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Other Budget Issues

Last Updated: 5/18/2010
Budget Issue: Elimination of asthma programs.
Program: California Asthma Public Health Initiative
Finding or Recommendation: Modify the proposal to preserve $1.2 million in funding for the California Asthma Public Health Initiative and eliminate $106,000 for a study within the Environmental Health Investigations Branch.
Further Detail

Proposal.  The Governor's May Revision proposes eliminating $106,000 in Proposition 99 funding for a study within the DPH’s Environmental Health Investigations Branch, and eliminating $1.2 million in Proposition 99 funding for the DPH’s California Asthma Public Health Initiative (CAPHI) as well as grants to Central Valley health departments.

The goal of CAPHI is to reduce the impact of asthma and eliminate related health inequities in California. This proposal would eliminate core public health functions related to asthma such as promotion of best practices in asthma care and management, policy analysis and development, convening of quality improvement collaboratives, partnering with other state, local, and non-profit entities (including the California Department of Education), and provision of statewide technical assistance and expertise. 

Background.  Asthma affects nearly 3 million people in California.  The state's Strategic Plan for Asthma indicates that costs for asthma-related hospitalizations totaled over $763 million in 2005.  Approximately 150,000 emergency department (ED) visits and 36,000 hospital discharges were attributed to asthma in California in that year. Rates of asthma-related  ED visits, hospitalizations, and mortality are significantly higher among minorities and low-income communities.  Most hospitalizations and severe adverse health outcomes related to asthma are preventable with proper clinical care and education, and through minimizing exposure to asthma triggers.

Funding for the program was reduced last year in the amount of $438,000 million, and has been reduced by approximately half from the 2008-09 funding level of $2.6 million.

Analyst’s Comment.  We believe that the proposal to eliminate the CAPHI is problematic for several reasons. First, the CAPHI provides core public health expertise and technical assistance statewide on a public health issue that affects a significant portion of the state's population.  Second, although we have not conducted a formal cost-benefit analysis of the program, we acknowledge that asthma disproportionately impacts low-income populations likely to be served by other state health programs, and believe it is likely that clinical quality improvements and better management of asthma that result from this program may lead to lower ER visitation and hospitalization rates among this population.   We have requested that we be provided with any evaluation and/or cost-benefit analyses that the DPH has conducted related to the program.  Lastly, we believe the small amount of funding provided to the program leverages a fairly large impact, since clinical collaboratives and partnerships with other entities result in in-kind contributions towards the public health goals of the program. 

Analyst’s Recommendation.We recommend modifying the proposal to preserve $1.2 million in funding for the CAPHI and eliminate $106,000 for a study within the Environmental Health Investigations Branch.