Deep cuts erode the foundations of US public health system, end
progress, threaten worse to come
[June 02, 2025]
By LAURA UNGAR and MICHELLE R. SMITH
CHARLOTTE, N.C. (AP) — Americans are losing a vast array of people and
programs dedicated to keeping them healthy. Gone are specialists who
were confronting a measles outbreak in Ohio, workers who drove a van to
schools in North Carolina to offer vaccinations and a program that
provided free tests to sick people in Tennessee.
State and local health departments responsible for invisible but
critical work such as inspecting restaurants, monitoring wastewater for
new and harmful germs, responding to outbreaks before they get too big —
and a host of other tasks to protect both individuals and communities —
are being hollowed out.
“Nobody wants to go swim in a community pool and come out of it with a
rash or a disease from it. Nobody wants to walk out their door and take
a fresh breath of air and start wheezing," said Lori Tremmel Freeman,
executive director of the National Association of County and City Health
Officials.
But local health officials say they now have no choice but to do a lot
less of it. The Trump administration is cutting health spending on an
unprecedented scale, experts say, including pulling $11 billion of
direct federal support because the pandemic is over and eliminating
20,000 jobs at national health agencies that in part assist and support
local public health work. It’s proposing billions more be slashed.
Together, public health leaders said, the cuts are reducing the entire
system to a shadow of what it once was, threatening to undermine even
routine work at a time when the nation faces the deadliest measles
outbreak since at least the 1990s, rising whooping cough cases and the
risk that bird flu could spread widely among people.
The moves reflect a shift that Americans may not fully realize, away
from the very idea of public health: doing the work that no individual
can do alone to safeguard the population as a whole. That's one of the
most critical responsibilities of government, notes James Williams,
county executive in Santa Clara County, California. And it goes beyond
having police and fire departments.
"It means not having babies suffering from diseases that you vanquished.
It means making sure that people have access to the most accurate and
up-to-date information and decisions that help their longevity,”
Williams said. “It means having a society and communities able to
actually prosper, with people living healthy and full lives.”
Keeping communities healthy saves lives — and money
Just outside a Charlotte, North Carolina, high school in March, nurse
Kim Cristino set out five vaccines as a 17-year-old girl in ripped jeans
stepped onto a health department van. The patient barely flinched as
Cristino gave her three shots in one arm and two in the other to prevent
diseases including measles, diphtheria and polio.
Like many other teens that morning, the girl was getting some shots
years later than recommended. The clinic’s appearance at Independence
High School gave her a convenient way to get up to date.
“It lessens the barriers for parents who would have to be taking off
from work and trying to get their kids to a provider,” Cristino said.
The vaccinations also help the community around her. The teen won’t come
down with a life-threatening disease and the whole community is
protected from outbreaks — if enough people are vaccinated.
The Mecklenburg County department, with "Protecting and Promoting the
Public’s Health” emblazoned on its van, is similar to other U.S. health
departments. They run programs to reduce suicides and drug overdoses,
improve prenatal health and help people stop smoking. They educate
people about health and test for and treat diseases such as HIV and
tuberculosis. Some, including Mecklenburg, operate medical and dental
clinics too.
“You come to work every day and think: What’s going to be my challenge
today? Sometimes it’s a new disease,” said Raynard Washington,
Mecklenburg’s director. “That’s why having a backbone infrastructure is
so important.”
What they do is cost-effective, experts have found. For every dollar
spent on childhood immunizations, the country is estimated to save $11;
on tobacco cessation, $2-$3; on asthma control, $70.
Disease prevention is unseen — and ignored
Critical care can be glamorous — surgeons, cardiologists and cancer
doctors can pull off breathtaking medical feats to save lives at the
last possible moment. Prevention work is low key. It’s impossible to
identify who was saved because, if it goes well, the person never knows
when they’ve fended off a mortal threat with the invisible shield of
public health.
“People don’t appreciate it,” said Dr. Umair Shah, former health
director for Washington state. “Therefore, they don’t invest in it.”
State health departments are funded by a varying mix of federal and
state tax money. Some states deliver services in a centralized way while
others provide resources to local departments, which generally also get
money from counties, cities or towns. Some large cities get direct
federal funding for their health departments.
Mecklenburg — a large department with around 1,000 workers serving 1.2
million people — has an annual budget of around $135 million, while some
metro hospitals have operating expenses in the billions. About 70% of
the department's budget comes from local funds, which helps fill gaps in
state and federal money. But Mecklenburg is still strapped for cash and
resources.
At times, employees work 12- to 14-hour days, especially during
outbreaks. Nurse Carmel Jenkins recalled responding to mpox exposures at
a day care center — arriving before 5:30 a.m. to alert the children’s
parents and working late into the evening.
“Even though there may be limited resources, we still have a service to
provide,” said Jenkins, a director of clinical services for the
department. “We don’t mind going above and beyond to be able to do
that.”
Chaos in Washington puts ‘lives at risk’
In March, the Trump administration pulled $11 billion from state and
local health departments without warning under the leadership of Health
Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist and
public health critic. The cuts abruptly ended COVID-era grants, which
had also been approved for non-COVID work including vaccination and
disease detection, tracking and testing.
A week later, thousands of people were laid off at the Centers for
Disease Control and Prevention. Many had worked closely with state and
local health departments to provide information, grants and other
support.
