‘It Will Set Us Back Multiple Decades’: Why Public Health Experts Are Panicking About the HHS Overhaul

This week, the Department of Health and Human Services (HHS) underwent a massive restructuring under its secretary Robert F. Kennedy Jr., resulting in the sudden departure of thousands of employees across the nation.

While Kennedy frames these changes as a cost-cutting and efficiency measure, public health experts warn that the cuts are eradicating critical programs, weakening state and local health infrastructure, and eliminating expertise that will be difficult to replace.

With essential services like disease prevention and outbreak response already crumbling, experts believe the fallout from this decision could set public health efforts back by decades.

Department-wide bloodbath

HHS has issued 10,000 layoffs as part of its restructuring plan. These job cuts have impacted employees across various agencies within the department — primarily ones that have been consolidated under the new structure.

The department has consolidated several of its agencies into a new entity called the Administration for a Healthy America — a move that downsizes and combines these agencies’ functions. Some of the agencies being funneled into the Administration for a Healthy America include the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Institute for Occupational Safety and Health (NIOSH).

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy said in a statement. “This Department will do more — a lot more — at a lower cost to the taxpayer.”

Thousands of HHS employees who were laid off took to online forums this week to share their experiences. Many of them had been working in the department for decades. Most of their anecdotes reveal that they were denied access to systems and buildings immediately upon learning of their elimination, leaving no time to finish projects or pass their work on to someone else.

Some HHS employees, including top officials from the National Institutes of Health, were given the choice between transferring to the Indian Health Service (IHS) — an HHS agency that provides healthcare services to Native Americans — or lose their job. Employees had to choose whether to take these roles in a matter of days.

IHS jobs typically require living in a remote area, noted Susan Polan, associate executive director for public affairs and advocacy at the American Public Health Association.

“The Indian Health Service has historically been understaffed. It has needed to build up its clinical staff, and its program staff as well. So it is a noble goal — but I don’t think that that was really what the goal was,” she stated. “I suspect it was just a way to offer the opportunity to fill a gap — while at the same time, expecting that that gap would not be filled, and people will leave.”

Programs being cut left and right

By instating a round of layoffs this substantial, President Donald Trump’s administration is dismantling core public health infrastructure, Polan said.

She pointed out that the reduction in workforce is already causing the sudden elimination of health programs across the country — including those focused on smoking prevention, gun violence, environmental disasters, HIV, reproductive health and disabilities.

“What does this mean? That kids will take up tobacco because the comprehensive tobacco prevention programs are gone. The existential threat of climate change will not be addressed, meaning less mitigation and responsive communities around the country. HIV prevention, which is one of the most cost-saving activities that we have seen, has been dramatically reduced, meaning the number of HIV cases and AIDS cases will go up. [There will be] an increase in infant mortality and maternal mortality — and this is all just a small piece of the damage done,” she declared.

Polan noted that these effects will be felt all across the country, as HHS agencies dedicate much of their funding to state and local public health efforts. For example, the Centers for Disease Control and Prevention (CDC) distributes about 80% of its resources to these programs.

One public health executive in Texas — Phil Huang, director and health authority for the Dallas County Health and Human Services Department — pointed out that while the elimination of preventive health programs may seem like an effective way to reduce costs in the short term, it is certain to increase costs in the long run.

For instance, one new case of HIV leads to about $420,000 of lifetime treatment costs, he noted.

“You multiply that for every new case that we get as a result of these [layoffs] and the lack of prevention support. It’s going to have a huge impact on us at the local level,” Huang stated.

He also said that these federal job losses will have a ripple effect.

While the immediate layoffs are at the federal level, their impact cascades down to state and local health departments. Many health programs are federally funded but implemented at the state and community levels — so when federal agencies like the CDC lose staff or entire divisions, they can no longer provide the funding and technical support that state and local health departments rely on, Huang explained.

Just last week, Dallas County’s health department had to lay off 11 of full-time staff members and 10 part-time employees due to funding problems, he noted.

“These are staff that work in our epidemiology group to respond to outbreaks, including the measles situation, to make sure that we don’t get spreading and we don’t have a situation like what’s being seen in West Texas,” he explained.

Huang added that the department has also canceled more than 50 immunization clinics and outreach events in the past couple weeks, many of which were targeted toward schools with low vaccination rates.

Setting public health back decades

HHS’ data collection is a crucial part of maintaining good public health, Huang pointed out.

