Do public health cuts make sense?


By Melanie Ruiz

The Examiner’s front-page headline decries cuts to the San Francisco Police Department (it’s going to be harder to patrol North Beach with all that overtime reduced). But there’s been a lot less press attention to the midyear cuts to public health.

DPH proposed $7.4 million in cutbacks, with some of the biggest losses to be suffered by HIV prevention programs. The mayor, however, rejected these program cuts, instead using HIV/AIDS reserve money to the programs going.

So the cuts will come elsewhere -- and may leave the city in worse shape over time.

Gregg Sass, chief financial officer of the public health department, presented the news to the Health Commission Dec. 15th, arguing that the proposed plan operated in large part by increasing program efficiencies and reducing or eliminating San Francisco’s support for programs cut in the state budget bloodbath. Sass said “there are a few, isolated instances of some very targeted program reductions.”

Those targeted programs reductions include two substance abuse residential treatment programs, yet to be named, which will be closed. The plan also cuts the backfill funds for state proposition 36 services, which are “provided to individuals charged with non-violent drug violations who choose drug treatment and counseling in lieu of incarceration,” according to the health department's program change request.

The people who run these programs that will be cut testified for more than an hour, making the case that the cuts are financially foolish -- because prevention is cheaper than treatment.

Representatives from the Homeless Youth Alliance (HYA), a harm reduction coalition for homeless youth in the Haight-Ashbury, were out in full force. “Twice a year our budget is up for cuts, and twice a year we have to stand up here and beg you to keep allowing us to save lives,” said Lani Riccobuono. Supporter after supporter came up, cheered on by an entire back section of the room, to testify to the vital role the HYA plays in the future of at-risk individuals. It’s a thriving, supportive community of people who explained that they have only found help and hope after walking through the drop-in center's doors.

And the infuriating level of the cuts was on display, too -- It costs only $58,729 to keep HYA's doors open – less than the cost of just one of Newsom’s five press spokespeople.

To be fair, the mayor’s office is taking cuts, too -- a total of $201,520. Those reductions will come through attrition, unfilled vacancies and salary reductions for top earners.

Supervisor Chris Daly has been drawing attention to the different growth rates of the police and health departments' budgets. According to Daly, the health department received $410 million in General Fund money last year, which fell to $343 million this year. The police department received $332 million, which rose to $345 million. In other words, public health received 16 percent less – and the police received four percent more.

Newsom’s proposed cuts include $6 million in reductions for the police department -- which is hardly enough to balance out past years of health cuts.

At the onset, Commission President James Illig noted that this was only a small step: “We want to hear how we're going to face the future, because more cuts are going to have to be made.” Next year the health department faces $101 million in cuts.

The main idea offered by speakers for the next round of cuts was simple – look elsewhere.

As Riccobuono sees it, the current strategy “is not only bad public health, it is balancing the budget on the backs of the most vulnerable population in San Francisco.”