The Florida Department of Health structure has been under siege for well over a decade. This effort has been a slow and effective process due to the lack of skilled leadership in the department and ineffective defenders of their programs. In the past, department staff educated legislators to the importance of Florida's public health initiatives; they have been silenced.
Surgeon General (State Health Officer) appointments have lacked appropriate experience to lead. Administrative infrastructure appointments, particularly the deputies, lack the stature and expertise to argue Health Department responsibilities. Health Department programs have become shooting gallery ducks, too often the victim of conservative politics. As a result, communities are less protected. The loss of department food service oversight is an example.
Much of the picking apart of Health Department regulatory responsibilities is driven by association lobbying groups anxious for tepid oversight. Conservative groups continue to attack women's health programs such as family planning.
The latest effort, Senate Bill 1824, suggests that the surgeon general or state health officer not be the face of Florida's public health effort. If not him or her, then who? The bill would delete language requiring the Health Department to combat disease and disabilities to the fullest extent possible. If not the Department of Health, then who?
Also, written into this bill is the 15-year failed effort to close A.G. Holley State Hospital, the last tuberculosis hospital in the state, with the intent of moving the patients to the private sector. Much of what A.G. Holley does is not profitable and would be a low priority for the private sector. Communities could be at serious risk for unmanaged or poorly followed tuberculosis patients along with compromised case tracking.
Florida ranks fourth in the nation for TB cases. TB is one of the programs that must be the responsibility of the state public health system along with sexually transmitted diseases and other communicable diseases.
Further reorganization is in the offing. The Florida public health effort, previously one of the finest in the nation, will go the way of other states due to shortsightedness, stinginess and a lack of public health leaders able or willing to defend their turf.
Dr. Marc J. Yacht is retired director of the Pasco Health Department.