In Brief:
- New York City’s public health department is charged with safeguarding the health of 8 million residents, doing work that is often invisible.
- In addition to its other responsibilities, it monitors infectious diseases entering the country.
- Michelle Morse, the acting health commissioner, talked to Governing about how her department is adjusting to shifting federal priorities.
The New York City Department of Health and Mental Hygiene is the oldest municipal health department in the country and one of the world’s biggest public health agencies. Like health departments in other jurisdictions, it’s adjusting to the possibility of funding cuts, but unlike most, it has big responsibilities beyond its borders.
In addition to the city’s 8 million residents, 52 million foreign visitors passed through New York airports last year. The city’s disease surveillance efforts are a first-line defense against infectious illnesses travelers might bring with them, whether new strains of germs already in the U.S. or pathogens not seen before.
New York is the most densely populated major city in the country, with outsized potential for infectious illness to spread. It was the biggest city in America in 1805, when a board of health was created to stop the spread of yellow fever. It was the first city to have its own bacteriological laboratory, created in 1892 amid a diphtheria outbreak — a lab that was the first to conduct COVID-19 testing.
Today, the city collaborates with local port health stations, part of a national system the Centers for Disease Control and Prevention (CDC) operates at ports of entry where international travelers are most likely to arrive. If necessary, CDC has the authority to isolate or quarantine people who arrive with certain communicable diseases.
If a traveler falls ill with an illness of concern while in the city, the health department notifies CDC so it can conduct a contact investigation, which may include notifying passengers who shared a flight with them. Local, national and even international public health protections rely on the city’s surveillance and communication network.
This infrastructure is likely to lose significant funding. In March, the U.S. Department of Health and Human Services canceled more than $11 billion in grants that had been awarded to state and local public health agencies during the pandemic. New York Attorney General Letitia James joined 22 other states in a lawsuit challenging these cuts, which were temporarily blocked by a federal judge in May.
The budget recently passed by the House also cuts Centers for Disease Control and Prevention funding by nearly 20 percent, and eliminates block grants to boost the capacity of public health departments.
Michelle Morse, acting commissioner of the NYC health department, spoke to Governing about the ways funding cuts have already affected the department’s ability to do its work and what might lie ahead.
Your department plays a unique role in regard to keeping disease out of the country. How much do people recognize this?
My sense is New Yorkers do, honestly, particularly because the past few years have been so laden with disasters. Unfortunately, the COVID-19 pandemic hit New York City first and hardest. When there were Ebola cases in the U.S., it was here.
I'm not sure how much the rest of the country has a sense of it, honestly, and I think that that's too bad. The beauty of New York City is that it's the most international city in the country, one of the most culturally diverse places I've ever been. But it does mean that we bear a disproportionate amount of risk when it comes to infectious threats and infectious disease outbreaks.
The New York City Health Department is structured in a way that's responsive to that fact. It’s been the case since our founding 220 years ago, when the health department was started in the middle of a yellow fever epidemic in the city that killed 5 percent of the city's population.
Some cuts to public health funding are still being debated. Some that have been made are being challenged in court. Have you lost capacity already?
We just got the news that preliminary injunction was awarded for the COVID-19 funds that were rescinded. That's really great news. At least for now, we're able to keep spending against that $110 million or so that was rescinded in our funding.
So far, we have had seven staff who were officially fired in an internship program that was fully funded by the Centers for Disease Control and Prevention. We're doing our best to make sure those folks are employed in other places. There has also been a cancellation of AmeriCorps. We have a number of people who are involved in that program who do community engagement work in the mental health space. That's another very tangible impact that we've experienced so far.
We have $600 million in federal funding in our budget; about 20 percent of our budget is federal. We're worried that even though there are signed commitments between the federal government and the New York City health department, because a third of the CDC was just fired, we're not going to have agreement to move forward with spending on a lot of the $600 million.
What might people with a voice in decisions about public health funding not realize about the consequences of cuts?
Part of the reason it's so hard for policymakers to understand public health is because when it works well, you have no idea that it's working behind the scenes. We call it the invisible shield.
We are definitively all less safe if we have a CDC and local health departments that are not able to function. Eighty percent of CDC domestic funding is to local health departments to make sure that lifesaving, life-protecting activities happen.
We have a public health lab, for example, that is fully funded by federal dollars. That lab is able to tell us within a few hours, is this a case of measles, or is it something else? That helps us determine if we are dealing with an outbreak. We need to be able to do that urgently, extremely quickly.
If that kind of function goes away, we are all definitively at higher risk of being impacted by very nasty infectious disease threats. This is true for tuberculosis, for H5N1 [bird flu]. These are significant public health threats that we have the programs, the people and the expertise to address and prevent. But if these funds go away, that invisible shield goes away.
What would that mean for local communities?
What we could expect to see is more measles outbreaks, more tuberculosis outbreaks, higher rates of death from flu and COVID-19, all kinds of other outbreaks, frankly, that would otherwise have been prevented.
We worry also about outbreaks at our restaurants in New York. We’ve seen increased rates of campylobacter [a type of bacteria that causes diarrheal disease], salmonella, etc. We don't want to see them go up any further.
There are a number of those kinds of threats that we are tamping down in the background, mostly invisibly, that will threaten the day-to-day life, safety and health of New Yorkers and of people across the nation if some of these key programs go away.
Any last thoughts?
The final thing I'll mention is that the Chronic Disease Center at the CDC was basically zeroed out in the HHS [Department of Health and Human Services] budget. Chronic disease, particularly cardiovascular disease and diabetes, is the No. 1 killer of Americans and the No. 1 killer of New Yorkers.
To not have a center focused on chronic disease policy, programs and data is incredibly concerning.
