This
week,
the
Department
of
Health
and
Human
Services
(HHS)
underwent
a
massive
restructuring
under
its
secretary
Robert
F.
Kennedy
Jr.,
resulting
in
the
sudden
departure
of
thousands
of
employees
across
the
nation.
While
Kennedy
frames
these
changes
as
a
cost-cutting
and
efficiency
measure,
public
health
experts
warn
that
the
cuts
are
eradicating
critical
programs,
weakening
state
and
local
health
infrastructure,
and
eliminating
expertise
that
will
be
difficult
to
replace.
With
essential
services
like
disease
prevention
and
outbreak
response
already
crumbling,
experts
believe
the
fallout
from
this
decision
could
set
public
health
efforts
back
by
decades.
Department-wide
bloodbath
HHS
has
issued
10,000
layoffs
as
part
of
its
restructuring
plan.
These
job
cuts
have
impacted
employees
across
various
agencies
within
the
department
—
primarily
ones
that
have
been
consolidated
under
the
new
structure.
The
department
has
consolidated
several
of
its
agencies
into
a
new
entity
called
the
Administration
for
a
Healthy
America
—
a
move
that
downsizes
and
combines
these
agencies’
functions.
Some
of
the
agencies
being
funneled
into
the
Administration
for
a
Healthy
America
include
the
Health
Resources
and
Services
Administration
(HRSA),
the
Substance
Abuse
and
Mental
Health
Services
Administration
(SAMHSA),
and
the
National
Institute
for
Occupational
Safety
and
Health
(NIOSH).
“We
aren’t
just
reducing
bureaucratic
sprawl.
We
are
realigning
the
organization
with
its
core
mission
and
our
new
priorities
in
reversing
the
chronic
disease
epidemic,”
Kennedy
said
in
a
statement.
“This
Department
will
do
more
—
a
lot
more
—
at
a
lower
cost
to
the
taxpayer.”
Thousands
of
HHS
employees
who
were
laid
off
took
to
online
forums
this
week
to
share
their
experiences.
Many
of
them
had
been
working
in
the
department
for
decades.
Most
of
their
anecdotes
reveal
that
they
were
denied
access
to
systems
and
buildings
immediately
upon
learning
of
their
elimination,
leaving
no
time
to
finish
projects
or
pass
their
work
on
to
someone
else.
Some
HHS
employees,
including
top
officials
from
the
National
Institutes
of
Health,
were
given
the
choice
between
transferring
to
the
Indian
Health
Service
(IHS)
—
an
HHS
agency
that
provides
healthcare
services
to
Native
Americans
—
or
lose
their
job.
Employees
had
to
choose
whether
to
take
these
roles
in
a
matter
of
days.
IHS
jobs
typically
require
living
in
a
remote
area,
noted
Susan
Polan,
associate
executive
director
for
public
affairs
and
advocacy
at
the
American
Public
Health
Association.
“The
Indian
Health
Service
has
historically
been
understaffed.
It
has
needed
to
build
up
its
clinical
staff,
and
its
program
staff
as
well.
So
it
is
a
noble
goal
—
but
I
don’t
think
that
that
was
really
what
the
goal
was,”
she
stated.
“I
suspect
it
was
just
a
way
to
offer
the
opportunity
to
fill
a
gap
—
while
at
the
same
time,
expecting
that
that
gap
would
not
be
filled,
and
people
will
leave.”
Programs
being
cut
left
and
right
By
instating
a
round
of
layoffs
this
substantial,
President
Donald
Trump’s
administration
is
dismantling
core
public
health
infrastructure,
Polan
said.
She
pointed
out
that
the
reduction
in
workforce
is
already
causing
the
sudden
elimination
of
health
programs
across
the
country
—
including
those
focused
on
smoking
prevention,
gun
violence,
environmental
disasters,
HIV,
reproductive
health
and
disabilities.
“What
does
this
mean?
That
kids
will
take
up
tobacco
because
the
comprehensive
tobacco
prevention
programs
are
gone.
The
existential
threat
of
climate
change
will
not
be
addressed,
meaning
less
mitigation
and
responsive
communities
around
the
country.
HIV
prevention,
which
is
one
of
the
most
cost-saving
activities
that
we
have
seen,
has
been
dramatically
reduced,
meaning
the
number
of
HIV
cases
and
AIDS
cases
will
go
up.
[There
will
be]
an
increase
in
infant
mortality
and
maternal
mortality
—
and
this
is
all
just
a
small
piece
of
the
damage
done,”
she
declared.
