CBOs, Public Health, and American Society

Sorry for the light posting of late, travel really takes it out of me. Anyway, back in the Hub of the Universe, I've come away from Atlanta with pretty much the same things I take from all the federal grantee meetings I attend -- five or six a year, at least.

We take it for granted, but it's actually notable that in the U.S., the federal government directly provides very little in the way of public health services. Funding from the relevant agencies -- the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, Health Resources and Services Administration being the most important -- goes to the states, to municipalities (mostly big cities) and to private grantees and contractors. Private grantees include large medical centers, but they also include thousands of small Community Based Organizations (CBOs, in the acronymic world of government). CBOs receive funding directly from federal agencies, and also are the ultimate recipients of a substantial portion of the federal funds awarded to states and cities.

There are some excellent reasons for this policy. Much of public health practice is by far the most effective when it is carried out by organizations indigenous to the affected communities -- organizations that are trusted, that employ people who come from the communities they serve, that understand the culture, the social structures, the social geography of communities. The grantee meetings are extraordinary experiences. I have never been a part of anything comparable to these gatherings, of people of every imaginable ethnicity, straight, gay, lesbian, transgender, Ph.D.'s and M.D.'s mingling as equals with peer counselors who might have graduated from high school. In the kind of work I do we quickly come to accept these experiences as ordinary, just the nature of our business. But of course they aren't.

The federal funding for CBOs accomplishes a great deal more than just purchasing services that benefit the public. Federal and state funding are the lifeblood for minority CBOs, particularly in newcomer communities that lack other infrastructure. They become essential advocates for their communities, providers of job opportunities, training and career ladders, institutions where public officials can identify community leaders and spokespeople to help connect communities with government and knit our multicultural society together. The federal government, to its credit, has not only purchased services from innumerable small, often struggling minority CBOs, it has invested in their capacity through technical assistance, training, and organization building.

The Bush administration's proposed cuts in spending on public health don't just threaten to make us all sick; they strike at an important part of the very fabric of society. With state budgets also having shrunk in recent years, CBOs have fallen on hard times. Many have laid people off, some have disappeared. If Congress goes along with budget cuts to the federal agencies that support healthy communities, the private organizations that are essential to the structure of those commmunities, and that make them effective partners in a multicultural nation, will be devastated.