Impact of budget cuts on public health law enforcement

Enforcement of public health laws depends in large part on the state and local public health workforce. Historically, public health law has been vulnerable to unfunded mandates, laws that are enacted without commensurate appropriation for their enforcement. More recently, repeated large reductions in state and local public health funding in the past 4 years have given rise to a whole new set of challenges. Ongoing pressure from political forces hostile to public health's restrictions on commercial activity have played a role in this trend, further constraining enforcement. As the workforce available to enforce public health law has shrunk, agencies have taken several types of action to mitigate losses in enforcement capacity. Based on information from public health research network members and other key informants, public health agency strategies are first characterized with regard to type, e.g., aggregating functions across enforcement targets, partnering with government units outside public health, or sharing services across public health agency jurisdictions. We then examine these strategies with regard to context, asking, for example, whether some approaches work better in larger jurisdictions, whether local agency autonomy makes a difference, and whether some cuts have been so deep as to require actions that would otherwise be unacceptable actions. Finally, we provide insights into the effectiveness of the most common strategies in specific contexts and summarize policy implications of our findings.