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Impact of Budget Cut to Missouri Health Departments

By Rick Hellman, KHI/HCF News Service, September 28, 2011

KANSAS CITY, Mo. -- If you want a good scare, critics say, go see “Contagion,” Hollywood’s latest installment in a bio-horror movie sub-genre that stretches back at least to 1971’s “The Andromeda Strain.”

And if that’s not enough, discuss the film with Bert Malone, manager of the Division of Environmental Health Services for the Kansas City, Mo., Health Department.

“The science is good. That is the way it would be likely to unfold,” said Malone, who saw the film on its opening weekend. “The possibility of a bio-terror attack or a rapidly emerging virus is one of the reasons we do communicable-disease surveillance, and actions like cutting surveillance funds pose an increased threat to public health. … That’s less preparedness. And if you’ve seen ‘Contagion,’ it’s scary. People talk about cutting spending, but I don’t think they realize the services that will be cut as a result.”

The general public likely doesn’t know that the KCMO Health Department has a six-person staff constantly poring over records from hospitals and doctors, checking for dangerous outbreaks, ready to alert them. Or that federal funding for that program stands to be cut 13 percent in the coming year and who knows how much after that.

But Malone and his colleague, Patrick Morgester, do. Morgester runs the Division of Communicable Disease Prevention and Public Health Preparedness. He also is president of the Missouri Public Health Association. Malone is its past president.

While the KCMO Health Department’s budget (around $23 million) and staffing (roughly 195 people) have been stable over the past three years, Morgester and Malone say they’ve learned of a series of impending federal cuts over the past three months.

The Health Department gets roughly $7 million a year from a property-tax levy and earns over $3 million in fees. But the rest comes from the feds and that is where cuts to public-health preparedness, lead-hazard remediation and air-quality control programs loom on the horizon.

In a state already ranked 50th in the nation in per-capita spending on public health, lawmakers’ constant refrain of “do more with less” has worn down their counterparts in Missouri’s rural areas, say Morgester and Malone.

“Rural health departments have less direct funding and less ability to juggle,” resources, Malone said. “They are no longer robbing Peter to pay Paul. … They are reducing services.”

That is true in Jefferson County on the southern fringe of St. Louis. It has been almost two years since the health department closed its two offices to the public on Fridays.

Director Dennis Diehl said the department continues to do inspections and respond to emergencies, but provides no direct services to residents (flu shots, TB medications, counseling) on Fridays.

Like his counterparts in Kansas City, Diehl recently learned of an impending 14 percent cut in federal emergency-preparedness funding.

But, he said, he’s more worried about an additional change in the state health department’s funding formula for locals that will result in a 50 percent cut to his funds in that category in the next year.

Diehl said Missouri’s tax-capping Hancock Amendment locks down his department’s property-tax revenue, keeping it behind the inflationary curve and making it ever more dependent on federal grants.

“It’s happening to a lot of local agencies,” said Mahree Skala, executive director of the Missouri Association of Local Public Health Agencies in Jefferson City. “They are not filling vacancies left by retirement. Some departments have cut back hours of operation. … Fifteen years ago, there might have been some fat, but that is long gone. Now, there is no way to do more with less.”

Health News


  • NPR News November 4, 2011
  • Kaiser Health News, November 3, 2011
  • Kansas City Star, November 2, 2011


  • Fox 4 KC News, November 4, 2011
  • KHI News, November 2, 2011
  • KHI News, October 31, 2011