Observing the recent funding cuts and removal of COVID-19 support by the Department of Health and Human Services (HHS) is reminiscent of past experiences. Having worked in public health for decades, I have witnessed funding shifts in response to political shifts, leadership priorities, and health issues. Once the public health emergency passes, the flow of cash is suddenly halted.

This cycle is not restricted to COVID-19. It has previously occurred with swine flu outbreaks, the Ebola virus, and the years following 9/11. Local health departments have struggled to serve residents who are at risk due to underfunding and an inability to obtain timely federal support, resulting in program dismantling and layoffs.

For decades, local governments have been over-reliant on federal funding to their detriment. According to the National Association for County and City Health Officials, which I previously led, more than half of local health department funding comes from federal grants, either directly or as pass-throughs from the state. Communities become vulnerable the moment the federal purse strings tighten.

There are a myriad of challenges with this trickle-down funding model. Firstly, funds are always disease-specific, which reduces flexibility. For instance, during the Zika outbreak, local health departments could not use funds for other vector-borne illnesses like Lyme disease. Second, fiscal cliffs caused by time-limited funding sources lead to layoffs and service interruptions when emergencies subside. Moreover, essential resources for vulnerable communities may be delayed for months or even years when securing or repurposing funding for unexpected threats, because it usually requires laborious federal legislative action. Finally, short award cycles and unclear regulations for blending different funding sources impede long-term planning and add administrative burdens.

The local effects of the recent federal cuts are evident. Nearly $500 million in Illinois public health grants have been clawed back, threatening initiatives that deal with substance abuse, mental health, and infectious diseases. This dependence on inconsistent funding highlights the vulnerability of local public health departments and their communities.

In response, my public health colleagues, officials, and other advocates have protested. However, I have a different take. What if we used this budgetary crisis to spark innovative ideas? Instead of viewing it solely as a setback, we could dedicate ourselves to exploring ways to improve our public health capabilities and safeguard our communities while shielding ourselves from the whims of federal funding.

There are solutions worth investigating if only we take the time to unearth them. There are about 3,000 local health departments in the United States, with each facing unique challenges. While there is no universally applicable solution, local governments may consider exploring options such as redistributing tax income and forming alliances with companies, medical facilities, and charitable institutions.

For instance, Cook County's 2025 budget of $24 million for its local health department represents a meager increase over 2024 and only a fraction of Cook County Health's $6.1 billion budget, which funds the county's public safety net healthcare system. This was a missed opportunity. Fortunately, there is still time to address this missed opportunity to increase public health department funding.

To keep their tax-exempt status, nonprofit hospital systems like Cook County Health and more than 150 others in Illinois must continue to provide community benefits, which makes them perfect partners for public health programs.

Additionally, the Chicagoland region offers business collaboration opportunities; corporations such as AbbVie and Walgreens could improve public health by implementing CSR programs. Additionally, philanthropic groups that concentrate on social determinants of health, such as The MacArthur Foundation and The Chicago Community Trust, could be useful partners for initiatives to improve community health and fill in the funding gaps. Every county has resources worth looking into, although not all are as bountiful as Cook County's.

Creative funding models like social impact bonds provide promising opportunities to support public health initiatives. Under this strategy, programs targeted toward enhancing health outcomes receive upfront funding from private investors. The government then reimburses these investors based on the initiative’s success as determined by pre-established results. This model aligns public and private interests while also providing incentives for successful program implementation.

Unbeknownst to most laypersons and elected officials alike, public health increases life expectancy and is also a smart investment. For every dollar invested, experts estimate a return of about $14.30, with local public health initiatives producing a return of $4.10. However, local governments frequently rely on federal handouts and wait for emergencies to prioritize funding for public health.

As I see it, we have two options at this crucial point: we can actively look for creative solutions, or we can bemoan funding losses. Local governments should bear the majority of the costs of basic public health services, while some federal assistance remains necessary. The future and well-being of our communities are at risk if we ignore this pressing need.

As the saying goes, “Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.” We have reached the point where, beyond pandemic-level health emergencies, local governments must become better at fishing for sustainable funding to protect residents from public health risks.