“I think the conversation now is less about cuts and more about uncertainty and instability," APH Director Adrienne Sturrup told City Council on Sept. 3.
What's happening
A large portion of the public health department's budget comes from federal sources, and more than half of its nearly 650 budgeted employees this fiscal year are supported by outside grants.
Federal spending cuts and adjustments this year affected APH through the loss of millions of dollars so far, and further changes are anticipated. The department says local health agencies now face a "funding crisis" affecting public-facing services and stability for hundreds of staff.
APH recently launched a website dedicated to tracking the impact of this year's federal funding uncertainty that states Austin faces "slower outbreak responses, reduced access to care and greater health disparities" without enough financial support.
This month, Sturrup reported on more than a dozen public health programs backed by nearly $16 million she said remain at risk with a "high level of uncertainty” for future funding. She also noted almost $19 million in grant funding that's been reduced or canceled over the past several months.
The outlook
For some at-risk programs, Sturrup said APH is working to shift staff and funding around to maintain reduced services in the short term while funding remains uncertain.
The department is also anticipating some public health repercussions as other programs are scaled back or face early and "abrupt" end dates, like vaccination services that expanded during the pandemic. Sturrup said those impacts could extend beyond COVID-19 to APH immunization work with other diseases like measles or the flu.
"We’re not going to be able to be in places and spaces that the community has come to expect us to be," she said.
Previous APH funding for substance use disorder response led to increased availability of Narcan, and partnerships with city medics and local nonprofits. The department still has some funding received through settlements of opioid-related litigation, although canceled grant funding had expanded that work.
“The ability to have that widespread education and outreach, and to support Narcan availability when it wasn’t readily available from the state, that was an important project for the city," Sturrup said.
What they're saying
City officials continue to express unease about this year's funding cuts and their impacts for residents. Mayor Pro Tem Vanessa Fuentes highlighted the refugee clinic losses as a negative for Austin's reputation as a welcoming city, and said ongoing changes at the federal level remain a concern.
“We are living in some very troubling times when it comes to public health, especially with all the changes that we’re seeing at the [Centers for Disease Control and Prevention] level and its ramifications at the local level, and what that means for our community," she said.
Given the significant funding losses, council member Ryan Alter also questioned whether Austin can now effectively respond to a future public health emergency. Sturrup said the department remains prepared thanks to lessons learned through COVID-19 response—but, APH is "back to square one" with recruitment and staff specialization.
"What I’ve said to the team is that we need to become a department of Swiss Army knives," she said. "We need to be ready to respond and move in any way, shape or form. And so I have a high level of confidence that we will be able to respond quickly, but the breadth and reach of our response will be limited just because of numbers and the time that it will take to train people.”
