PSR PA says: “Invest in Public Health in the Philly City Budget”

This week has seen final opportunities for Philadelphians to engage City Council on the fiscal year 2025-2026 budget with public hearings Tuesday and Wednesday. Members of the public could sign up in advance to provide spoken testimony of 2 minutes or less. PSR PA continues to encourage civic participation as a vital tool for driving public health and environmental justice outcomes. Recently, we launched our  “Civics Explained” video series, which is designed to help residents better understand how to engage in these important processes and make their voices heard.

In the city budget, PSR PA has advocated for investments in public health as medical professionals raise the alarm on climate change, air quality and environmental pollutants. PSR PA supports the Safe and Healthy Homes initiative, including PEA’s $10 million dollar ask for the Built To Last program and the administrative costs that enable coordination and communication with residents who receive assistance. We also underscored the need for inspections with funding for Licencing and Inspections to prevent harmful conditions in rental properties, like mold, failing appliances, or gas leaks. Both inspections and repair funding help prevent long term health conditions. We also argued for investment in green and public spaces that improve air quality, and for the public transit that many residents depend on and that reduces pollution from car congestion.

As part of our mission, we believe empowering individuals with civic knowledge is essential to building healthier communities. By participating in budget hearings, contacting elected officials, or learning about city operations through our educational content, every Philadelphian can play a role in shaping a safer, more equitable city.

In addition, we also focused on how our city’s resources can be utilized to address violence and other health crises through preventative, cost-effective investments. Walter Tsou, the former Health Commissioner of Philadelphia and a board member, gave the following testimony May 14th:

Good morning, my name is Dr. Walter Tsou and I had the pleasure of serving as Health Commissioner during the beginning of the Street Administration.  

My budget request is to strengthen our funding for public health and to ask the Administration to appoint a head of the Department of Behavioral Health and Intellectual Disability Services.  It has been now over a year without a leader for DBHIDS at a time when mental health is an enormous burden on our city.  Even worse, the proposed federal Medicaid cuts are likely to fall directly on mental health services blowing a huge hole in the city budget.  Who will help steer our mental health services through these choppy waters?  We need to know.

The public health department is always the ugly stepsister of city government. It is often not a priority for funding, even though health care is enormously expensive and prevention underappreciated.  During COVID and the next pandemic that will come, many of the key essentials around immunizations, contact tracing, PPE, and health education had to be contracted out.  These services should be in house and part of the health department. Disease surveillance, health inspections, our district health centers are really daily, year round operations.  Unfortunately, most of the health department budget comes from the federal government directly or indirectly which makes it particularly vulnerable to the projected federal cutbacks.  Prudence would dictate that we need to have funds available to protect these vital jobs that help make our city healthier.

I would like to offer a different take on violence that has plagued our city for decades.  Much has been made of the reductions in crime that we have seen in the past few years.  The reduction has been applauded if not fully understood.  I attribute much of this to the Biden Administration’s wise decision to retain and enhance the safety net during the pandemic which had record employment, put more money in people’s pockets, leading to less financial stress and wait for it – less anger.  Before guns, angry people punched people but today, they shoot them.  Now my prediction is that the proposed Trump cutbacks in Medicaid, food and nutrition programs, and myriad other programs will lead to more financial stress and yes – anger.  And what do angry people do?  They take it out on others.

So be prepared for a rise in gun violence.  The solution is not to have more police.  But it may be having more community public health workers.  The same people who could do disease surveillance, health education, contact tracing during pandemics could be doing home visits, follow up on missed immunizations, doing baby checks, home safety inspections including safes for gun storage or fire alarms, etc.  In other words, people who would not invite police in their homes are more likely to invite health workers whose goal to do a health checkup on their loved ones.  The value of community health workers has been shown repeatedly in the public health literature.  Yet, most governments have failed to recognize the important role that hiring people from Philadelphia neighborhoods who look after their neighbors could be the most cost effective person in city government. I want to plant the seed about a smarter way of approaching both health and stress in our city that will set us apart from the looming violence across America and make our city truly one of brotherly love and sisterly affection.  Thank you.

Walter Tsou, MD, MPH