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ASHINGTON —  When Microsoft cofounder Bill Gates sat down with President Trump and his aides a couple of months ago, he tried to convince the new president that public health funding was not something that could be sacrificed.

“It’s an education process,” he said.

Those pleas seem to have fallen on deaf ears. The budget outline released by the White House Tuesday contains sharp cuts to everything — from a $76 million reduction in global health funding that includes HIV programming to grass-roots community health grants. And while it’s not clear what cuts will survive the congressional budget process, the proposal reveals a White House that, for the most part, wants a leaner public health system, and less American money used overseas.

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Below are some of the most notable funding reductions slated for the Department of Health and Human Services, as well as one funding increase. HHS oversees multiple agencies tasked with protecting our health.

Domestic HIV/AIDS programs

The proposed cut for the Centers for Disease Control and Prevention includes a $186 million decrease in funding that affects HIV/AIDS prevention. In the CDC’s own budget request justification, officials acknowledge up-front the impact: “At the FY 2018 requested amount, CDC will reduce activities around testing, support services for persons living with HIV, and prevention services. In addition, CDC’s ability to implement innovative demonstration projects or research examining strategies related to high impact prevention and new tools supporting HIV prevention will be reduced.”

Chronic disease prevention, health promotion

The proposed budget cuts $222 million, compared to 2017 spending levels, for disease prevention and health promotion programs. It eliminates $51 million for “Racial and Ethnic Approaches to Community Health” programs, $18 million for cancer prevention efforts, and $8 million for an epilepsy program.

Domestic CDC preventive health programs

Gone, too, would be $136 million for public health preparedness and response programs. Most of that cut is a $107 million reduction for “Public Health Emergency Preparedness Cooperative Agreements,” a federal cooperation with state and local governments to ensure local public health departments have the resources to respond to a crisis.

CDC-funded occupational health and safety programs are taking a $138 million hit, which the agency says would prevent it from funding “state and academic partners for conducting, translating, or evaluating research” as it has in years past.

The budget would also eliminate $64.9 million for “emerging and zoonotic infections,” including activities related to chronic fatigue syndrome and prion disease.

International CDC preventive health programs

It’s not just health programs at home getting the axe — the HHS budget outline, in fact, is titled “Putting America’s Health First.” And the State Department budget includes a $2 billion cut to global health assistance, which includes a $225 million reduction in the US contribution to the Global Fund.

Mental health services

The Substance Abuse and Mental Health Services Administration would take two hits: a $116 million cut to mental health services block grants, and a $136 million reduction in “programs of regional and national significance.”

Community Services Block Grants

One of the biggest line-item cuts in the entire budget comes from HHS Community Services Block Grants, a $714 million pool of money awarded to communities around the country to address issues of poverty — and often poverty’s public health implications. Those grants would be zeroed out entirely in 2018 under the White House’s funding request.

Vaccines: ups and downs

President Trump has created controversy over his views on vaccination, but the White House does boost the HHS “vaccines for children” line item by $161 million.

The budget, however, also recommends an $89.5 million cut for federal participation in an immunization program. The entire budget was also written under two assumptions that are likely to reduce vaccination rates: the end of the Prevention and Public Health Fund after 2018, which funds thousands of immunization programs nationwide, and the repeal of the Affordable Care Act, which includes Medicaid rollbacks that could hinder vaccine access.

Childhood exposure to lead and other toxic substances

The Agency for Toxic Substances and Disease Registry isn’t a big line item by HHS standards, but it didn’t escape the chopping block either, with a recommended $13 million reduction from its $75 million allocation in 2017. A program worth $10 million for local grant programs to reduce environmental exposure was untouched.

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  • As a public health professional working in a State Health Department, this is frightening. States are not financially equal, and the population I serve will suffer if this budget were to be accepted as is – the loss of the PPHF alone will be significantly felt.

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