Tuesday, April 24, 2018
Opinion

Bill damages Florida's efforts to promote public health

Florida's public health leadership urges Gov. Rick Scott to veto legislation that would seriously weaken the protection and promotion of public health by the Department of Health.

The Florida Public Interest Research Group, the Florida Public Health Association, the Florida Public Health Institute, the Florida Environmental Health Association and several distinguished former public health leaders have joined together to send a letter to the governor requesting that he veto CS/CS/CS/HB 1263, sponsored by Rep. Matt Hudson, R-Naples. The sponsor of the Senate companion, CS/SB 1824, was Sen. Rene Garcia, R-Hialeah.

The bill should be vetoed because:

An unacceptable risk to public health is created by the closure of the A.G. Holley Tuberculosis Hospital (AGH), which treats patients who either have dangerous forms of multiple drug-resistant TB, or are ordered by a court to be treated until they are cured because they are not compliant with taking medications. The problem is that the bill closes AGH but fails to provide assurance that patients treated at AGH would be continued to be treated elsewhere. No comparable institution exists in Florida that has the knowledge, expertise or success in treating these patients who pose a risk to public health.

Preventive health programs are eliminated, and DOH would no longer have the promotion of healthy lifestyles as a public health goal. The bill repeals all sections of Florida law that direct DOH to promote healthy lifestyles to prevent disease, premature deaths and disability. Healthy lifestyle promotion to prevent disease is part of the core mission of public health. It is well established in medical research literature that lifestyle conditions exceed communicable diseases in morbidity and in the cost of medical care. Healthier people will use fewer health care resources, which then reduce costs for health care to government, businesses and families. Preventive health is fundamental to public health.

For-profit Medicaid HMOs will increase profits at the expense of taxpayer funding for public health because a 1996 statute is repealed that requires Medicaid HMOs and the MediPass program to pay county health departments (CHDs) when certain services are provided without prior authorization. These services include immunizations, sexually transmitted disease treatment and diagnosis, and family planning. CHDs will be left in a position of having to accept whatever reimbursement is offered, if reimbursement is offered at all.

Public health programs for women and minorities are devalued because the bill eliminates authorization for a DOH Office of Women's Health Strategies, a program to dispense contraceptives to women with low incomes, the Osteoporosis Prevention and Education Program, and the authority for the state surgeon general to appoint an advisory committee to advise DOH on ways to improve the health of minority groups.

The bill makes unnecessary changes to the organizational structure of DOH by eliminating the Division of Environmental Health, which has a long-standing reputation for professional excellence. Programs that regulate septic tanks, drinking water from private wells, protect the public from radiation hazards and address illnesses spread from animals to humans like the West Nile virus and rabies would be moved to other divisions, principally a new Division of Emergency Preparedness and Community Support, which have little in common with environmental health programs. Quality is expected to decline because environmental health programs would no longer be administered together to produce synergy and a sharp program focus.

Finally, the bill eliminates a requirement that DOH foster the recruitment, retention and continuing education and training of health professionals and managers that are needed in public health. An adequately trained public health workforce is needed to protect public health.

The public health leaders supporting a veto include Dr. Claude Earl Fox, Dr. Landis Crockett and Dr. Marc J. Yacht as well as Ed Feaver and Bob Williams, who both served as former secretaries of the Department of Health and Rehabilitative Services.

Public health is a core responsibility of government. The economic downturn has increased the need for the services that DOH provides. The Legislature should be looking for ways to strengthen public health, thus increasing the health and well-being of society, not weaken it.

The governor should veto this bill. It would create long-term damage to DOH's mission to protect and promote public health.

Dr. E. Charlton Prather, far left, is a former state health officer. Dr. Charles Mahan is a former state health officer and professor and dean emeritus, USF College of Public Health. The state health officer is Florida's chief public health official. The surgeon general at the Department of Health is also the state health officer.

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