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Eight major factors are interacting in our society today that require we make substantial changes in how we design practical programs, which prevent disease and injury, promote good health, protect the environment, and enhance environmental sustainability. These factors are: financial stress; regulatory reform; environmental justice; our changing planet; a multitude of environmental pollutants and their interactions; emerging and re-emerging infectious diseases, primarily of a zoonotic nature; where we live, work, play, and are educated; and the potential increase in acute and chronic disease in our mobile, growing, and aging population.

Financial Stress

Financial stress at the personal level has led to increased homelessness and poverty. The largest numbers of new homeless are women and children. Hunger is another factor which contributes to disease, especially when there are negative environmental factors involved.

Financial stress at the state and local level of government has led to the reduction of many programs meant to protect the health and welfare of our citizenry in a time when more services are needed, not less. A research brief from the National Association of County and City Health Officials dated December 2011 stated that there has been a widespread reduction in essential services including environmental health services at the local and state level. In 2011, 55% of all local health departments cut at least one program protecting citizens in the communities. This affected 68% of the US population. Local health departments reduced environmental health services by 18% overall and by 21% excluding food safety programs. Epidemiology and surveillance was reduced by 9% and emergency preparedness was reduced by 20%. All of these losses are extreme.

There has also been a loss of trained professionals from local health departments. From 2008 through 2011, a total of 34,400 jobs were eliminated. Negative job impact has affected not only essential program areas but also the morale of working professionals. Emergency management is an example of this dire situation. Disasters and acts of terrorism can only be contained by highly trained individuals who need to be available to respond when the emergency occurs. The reality of disasters and the potential for terrorist acts has increased substantially. With the political situation constantly in flux, federal, state, and local officials must be prepared to respond immediately to the disaster to prevent loss of life and destruction of facilities and infrastructure, which leads to even further compression of the funds available to help the citizenry.

At the federal level, there have also been substantial changes in the budget for Environmental Health Programs. From 2010 to 2012, there was a 30% reduction in funding for the Centers for Disease Control and Prevention’s (CDC’s) National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry, which provide funding and services to states and other groups. The new Healthy Home and Community Environments Program will be funded at a 51% decrease from the merged Healthy Homes and Lead Poisoning Prevention Program and the CDC’s National Asthma Control Program. There will also be substantial reductions to the Basic Environmental Health and Radiation Preparedness Programs, Climate Change Program, Environmental Health Tracking Program, Healthy Community Design Program, and Safe Water, Food, and Waterborne Illnesses Programs. In the past, the federal government helped support state and local health departments through grants, loans, and tax subsidies, when there was a serious need, but now this help will be reduced. (See endnotes 1, 2, 3, 4, 5, 6.)

Preparation for bioterror and health emergencies has deteriorated across the country because of severe budget cuts. In 2011, the Trust for America’s Health and the Robert Wood Johnson Foundation in their ninth annual report, Protecting the Public from Diseases, Disasters, and Bioterrorism, stated that 51 of the 72 cities in the Cities Readiness Initiative are at risk of being eliminated; 24 states are at risk of losing CDC epidemiologists; and all 50 states would lose the support of the CDC during a response to nuclear, radiological, chemical, and natural disasters. Although the public health and national security communities have repeatedly discussed the serious need for new funding for dealing with bioterrorism and other disasters and emergencies, funds continue to be cut in these areas. (See endnote 7.)

The President’s budget for the remainder of the 2016-2017 budget year was issued in March 2017. The Department of Health and Human Services received a total cut of 18% of its existing budget, including the National Institutes of Health 20% cut of $5.8 billion; CDC loses funds to fight Ebola outbreaks research and operational funds. This is devastating for medical research.

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