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News State / Region Budget Cuts Threaten Public Health Programs

Services offered by the Macon County Public Health Center could be significantly altered if current budget proposals pass the legislature. Above, health department employees Lisa Marling and Leigh Tabor are hard at work. Photo by Vickie CarpenterProposed legislation could drastically alter services.

Education is not the only social service that stands to be gutted in the state budget negotiations currently under way in Raleigh. Public health services are also on the chopping block.

According to Jim Bruckner, Macon County’s Director of Public Health, several pieces of proposed legislation could dramatically impact local public health services, including a proposal to abolish the Health and Wellness Trust Fund (HWTF), which helps to fund preventative health programs targeting tobacco use and obesity.

The $19.4 billion budget approved by the Senate Appropriations Committee is only slightly revised from a House budget proposal passed last month. Both bills would see numerous cuts to public health that would impact services at the county level.

Proposed legislation could drastically alter services.

Asked what the main concerns are facing public health in light of the pending 2011-2012 budget, Bruckner listed numerous specific proposals in the bill, including:

• Proposed abolishment of the Health and Wellness Trust Fund. This will greatly reduce youth tobacco prevention and cessation programs (such as TRU clubs) currently active in Macon County schools.

• Proposed reduction in the number of optional services for eligible adult Medicaid recipients. This will mean more patients will have to pay out of pocket for adult dental services which, in this difficult economic time, may create a barrier to these services when people have to decide whether to pay their bills or seek necessary dental services.

• Proposed reduction in Health Choice dental benefits for children through age 18. If these children do not transition to Medicaid, this will create a potential revenue loss of $40,000 to Macon County.

• Proposed elimination of the state level Environmental Health Staff; Private Drinking Well Water Program (PDWW); Wastewater Discharge Elimination (WaDE) program; and Pest Management (Vector Borne Disease Control) Program. This leaves counties with the unfunded mandate of management and enforcement of these programs.

• Proposed reduction in the Breast and Cervical Cancer Control Program (BCCCP) which will reduce the number of screening mammograms for women ages 40-49 years old offered through the Health Department.

According to county health department officials who spoke at a recent meeting of the League of Women Voters, such cuts disproportionately impact lower-income families at a time when there is the greatest need for services.

Meanwhile, local health departments must also keep a nervous eye on the federal budget. Bruckner cites numerous block grants that federal legislators are eyeing for drastic reductions, including the following:

• Maternal and Child Health Block Grant
• Community Service Block Grant
• Family Planning Block Grant
• Women, Infants, and Children (WIC) Block Grant
• Preparedness/response Block Grant

If these proposed reductions are carried out, it could result in the reduction in or elimination of prenatal and child health clinical services, family planning services, WIC services and several other services and/or health promotion programs currently offered by the health department in Macon County.

According to Barry Patterson who heads up the county’s environmental health program, more than 30 bills all together target public health and environmental health funds. Patterson noted that such cuts leave the county more vulnerable to natural disasters, security threats and other emergencies.

Youth tobacco prevention program may be eliminated

The Health and Wellness Trust Fund was established by the state to administer funds from the national tobacco settlement. In Macon County, HWTF funds youth tobacco prevention programs such as TRU (Tobacco Reality Unfiltered). School TRU clubs in Macon County and across the state are established to educate students about the dangers of tobacco and stop tobacco use before it starts.

Dawn Wilde, Health Educator for Macon County Schools, is also the county’s tobacco prevention coordinator. Through Wilde’s efforts, there are already three active TRU clubs in Macon County (Franklin High School, Macon Middle School, and Mountain View Intermediate). At the League of Women Voters forum, Wilde cited several statistics which illustrated the efficacy of such programs in Macon County.

Since 2005, the county has seen steady decreases in tobacco use by students in the school system. According to the county’s Youth Risk Behavior Survey, between 2005 and 2009, the number of high school students who smoked before the age of 13 dropped from 25.4 percent to 17.8 percent. Similarly, the number of high school students who said they had used cigarettes in the past 30 days dropped from 32.7 percent to 27.5 percent.

In the same period, the number of middle school students who reported smoking before the age of 11 dropped from 19.3 percent to 12.6 percent. Middle school students who said they had smoked in the last 30 days dropped from 15.4 percent to 9.4 percent.

While these drops are encouraging, comparison with statewide statistics demonstrates a continued need in the county for the prevention programs. For the whole state of North Carolina in 2009, 12.4 percent of high school students reported smoking before the age of 13, and 17.7 percent reported having smoked cigarettes within the past 30 days.

Wilde notes for every pack of cigarettes sold in the state, it costs North Carolina taxpayers $7.17 in healthcare costs to treat the serious chronic diseases brought on by cigarette smoking. She adds that more than 10,000 children in North Carolina will become regular smokers this year. Eliminating preventative programs such as TRU does not help the economy, she says, but actually contributes to rising healthcare costs in the state.

If the HWTF is abolished as proposed, all funding for these activities will cease on July 1 and will equate to a loss of more than $85 million to preventative health programs in the state over the next five years. Bruckner says that while the county will do everything it can to continue some level of tobacco prevention in the school system, its efforts will be dramatically constrained if it loses funding.

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