Polan
noted
that
these
effects
will
be
felt
all
across
the
country,
as
HHS
agencies
dedicate
much
of
their
funding
to
state
and
local
public
health
efforts.
For
example,
the
Centers
for
Disease
Control
and
Prevention
(CDC)
distributes
about
80%
of
its
resources
to
these
programs.
One
public
health
executive
in
Texas
—
Phil
Huang,
director
and
health
authority
for
the
Dallas
County
Health
and
Human
Services
Department
—
pointed
out
that
while
the
elimination
of
preventive
health
programs
may
seem
like
an
effective
way
to
reduce
costs
in
the
short
term,
it
is
certain
to
increase
costs
in
the
long
run.
For
instance,
one
new
case
of
HIV
leads
to
about
$420,000
of
lifetime
treatment
costs,
he
noted.
“You
multiply
that
for
every
new
case
that
we
get
as
a
result
of
these
[layoffs]
and
the
lack
of
prevention
support.
It’s
going
to
have
a
huge
impact
on
us
at
the
local
level,”
Huang
stated.
He
also
said
that
these
federal
job
losses
will
have
a
ripple
effect.
While
the
immediate
layoffs
are
at
the
federal
level,
their
impact
cascades
down
to
state
and
local
health
departments.
Many
health
programs
are
federally
funded
but
implemented
at
the
state
and
community
levels
—
so
when
federal
agencies
like
the
CDC
lose
staff
or
entire
divisions,
they
can
no
longer
provide
the
funding
and
technical
support
that
state
and
local
health
departments
rely
on,
Huang
explained.
Just
last
week,
Dallas
County’s
health
department
had
to
lay
off
11
full-time
staff
members
and
10
part-time
employees
due
to
funding
problems,
he
noted.
“These
are
staff
that
work
in
our
epidemiology
group
to
respond
to
outbreaks,
including
the
measles
situation,
to
make
sure
that
we
don’t
get
spreading
and
we
don’t
have
a
situation
like
what’s
being
seen
in
West
Texas,”
he
explained.
Huang
added
that
the
department
has
also
canceled
more
than
50
immunization
clinics
and
outreach
events
in
the
past
couple
weeks,
many
of
which
were
targeted
toward
schools
with
low
vaccination
rates.
Setting
public
health
back
decades
HHS’
data
collection
is
a
crucial
part
of
maintaining
good
public
health,
Huang
pointed
out.
With
the
CDC’s
Center
for
Forecasting
and
Outbreak
Analytics
being
shrunk,
he
is
concerned
local
authorities
won’t
be
able
to
receive
warnings
about
outbreaks
and
public
health
threats.
This
means
officials
will
struggle
to
warn
the
public
about
disease
outbreaks,
track
new
drugs
in
the
supply
chain,
and
monitor
foodborne
illnesses
and
wastewater
for
emerging
health
risks.
Huang
also
noted
that
the
job
cuts
will
further
reduce
the
CDC’s
ability
to
provide
up-to-date
recommendations
and
best
practices
for
clinicians
and
public
health
workers,
compounding
the
challenges
of
outbreak
response.
“This
truly
is
setting
us
back
decades.
You
cannot
just
build
this
back
again
—
it’s
taken
so
long
to
develop
this
expertise
and
the
systems
to
do
this.
[The
layoffs
are]
destroying
that,
and
it
will
set
us
back
multiple
decades,”
Huang
declared.
The
Trump
administration
is
heralding
the
layoffs
as
a
means
to
reduce
bureaucracy,
but
these
cuts
aren’t
just
about
eliminating
bureaucratic
positions
—
they’re
also
about
losing
valuable
subject
matter
experts
who
provide
important
guidance
to
state
and
local
public
health
agencies,
said
Chrissie
Juliano,
executive
director
of
the
Big
Cities
Health
Coalition.
Making
up
for
this
loss
of
expertise
and
institutional
knowledge
may
prove
impossible
—
the
scale
of
HHS’
cuts
makes
it
virtually
impossible
for
non-governmental
entities
to
fill
the
gap,
she
remarked.
“You
can’t
just
replace
this
amount
of
federal
money
and
this
amount
of
federal
expertise
and
people.
Absolutely
there
is
a
role
for
the
private
sector,
philanthropy,
organizations
and
partners.
But
the
federal
government
plays
a
critical
role
in
the
public
health
system
and
in
how
the
system
as
a
whole
operates,”
Juliano
stated.
