening for STDs and blood-borne disease, smoking cessation programs and enforcement of tobacco regulations, as well as a decline in PhysEd classes in schools.
Funding for innovative approaches, responsible for progress on many public health issues in the 1990s, has been significantly reduced. Without a commitment to maintaining levels of support from a variety of funding sources, the public health system responsible for many good health outcomes enjoyed by residents and visitors in Boston, and an important part of the public infrastructure in times of an epidemic or a terrorist attack, is seriously compromised.
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