CHICAGO — City Council voted to approve Mayor Brandon Johnson’s first budget last week, but local experts say the spending plan continues a troubling pattern that could ultimately worsen public health inequities throughout Chicago.
Johnson’s budget, approved Wednesday, allocates $76.8 million from the city’s general operating fund to the Chicago Department of Public Health for 2024. That’s about $6.5 million more than this year, but the department’s budget will still drop nearly 10 percent as pandemic-era grants expire.
Almost 90 percent of the department’s overall funding comes from grants.
Block Club’s Quinn Myers explains how Mayor Johnson’s proposed budget is funded:
By not using tax dollars to fund the department instead of grants, which often have restrictions on how they are used, experts say Chicago is limiting its ability to tackle public health issues that disproportionately affect Black and Brown neighborhoods, such as environmental health, opioid use, HIV prevention and more.
The department also is struggling to fill hundreds of jobs.
“A critical pandemic lesson is that underfunding governmental public health is foolish and deadly,” said Wesley Epplin, policy director at the Health & Medicine Policy Research Group. “Public health is not optional. We need sufficient flexible local funding for [the Chicago Department of Public Health] such that it has the staff and capacity to respond to current and emergent public health problems.”
Those issues now will fall to Dr. Olusimbo “Simbo” Ige, whom Johnson appointed as the department’s new commissioner. Ige, managing director at the nonprofit Robert Wood Johnson Foundation based in New Jersey, will take over the role Dec. 4, according to the Mayor’s Office.
“It is a distinct honor to serve the city of Chicago in this role,” Ige said in a statement about her appointment. “Through collaboration with the Johnson Administration and with community members in Chicago, I am confident that we can improve the health outcomes for all Chicagoans. I have spent my entire career in the public health field, and I look forward to bringing all that I have learned to CDPH.”
Johnson’s office did not return multiple requests for comment and the Department of Public Health referred all questions to the mayor’s office.
How Limited Funding Led To Lost Jobs, Fewer Services For Black And Brown Neighbors
Howard Ehrman, the city’s top doctor under Mayor Harold Washington, said the public health department is a shell of what existed in the ’80s.
The department had grown throughout the late ’60s and ’70s in response to the civil rights movement, which pushed for equitable access to public health, housing, education and more for Black people, Latinos, Native Americans and low-income people, Ehrman said.
But many of these resources, ranging from mental health to STD/STI care, were privatized under Mayor Richard M. Daley in 1989 and continued when Rahm Emanuel took office in 2011, said Ehrman, co-founder of the People’s Response Network.
Brick-and-mortar health centers were closed in favor of partnerships with federally qualified health centers like Howard Brown Health, among others.
When Ehrman left the department in 1991, there were still about 2,000 employees and 57 facilities across the city, he said. Johnson’s budget allocates for 1,175 full-time positions next year, including about 300 from the city’s corporate budget.
However, only a fraction of those positions are filled. The department has 493 vacancies, making up about 42 percent of all positions, former acting commissioner Fikirte Wagaw told alderpeople during last month’s hearing.
These cutbacks happened to health departments at city, state and federal levels across the country, but nowhere experienced as drastic of cuts as Chicago, Ehrman said. Shrinking budgets have made it harder to address health inequities across Chicago.
“This decline meant that Black and Brown communities of Chicago had much less access to the department of health,” Ehrman said. “It reduced our capacity to go out to where the people are at, and one of the best ways to get to the people at highest risk — whether it’s mental or physical health, HIV or COVID — is not by expecting them to walk into your facility. It’s to go out where they’re at.”
These cuts to the health department also affected Black and Brown communities economically, Ehrman said. Many of the workers at the Chicago Department of Public Health were Black and Brown women, who lost union jobs with full benefits and health care as their positions were eliminated.
“So it’s not just a question of health,” Ehrman said. “It’s also a question of the major destruction of economic power of African American and Latino neighborhoods.”
‘There’s No Way You Can Support This Department On Grants’
Wagaw addressed the department’s funding model and other challenges facing the health department during last month’s budget hearing. She told alderpeople relying on grants to fund public health was “not a good model,” but she doesn’t “know the answer moving forward.”
Principally, what the department needs is more state and city tax dollars to expand or introduce programs like community health workers, nurse home-visiting services, Healthy Chicago Equity Zones, migrant health and community health assessment and planning, Epplin said during last month’s budget hearing.
Johnson’s budget does send more money to the department, but even more COVID-related grants are set to expire over the next two years. Grants can help the public health department address certain issues, but much of that money is categorical and can’t be spent on other health threats, Epplin said.
“We’re glad to see an increased investment in mental health services,” Epplin said. “Still, Chicagoans need more funding for other critical public health services.”
Restoring the Chicago Department of Public Health to its previous levels is crucial to attaining better health outcomes and equity for Black and Brown Chicagoans, Ehrman said. He agreed that would require the city to cough up more of its own money to support the department instead of being subsidized by grants, he said.
“The fact that only [9] percent of the [Chicago Department of Public Health] budget comes from the corporate budget is just going to make every racial inequity indicator worse than it already is,” Ehrman said. “There’s no way you can support this department on grants, even when there were a lot more grants for this stuff than there are now.”
Fully funding the department would require increasing Chicago’s tax revenue, but not at the expense of working-class people, Ehrman said. The former commissioner suggested reestablishing the head tax — a tax on businesses with more than 50 employees that Emanuel eliminated in 2011 — and implementing the financial transaction tax.
“There’s no way to solve the problems in the Department of Public Health, or even Chicago Public Schools, Chicago Housing Authority or anything else, without making the wealthy and the corporations pay a much bigger share into the city’s corporate budget,” Ehrman said. “And then you have to use the corporate budget to pay a much bigger share into the health department.”
Ige replaces Dr. Allison Arwady, whom Johnson fired in August.
Ige was assistant commissioner for New York City’s Department of Health and Mental Hygiene until early this year, according to the Mayor’s Office. In New York, she focused heavily on outreach to Black residents, including for COVID-19 vaccinations, according to the Tribune.
“Dr. Ige is a tremendous addition to not just our administration, but to the City of Chicago,” Johnson said in a statement. “Dr. Ige is someone who understands the balance between hard data and community interaction when assessing public health problems and solutions, and with decades of experience in public health, she brings a clear-eyed understanding of both the challenges and the opportunities that CDPH and our city face, and how we will collectively overcome them.”
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