The Silver Lining

Could public health budget cuts be a good thing?

At the Large Public Health Department where I work, we’ve been going through a long period of belt-tightening. This year, for the first time in 5 years, employees got a “retention” raise. Our programs are having to cut corners and, in some cases, entire programs are disappearing. It has been a rough go for everybody.

The upside of all of this is that, as funding decreases, policy becomes the focus. Before, direct client services were often the goal of most of our programming. Now our efforts are shifting. Here’s an example: we had a tobacco cessation program that was wildly successful (94%, to be exact). Numbers like that are hard to come by, and no one wanted to mess with the program because of that. But let’s put those numbers in perspective. The program was client-focused, so maybe in a session, the worker would see 3-4 people. In the course of a month, maybe 30 or 40. Of those 30 or 40, 94% would quit smoking – so, we’ve successfully reached a total of 28-37 people. As with tobacco cessation programs across the country, ours has been forced by grant funding to shift their focus to policy efforts. Now, although they have a lower success rate, they are reaching thousands of people per month with the same amount of money. Doesn’t this make more sense?

Think about all of the greatest public health advancements. Clean water – and toilets! Vehicle safety. Hand-washing. Immunization. What all of these have in common is that they reach a large number of people and are fairly passive to adopt as practices. This is how public health works best, in my opinion. I’m excited to see policy get more recognition in the coming years.


3 thoughts on “The Silver Lining

  1. Yes, and no. It’s great to hear you’re inspired by policy work, and in some ways there’s a lot that can be accomplished by that. But if all direct service providers transition to policy work, who is left to provide direct service? Afterall it is much cheaper to pay 5 people to write policy than it is to pay 20 to provide services to others. I don’t think it’s great that your successful program now helps less people. The goal of policy work for human services is to increase the support for successful programs like your own.

    • Thanks for your comment. I do not believe that all direct service work should go away – it is important work and needs to be done. As my interest is in policy, I’m just glad to see it getting more attention at long last.
      To be clear, the tobacco program does not help less people – it helps WAY *more* people but has a lower success *rate* because it also reaches more people. Does this make sense?

  2. Yeah, thanks for clarifying.I misinterpreted what you were saying. I think there’s a lot we can learn from belt-tightening as you’re pointing out, and it’s awesome your program is growing in spite of it. It would be great to get these lean, tried-and-true programs like your own more funding though.

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