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Public health departments are on the front lines against the flu

As H1N1 gains strength, the state's often maligned ranks of government health workers, beset by budget cuts, step up.

October 25, 2009|Cathleen Decker

Government employees tend to be easy fodder for mockery. That is particularly true when the ribbing suits the needs of political candidates trying to appear vigilant about the growth of government.

In her quest to become governor of California, for example, Republican Meg Whitman has repeatedly teed off on those who get their paychecks from the public. The former businesswoman derided bureaucrats who "rarely have the desire to think things through."

She lamented the employment of "mid-level bureaucrats" as though they were buffing their nails at the DMV while the rest of us stewed in line. She criticized "a selfish and arrogant bureaucracy, unwilling to give even an inch even in the toughest of economic times."

All that irked many bureaucrats, mid-level and otherwise, because they have in fact agreed to concessions to save the state billions this year.

But they got a certain revenge last week, as Californians tried to outsmart an elusive flu virus. On whom were Californians relying? Government workers.


Public health agencies tend to operate in the shadows of public opinion. Their services to the poor and uninsured go to a fraction of the population, and the rest may find their roles hard to pinpoint. In many cases, that is because their first weapon is prevention, and what they prevent is by definition invisible to the outside world. "It is really hard for us to tell our story," said Dr. Helene Calvet, the city health officer in Long Beach. "We are not good at self-promotion."

Many of those concerned about the H1N1 virus now circulating through California have been dealing solely with private doctors, but public health doctors still are making many of the decisions that affect them. A federal declaration, made earlier this year, put local and state health agencies in charge of fighting the pandemic.

Since last spring, those agencies have worked with local hospitals and physicians on how best to confront the virus. They have been trying to educate schools and employers -- and the public -- about what is already here and what may be coming.

They are also a key conduit for the dispersal of vaccine as it slowly arrives. In some areas, public health officials are holding clinics themselves to inoculate high-risk residents. In other locales, including Long Beach, health officials are forwarding their cache of vaccine to local doctors.

They are fighting at diminished strength. Health agencies have been hammered by California's perennial financial problems, and a budget mechanism that was meant to stabilize the money they receive is making matters worse. In 1991, as California confronted its last notable recession, funding for local health programs became tied to receipts from car license fees and sales taxes. Unfortunately for the doctors and nurses, both have nose-dived in this recession.

The most recent report from the state Department of Finance said sales tax receipts were running more than $300 million behind estimates for the year, and car fees were $77 million below estimates. On the ground, that has meant shrinking public health departments.

"We are definitely challenged," said Dr. Edward Moreno, the health officer for Fresno County and the president of a statewide organization of local health officials. "Our capacity to mobilize forces to respond to a pandemic is reduced."

Dr. Jonathan Fielding, Los Angeles County's public health officer, said his department, too, is smaller than it once was, but he hopes the pandemic will heighten appreciation for undervalued government agencies.

In defiance of stereotypes, he notes, county workers are volunteering to help out at the flu vaccine clinics, which began Friday. More than five dozen are already scheduled, many on nights and weekends.

"This is an 'all hands on deck' enterprise," he said. "The largest undertaking this department has ever had."

In Long Beach, the city health department has held round-robin meetings with hospitals, doctors, businesses and the school district to figure out their joint response. The department has lost more than 20% of its staff in recent years, or about 90 jobs. In three recent rounds of layoffs, a prenatal clinic and other offerings were shuttered. Calvet, the city health officer, said two nurses would have been let go recently but for new federal flu money.

The Long Beach response starts with plans already in place for emergencies ranging from earthquakes to terrorism, then tailors them for the current circumstances. Vaccinations, for instance, will take place in Long Beach schools, a reflection of public demand and the fact that statistics show the young to be inordinately affected by the H1N1 virus.

But public health officials cannot control their chief weapon, the vaccine itself. Health officials last week were growing concerned that delays in receiving vaccine stocks would spur a public backlash against them, a potential downside of a rare opportunity to shine.

"You can do the best job whatsoever, and you can get criticized," said Calvet. "But we're hoping that people see the importance of public health."


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