The Budget War for Public Health
The power of prevention, if only we bought it
Too often it is only in times like this that health departments receive the funding they actually need. In so many ways, NYC’s 2020–2021 budget has not met this moment. While the city covers 92% of the NYPD’s close to $6 billion executive budget (not counting its total $11 billion budget, which includes officer pensions), it only covers 51% of the DOHMH’s $1.6 billion.
In the mid-1960s, under president Johnson’s Great Society, the nation shifted resources from prevention to treatment. This made way for a bustling private health sector — for those who could afford it, by the time Reagan stepped in and shrunk public agencies. It also gave a false sense of security that we could tackle any public health crisis, that prevention of an invisible threat was a waste of money. As we’re reminded not often enough, this couldn’t be further from the truth. An investment in public health prevents the loss of all other investments, except for maybe one: drugs.
Mitch McConnell’s suggestion in April that states should turn to bankruptcy will sound harshly similar to Gerald Ford when he effectively told New York City to drop dead in 1975. This was after the city had pleaded for federal aid. In the years that followed, the city faced the onset of the HIV/AIDS epidemic unsurprisingly poorly with its thinned out task-force and shifted priorities as it waited for a national response. By the 1990s, the NYC DOHMH reached its lowest point at the bottom of a thirty year slope. After thirty years of budget cuts, it neared insolvency.
The city’s fiscal year runs from July 1 to June 30, and so, it barreled towards its end this Tuesday with a tight budget on its hands, the tightest its ever seen, tighter than after 9/11, after Sandy, after the recession of 2008–2009. The public asked for, among other things, a cut to the over-bloated agency on the bill, the NYPD — clearly so, from the amount of destruction it caused as the public peacefully protested its brutal force. Instead, the proposed $1 billion cut, in effect, transferred officers to the Department of Education’s budget, thereby keeping police in schools.
The DOHMH’s budget was cut from $1.8 billion to $1.6 billion—the only agency tasked with getting us over the next wave, and the next one, as we ride out this pandemic, which I surely hope no one thinks is nearly over. Our educators will just have to do what they’ve always done to pick up the spare change, be a watchdog for the private sector.
The recession of 2009 had prompted the adoption of restaurant letter grades in July 2010, now a decade old, which guaranteed higher fines. By 2012, the DOHMH reached peak annual revenue at $53.6 million. I’ll say it now, and let this be a warning to those who need to hear it: If the restaurant industry floated on 3–5% profits pre-pandemic, I can assure you there won’t be much left to support the collection of fines this year. The city will need to plan on getting that money elsewhere, and it will no doubt need it.
The budget may have officially been finalized on Tuesday, but there is still more that can be done. City Council still needs to answer their phones, and thankfully many individuals have stepped up, including the city’s Public Advocate, Jumaane Williams, who has vowed to prevent the execution of the budget during its final tax warrant process under the New York City Charter Ch. 58, Section 1518.
It is also worth noting that New York Governor Andrew Cuomo’s executive ruling that police departments will lose state funding next April if they fail to reimagine public safety is not an impetus for the NYPD. Remember, 92% of its budget comes from the city. In a year when all other agencies are taking a cut, when we can’t hire more doctors or nurses, but we can hire more police officers, we won’t be fooled. We won’t ignore what was lost.
We can, and must, cut this plague off at the source. We can, and must, continue to fight for a blank sheet of paper, on which we will start from scratch.