Another
public
health
expert
—
Lori
Freeman,
CEO
of
the
National
Association
of
County
and
City
Health
Officials
—
pointed
out
that
many
of
the
layoff
victims
were
accomplished
scientists
and
medical
professionals,
often
leaders
in
their
fields.
“These
are
world
experts
on
lots
of
different
things
—
hosts
of
diseases
and
ailments
and
public
health
in
general
—
and
they
are
the
group
of
experts
in
the
federal
governmental
public
health
system
that
our
local
and
state
health
officials
turn
to
at
the
worst
of
times
to
help
to
inform
the
best
way
of
managing
an
emergency
and
a
response
to
a
situation,”
Freeman
explained.
She
added
that
she
is
worried
about
removing
these
experts
from
the
public
health
system
—
especially
because
“it
may
be
very
difficult
to
recruit
them
back
in
and
build
memory.”
Freeman
also
noted
that
public
health
workers
usually
juggle
multiple
responsibilities,
including
disease
surveillance,
community
education,
immunization,
maternal
programs,
substance
abuse
initiatives
and
emergency
preparedness.
With
all
of
this
on
their
plates,
staffing
shortages
will
make
emergency
responses
and
routine
public
health
work
nearly
impossible,
she
said.
As
is
the
case
whenever
federal
health
funding
is
cut,
the
effects
will
be
the
worst
in
the
nation’s
rural
communities,
Freeman
added.
She
said
that
a
majority
of
the
country’s
health
departments
are
small,
serving
populations
fewer
than
50,000.
These
organizations
rely
heavily
on
federal
funding
—
and
even
the
loss
of
a
few
staff
members
can
cripple
their
ability
to
function,
Freeman
stated.
Lack
of
transparency
Public
health
leaders
are
confused
about
the
purported
intentions
behind
HHS’
restructuring.
HHS
Secretary
Kennedy
says
this
plan
will
help
reverse
the
nation’s
chronic
disease
epidemic
—
but
this
goal
is
wholly
undermined
by
cuts
to
programs
like
the
FDA’s
tobacco
control
efforts
or
local
HIV
prevention
efforts,
Freeman
pointed
out.
Sharon
Gilmartin,
executive
director
of
the
Safe
States
Alliance,
said
she
was
baffled
by
the
shortsightedness
of
HHS’
plan.
“What
may
look
good
on
a
budget
spreadsheet
will
no
doubt
look
different
in
our
homes
and
communities,”
she
declared.
Gilmartin
condemned
the
administration’s
lack
of
transparency,
as
well
as
its
failure
to
provide
guidance
on
how
agencies
should
manage
the
work
previously
handled
by
terminated
employees.
She
also
expressed
concern
that
HHS
implemented
its
largest
round
of
layoffs
in
modern
history
with
“zero
input
or
guidance
from
Congress.”
Monday,
the
day
before
the
layoffs
began,
the
Senate
Appropriations
Committee
sent
a
letter
to
Kennedy
calling
his
leadership
decisions
at
HHS
“unprecedented
and
harmful.”
This
has
been
met
with
no
response,
Gilmartin
noted.
The
layoffs
speak
to
the
ongoing
power
struggle
between
Congress
and
the
executive
branch
over
control
of
public
health
policy,
she
added.
“We’ve
heard
multiple
restructuring
plans
that
will
attempt
to
pick
up
certain
programs
and
move
them
into
newly
created
agencies
or
pre-existing
agencies.
I
can
tell
you
that
it’s
not
as
easy
as
picking
something
up
and
placing
it
down.
There’s
specific
expertise
and
resources
and
capacity
in
each
of
these
departments
and
divisions
and
centers
that
have
been
honed
over
decades,”
Gilmartin
explained.
She
said
these
types
of
rash
decisions
make
her
and
other
public
health
leaders
worried
about
who
is
ultimately
in
control
of
public
health
—
as
well
as
what
data,
if
any,
they’re
using
to
inform
their
choices.
“They
clearly
are
eliminating
whole
divisions
and
branches,
which
doesn’t
speak
to
bureaucratic
streamlining.
It
speaks
to
moving
forward
an
agenda
which
has
not
been
elucidated
for
the
public
health
community,”
Gilmartin
declared.
Her
concerns
highlight
the
uncertainty
surrounding
the
future
of
federal
health
policy.
Not
only
does
HHS’
restructuring
raise
concerns
about
the
deterioration
of
public
health,
the
lack
of
transparency
and
coherent
strategy
behind
this
decision
deepens
experts’
fears
about
the
long-term
consequences
for
the
nation’s
health
infrastructure.
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