With the CDC’s Center for Forecasting and Outbreak Analytics being shrunk, he is concerned local authorities won’t be able to receive warnings about outbreaks and public health threats. This means officials will struggle to warn the public about disease outbreaks, track new drugs in the supply chain, and monitor foodborne illnesses and wastewater for emerging health risks.

Huang also noted that the job cuts will further reduce the CDC’s ability to provide up-to-date recommendations and best practices for clinicians and public health workers, compounding the challenges of outbreak response.

“This truly is setting us back decades. You cannot just build this back again — it’s taken so long to develop this expertise and the systems to do this. [The layoffs are] destroying that, and it will set us back multiple decades,” Huang declared.

The Trump administration is heralding the layoffs as a means to reduce bureaucracy, but these cuts aren’t just about eliminating bureaucratic positions — they’re also about losing valuable subject matter experts who provide important guidance to state and local public health agencies, said Chrissie Juliano, executive director of the Big Cities Health Coalition.

Making up for this loss of expertise and institutional knowledge may prove impossible — the scale of HHS’ cuts makes it virtually impossible for non-governmental entities to fill the gap, she remarked.

“You can’t just replace this amount of federal money and this amount of federal expertise and people. Absolutely there is a role for the private sector, philanthropy, organizations and partners. But the federal government plays a critical role in the public health system and in how the system as a whole operates,” Juliano stated.

Another public health expert — Lori Freeman, CEO of the National Association of County and City Health Officials — pointed out that many of the layoff victims were accomplished scientists and medical professionals, often leaders in their fields.

“These are world experts on lots of different things — hosts of diseases and ailments and public health in general — and they are the group of experts in the federal governmental public health system that our local and state health officials turn to at the worst of times to help to inform the best way of managing an emergency and a response to a situation,” Freeman explained.

She added that she is worried about removing these experts from the public health system — especially because “it may be very difficult to recruit them back in and build memory.”

Freeman also noted that public health workers usually juggle multiple responsibilities, including disease surveillance, community education, immunization, maternal programs, substance abuse initiatives and emergency preparedness. With all of this on their plates, staffing shortages will make emergency responses and routine public health work nearly impossible, she said.

As is the case whenever federal health funding is cut, the effects will be the worst in the nation’s rural communities, Freeman added.

She said that a majority of the country’s health departments are small, serving populations fewer than 50,000. These organizations rely heavily on federal funding — and even the loss of a few staff members can cripple their ability to function, Freeman stated.

Lack of transparency

Public health leaders are confused about the purported intentions behind HHS’ restructuring. HHS Secretary Kennedy says this plan will help reverse the nation’s chronic disease epidemic — but this goal is wholly undermined by cuts to programs like the FDA’s tobacco control efforts or local HIV prevention efforts, Freeman pointed out.

Sharon Gilmartin, executive director of the Safe States Alliance, said she was baffled by the shortsightedness of HHS’ plan.

“What may look good on a budget spreadsheet will no doubt look different in our homes and communities,” she declared.

Gilmartin condemned the administration’s lack of transparency, as well as its failure to provide guidance on how agencies should manage the work previously handled by terminated employees.

She also expressed concern that HHS implemented its largest round of layoffs in modern history with “zero input or guidance from Congress.”

Monday, the day before the layoffs began, the Senate Appropriations Committee sent a letter to Kennedy calling his leadership decisions at HHS “unprecedented and harmful.” This has been met with no response, Gilmartin noted.

The layoffs speak to the ongoing power struggle between Congress and the executive branch over control of public health policy, she added.

“We’ve heard multiple restructuring plans that will attempt to pick up certain programs and move them into newly created agencies or pre-existing agencies. I can tell you that it’s not as easy as picking something up and placing it down. There’s specific expertise and resources and capacity in each of these departments and divisions and centers that have been honed over decades,” Gilmartin explained.

She said these types of rash decisions make her and other public health leaders worried about who is ultimately in control of public health — as well as what data, if any, they’re using to inform their choices.

“They clearly are eliminating whole divisions and branches, which doesn’t speak to bureaucratic streamlining. It speaks to moving forward an agenda which has not been elucidated for the public health community,” Gilmartin declared.

Her concerns highlight the uncertainty surrounding the future of federal health policy.

Not only does HHS’ restructuring raise concerns about the deterioration of public health, the lack of transparency and coherent strategy behind this decision deepens experts’ fears about the long-term consequences for the nation’s health infrastructure.

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