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Because we are on the edge of a crisis with the Ebola virus, people are finally noticing Public Health. When Public Health is doing their job, nobody even notices them. But when grave errors are made, the general public and the media is quick to criticize. But who is at fault here? Are the health departments even equipped to handle Ebola or any other crisis after experiencing severe budget cuts year after year?

According to a survey conducted by National Association of County and City Health Officials (NACCHO), and Association of State and Territorial Health Officials (ASTHO) there has been a reduced workforce and a discontinuation of several programs and services.

ASTHO reports their findings of Public Health job cuts as:

• Approximately 11,000 state jobs have been lost in central, local and regional offices.
• Approximately 7,150 state employees in central offices lost their jobs.
• Approximately 4,400 state employees assigned to local/regional offices lost jobs.
• Combining these data with the latest numbers from NACCHO’s survey of local health department job losses and program cuts reveals that more than 51,000 state and local jobs have been lost since 2008. This represents more than 19 percent of the total state and local health department workforce.

As reported earlier this week by Bloomberg Businessweek, “city, county, and state health departments employ almost 60,000 fewer people than they did in 2008; a drop of almost 20 percent in six years.” According to Albert Wu, Professor at John Hopkins Bloomberg School of Health, “There are fewer people to deploy to take care of education, training, public service messages, and other information. Ebola is not the first and is not the last challenge to our public health system.”

Clearly, these kind of cuts are neither wise nor sustainable. However, in an environment where every agency is looking for more money from a limited federal budget, additional funds for public health are difficult to come by. The general public does not wish to pay more taxes. In addition, the media is quick to point out failures and demand more efficiency.

Sure, there is always room for improving efficiency in any large (private or public) organization. How can we increase efficiency for public health and local health departments (LHDs)? Can lessons from private businesses be applied to public health? Some relevant questions to ask and explore:

• Can LHDs increase revenue by billing to private payers rather than just relying on federal grants and Medicaid funding?
• Can software technology, such as Electronic Health Record (EHR), improve efficiency?
• Can we apply proven process improvement techniques, such as lean six sigma from manufacturing, to cut waste (from patient flow) and improve service to patients?
• Can we train or retrain our staff to do more with less?
• How long does it take to train people on new technologies (e.g. EHR) and process improvement techniques?
• How long does it take to reap benefits from these new methods?
• Can such improvements offset the massive 20% reduction over the past six years?

We all wish to live in a country with no epidemics like Ebola spreading. Clearly, public health is a priority for all of us. The question is, can we do we do more with less? What do you think?