The sudden, one-two punch delivered a serious blow to the system, public
health leaders said in interviews, court filings and public testimony.
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A dentist cleans the teeth of a child in the public health
department’s mobile dental clinic visiting Starmount Elementary
school in Charlotte, N.C., on March 20, 2025. (AP Photo/Mary Conlon)
 A Kennedy spokesman said in an email
that America remains unhealthy compared with other developed nations
and HHS is reorganizing what he said were “broken systems” and
reprioritizing resources to “centralize programs and functions that
will improve our service to the American people.”
“These cuts are not about abandoning public health — they’re about
reforming it,” spokesman Andrew Nixon said, adding: “We reject the
implication that HHS has turned its back on urgent health threats.”
HHS justified the grant cancellations by saying the
money was for COVID and the pandemic is over. But most of the cuts
were in areas that are especially important given today’s health
threats. The biggest chunk, more than $8.9 billion, involved
epidemiology and laboratory capacity related to infectious diseases,
while another $2 billion was related to immunizations. In some
places, the cuts are on hold due to a federal judge’s order in a
lawsuit by states. But elsewhere, cuts are continuing.
In Mecklenburg, for example, 11 community health workers lost their
jobs, meaning less outreach to groups like the Hispanic community.
All eight employees dedicated to the mobile vaccine program were
laid off.
In Columbus, Ohio — one of several communities in Republican-led
states suing over the cuts — the health department had to lay off
nine disease intervention specialists. This left it operating at 25%
capacity in its disease tracing and investigation work just as it
prepared to address a measles outbreak.
Kansas City, Missouri, will not be able to do its own testing for
infectious diseases because the cut came just as the city was about
to buy $500,000 worth of equipment. And Nashville had to end a
program offering free flu and COVID tests and cancel plans to buy a
van to deliver vaccinations.
The cities complained the cuts had created “severe budget
uncertainty” and forced them to redirect their limited resources “to
respond to the resulting chaos.”
CDC staff cuts are also having a ripple effect on state and local
departments. Children who are deaf or hard of hearing will no longer
benefit from an early intervention program run by states after
everyone who worked on the program at CDC was laid off. The team in
the Office on Smoking and Health, which funds state tobacco hotlines
that help people quit, was let go.
So was the CDC team that worked to reduce drownings, partly through
funding low-cost swimming lessons in local communities. Drownings
kill 4,000 people a year in the U.S.
“The experts who know the things that can be done to help prevent
the No. 1 cause of death from children ages 1 to 4 have been
eliminated,” Connecticut state health commissioner Dr. Manisha
Juthani told a Democratic congressional hearing in April, referring
to drownings.
She said the abrupt and disorganized nature of the cuts leaves her
department scrambling as officials try to understand what is being
cut and to close important programs on the federal government’s
impractical timelines.
“The current uncertainty puts lives at risk,” she said.
Public health funding is going bust — and about to get worse
The new cuts are especially damaging because health departments are
funded differently than other government agencies meant to protect
the public: Funding pours in during emergencies and slows to a
relative trickle when they subside. Mecklenburg’s Washington notes
the contrast with fire departments, which are kept ready at all
times, not scrambling to find firefighters and fire trucks when
houses are already burning.
With health departments, “there’s a long-established pattern of
boom-and-bust funding,” said Dr. Steven Stack, Kentucky’s public
health commissioner and past president of the Association of State
and Territorial Health Officials.
A temporary surge of money during the pandemic allowed some health
departments to expand and strengthen programs. In Alabama, the
influx of COVID money allowed the state to reopen a health
department in largely rural Coosa County that closed a decade ago
due to a lack of money. In California’s Santa Clara County, a COVID-era
lab grant paved the way for a new science branch with nearly 50
positions.
But by early this year, most of that money had disappeared, along
with other COVID-era grants across the nation — some because they
ended and some because the government rescinded them. Departments
were again left brittle and vulnerable.
“We’re facing funding cliff after funding cliff after funding
cliff,” said Dr. Sara Cody, Santa Clara County’s health director.
“What really worries me is I felt that we had finally built the
infrastructure in the public health department. ... We were still
pretty trim, but we weren’t just, like, bones.”
In Chicago, one-time COVID grants made up 51% of the health
department budget, and their ending will push staff numbers below
the pre-pandemic level of 588 — slowing responses to outbreaks and
forcing officials to scale back food safety, violence prevention and
other programs.
In Mecklenburg, the department lost 180 employees as COVID funds
dried up. It also lost a wastewater monitoring partnership with the
University of North Carolina at Charlotte that helped the county
react quickly to changing COVID variants and could have also been
used to detect new threats like bird flu.
The cuts are not over.
The Trump administration has proposed cutting billions more from
CDC’s budget, enough to cut the agency’s spending in half. CDC sends
about 80 percent of its budget to states and local communities.
Michael Eby, director of clinical services in Mecklenburg, said the
relentless cuts to the system leave departments unable to respond to
new pandemics and old diseases returning across the United States.
“Without the appropriate funding, we can’t properly address these
threats,” he said. “We’re at risk of them getting out of control and
really causing a lot of damage and death to individuals that we
could have saved, that we could have protected.”
___
Ungar reported from Charlotte and Louisville, Kentucky, and Smith
reported from Providence, Rhode Island. Associated Press reporters
Mary Conlon in Washington and Kenya Hunter in Atlanta contributed to
this report.
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