The danger of declining funds: Public Health Preparedness in NYC.

Since 2001, the New York City Department of Health and Mental Hygiene (NYC DOHMH) has built a strong public health preparedness foundation, made possible in large part by funding from the Public Health Emergency Preparedness (PHEP) Cooperative Agreement provided by the Centers for Disease Control and Prevention. While this funding has allowed NYC DOHMH to make great progress in areas such as all-hazards planning, risk communication, disease surveillance, and lab capacity, the erosion of federal preparedness dollars for all-hazards preparedness has the potential to reverse these gains. Since the initiation of the PHEP grant in 2002, PHEP funding has steadily declined nationwide. Specifically, the total federal allocation has decreased approximately 20%, from $862,777,000 in 2005 to $688,914,546 in 2009. With city and state budgets at an all-time low, federal funding cuts will have a significant impact on public health preparedness programs nationwide. In this time of strict budgetary constraints, the nation would be better served by strategically awarding federal preparedness funds to areas at greatest risk. The absence of risk-based funding in determining PHEP grant awards leaves the nation's highest-risk areas, like New York City, with insufficient resources to prepare for and respond to public health emergencies. This article examines the progress New York City has made and what is at stake as federal funding continues to wane.