Sustaining a Robust Public Health Infrastructure

Public Health Responses Require Public Health Resources
By Sarah Ravenhall, MHA, CHES
Executive Director, the New York State Association of County Health Officials

There are 2,800 local health departments in the United States, 58 of which are situated in New York State. Local health departments serve on the front line of all emerging public health crises while protecting and promoting the health, safety and well-being of the residents they serve. As the membership association for New York's local health departments, the New York State Association of County Health Officials (NYSACHO), supports, empowers and advocates to advance the work local health departments conduct within their jurisdictions. Public health is a vital government function that addresses our joint responsibility for keeping residents and communities safe and healthy.

Many elements of the 2019-2020 Enacted State Budget undermine public health protections while others hold promise, including removal of the State's regulated cannabis proposal.  When progressive public health policies are passed into law, it is often the local health departments who are on the front lines implementing and adjusting to new mandates. It is critical that we continue to remind policy makers that public health responses require public health resources.
  • Article Six state aid for general public health work provides partial reimbursement to support local public health services. This year, Article Six reimbursement was reduced from 36% to 20% for New York City Department of Health and Mental Hygiene. This reduction is a significant detriment to public health which will likely have a considerable impact on public health programming.
  • The budget includes statutory language to lower the definition of elevated blood lead level from 10 to 5 micrograms per deciliter, which while sound public health policy, will increase workload by an estimated 203% and will cost $35 million dollars to implement.  Protecting children from lead poisoning is the first priority of local health departments who will need to hire and train new staff and purchase new equipment in order to adhere to this new mandate.  
  • Early intervention offers services to babies and young children with developmental delays. In many jurisdictions, we are seeing gaps in service availability and provider capacity which has created long wait lists and barriers to care for eligible families. This year, the budget passed a 5% rate increase for targeted providers including speech language pathologists, occupational therapists and physical therapists. This rate increase is a motivating starting point for addressing barriers to care, however it is yet to be seen how this will truly impact provider wait lists and service accessibility. It is our hope to see this rate increase extended and inclusive of all Early Intervention service provider types next year.
  • The recreational cannabis proposal, of which County Health Officials strongly oppose, was not included in the final budget agreement. Findings from other states with legalized recreational programs demonstrate an increase in unintentional exposures in children, related emergency department visits and hospitalizations, calls to poison control centers and motor vehicle accidents. Although there is still time for the Governor and Legislature will work to come to agreement on this issue, there is meaningful evidence to demonstrate that public health must be funded to protect and inform communities.
  • New York has long been a national leader in the fight against tobacco, adopting the Clean Indoor Air Act and spending millions of dollars on anti-tobacco advertising and programs. NYSACHO has long supported the state's aggressive stance against tobacco, and is thrilled to see tobacco 21 legislation passed in both houses which will restrict the purchase of tobacco products, e-cigarettes and flavored tobacco to individuals age 21 and older. 
To sustain New York's public health system, it is critical that the role of the local health department continue to be recognized as an essential service. While we continue to counter escalating public health crisis such as the measles outbreak, opioid epidemic, water contaminants, lead poisoning and tick-borne illness, flexible funding that can be used to target unique local level needs is more critical than ever. Ensuring the availability of funding to public health programs will allow counties to mitigate threats to their communities and protect citizens. Remember, public health policy is only as strong as the resources linked to them.

For more information, or to contact the New York State Association of County Health Officials office please visit