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A guest blog entry from Jay Smith, MD, MPH, NHPHA Policy Committee Co-Chair

Everyone knows that prevention matters but its mostly just public health people who think about it in all of the three stages - primary (improving overall health), secondary (increasing screenings/preventive efforts), and tertiary (improving treatment and recovery).  As you all know, primary prevention involves lots of messaging and trying to change underlying conditions whether that is exposures or immunity levels or other underlying resilience factors.  Often that is not completely successful or as fully possible as would be optimal.  So we end up moving on to the secondary and tertiary levels of prevention that reduce morbidity and mortality though we may not get a full pound of cure for each ounce as we do with primary efforts.

It's probably stretching the prevention metaphor too far, but I’d like to suggest that our efforts to increase everyone’s awareness of the devastating cuts in Health and Human Services being sent to the House floor next week by the majority are akin to primary prevention.  The budget proposal will likely go through the House with all of these cuts but raising public awareness of the negative outcomes that will ensue will help in the next phases of the struggle.  There are so many lines of cuts and understanding their impact is difficult.  They include contracts for drug and alcohol treatment services and prevention efforts; cuts to emergency shelter programs for homeless housing; decreases in personal care and transportation funds and meals programs for elderly and disabled people.  I won’t try to put everything in this newsletter.  Restoring these cuts to get the needs met that contribute to a healthy New Hampshire at the next level of budget review (the Senate) or the level after that (if Governor Hassan is persuaded she needs to veto what comes from the legislature in June) is the goal.  Here are the cuts as of March 13.
Make yourself and others aware of them and vocal about the effects.  Politicians may react now or later in the process to large enough amounts of feedback from constituents so write personalized messages to your own representatives.  I will update the information about the cuts and links to other organizations’ analyses soon.  A number of these groups are having a news conference today, March 30th at 12:15 in the lobby of the Legislative Office Building.  

Concord often seems far away from people’s own lives and concerns.  And the budget seems mystifying.  As you look at the proposed cuts, link them to the lives of people that you know and make them aware of what could happen.  The total decrease from the governor’s proposed HHS budget is $119 million dollars, almost 10% of the total.  The cuts are not even across the entire HHS budget and the total the House finance committee proposed is about 9% less than what was enacted in the last biennium.  For example, the impact that would occur with these reductions to drug and alcohol treatment funding are estimated to mean 955 fewer people per year getting services.  Drug and alcohol prevention in 50 schools serving 3350 students per year would also be cut.  There is already a severe shortage of treatment available and the governor’s budget proposed additional funds. The House proposal reduces funding for these additional services in the biennium by $6 million causing loss of services for more than 500 additional people each year.  In the two years of the budget, up to 7,000 fewer students would receive targeted prevention services.  As with a number of other areas, these cuts also risk loss of Federal funds, which in this case would mean an additional 726 treatment and 1,158 prevention services not delivered.
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