Mayor Brandon Johnson’s first budget comes at a crossroads for the Chicago Department of Public Health.
More than three years after COVID-19 put the Health Department on the front lines and made it among the city’s most vital and prominent departments, Johnson’s decisions to prioritize spending there as federal pandemic dollars dry up will help shape how prepared Chicago is another significant public health crisis arises.
While Johnson, who campaigned promising he would focus on mental health spending, and his administration insist he has an eye on keeping Chicago in good shape, some observers are concerned the city is not putting enough of its own money into ensuring that the gains made in the last three years are not lost.
Johnson’s 2024 plan devotes relatively few additional city resources to maintaining the systems created during the pandemic. Instead, the new mayor’s 2024 proposal for the Department of Public Health promises to increase mental health spending by more than $15 million.
Those moves have even caught the attention of some City Council members, one of whom recently pressed the new head of the Health Department about the administration’s overall plans.
“Aren’t we cooking already?” asked Westside Ald. Jason Erwin, 28th, noting that federal money to pay for such preparedness is evaporating.
Johnson’s budget plan, unveiled earlier this month, includes the opening of two city-run mental health clinics next year, a pilot project as part of the mayor’s overall campaign promise to reopen six mental health clinics closed during of Mayor Rahm Emanuel’s term.
The policy on mental health clinics is important to Johnson’s strong union backers, the American Federation of State, County and Municipal Employees, which lost dozens of union jobs when those clinics closed.
Johnson’s budget also increases funding for the non-police 911 response program, which the mayor supports, by doubling the program’s staffing in the 2024 budget.
Right now, it’s hard to get policymakers and residents to continue putting money and staff into being ready for the next disaster, said Chrissy Giuliano, executive director of the Coalition for Big Cities Health, an organization that advocates for dozens of city health departments.
“It’s hard, in peacetime, if you will, to make a case for continuing to keep the infrastructure and systems in place,” Giuliano said.
“We have the pandemic and we’re increasing those dollars, and rightly so, because the field needed the money,” she said. “But as they start to disappear, we’re going to go back to picking and choosing how prepared jurisdictions are at the local and state level so that we can see ourselves behind the eight again the next time we have an infectious disease outbreak or a natural disaster or terrorist attack.
The Department of Health has long operated as just another cog in the city’s vast municipal bureaucracy, but it has become as familiar to Chicagoans during the height of the COVID-19 pandemic as the police department.
During the pandemic, Health Commissioner Dr. Alison Arwadi, an infectious disease expert, won both praise and scorn as the face of Mayor Laurie Lightfoot’s edicts on business closings and reopenings, limits on the size of public gatherings and vaccine requirements.
Shortly after taking office, Johnson followed through on a campaign promise to oust Arwadi from office, a move that delighted his supporters in the Chicago Union of Teachers, who became furious at her efforts during the pandemic to reopen public school buildings faster than they thought was safe.
The department is now run by Acting Public Health Commissioner Fikirte Wagau, a longtime administrator at the agency who is not a physician. Johnson has not named a permanent commissioner since firing Arwadi in mid-August.
With new COVID vaccines now available and another winter season of potential COVID spikes looming, neither Wagau nor Johnson have been nearly as prominent a figure as Arruadi was when advising Chicagoans on the latest disease data .
Arwadi was a constant presence in television interviews, and her regular “Ask Dr. Arwadi” online segments, where she answered questions and shared updates on new options, became routine viewing for many in the early months of the pandemic.
In a statement responding to questions about the city’s lack of pandemic preparedness spending in the 2024 budget, Department of Health spokesman Andrew Buchanan said the city is “taking a proactive approach to evaluate continued reductions in the cost of temporary COVID grants -19, intended primarily for the pandemic response.” Many of the federal grants continue through 2026, Buchanan pointed out.
“Pending, the (Office of Management and Budget) is undertaking an extensive process in (the fourth quarter of) 2023 and (the first quarter of) 2024 to evaluate existing programs for ways to create efficiencies in service delivery, as well as to prioritize programs with demonstrated success in terms of impact,” Buchanan said in the statement. “Some losses in temporary COVID funding have already been mitigated through increased investments in CDPH’s corporate budget, and it is important to note that CDPH’s budget does not include staff cuts and no programs have had to be suspended.”
Johnson’s budget plan already illustrates the broader shutdown of Chicago’s massive influx of federal COVID money.
Even with millions of unused dollars carried over from this year, Chicago’s share of federal grants for epidemiological health capacity is expected to decrease by more than $42 million in 2024 from 2023, according to Johnson administration budget documents.
While still accounting for about $283 million in the city’s 2024 budget, those grants will continue to decline in the coming years as federal support for local governments’ response to the COVID-19 pandemic wanes.
Wagaw told councilors at her department’s city council budget hearing that the epidemiology grants “have really funded a tremendous amount of work across the department.”
“Almost anything but vaccines and clinical care, we could use those dollars to support the COVID and emerging disease response,” Wagau said.
Another grant, for public health emergency preparedness, is down about $10 million year over year.
That federal funding dates back to just after the terrorist attacks of Sept. 11, 2001, and will likely continue in some form, Wagau said.
“But during COVID, it also got one-time funding channeled through it, and we saw the end of some of that funding,” she said.
The reductions caught the attention of Erwin, who asked Wagau to explain how the city could be set up to respond to various crises if federal money to pay for such preparedness evaporates and the city doesn’t use its own funds to support those parts of the Department of Health .
The senior alderman, who chairs the council’s budget committee, indicated that the Department of Public Health plans to spend city money to fill six new emergency preparedness positions in 2024, which Wagau said are due “right at the end of that grant I mentioned that it’s one-time COVID money.”
But the $469,715 earmarked for those six jobs pales in comparison to the money the city loses from the grants, Ervin noted.
“I just want to understand our position and how we intend to be ready if we get involved in another large-scale emergency like we had during COVID-19,” he said.
Wagaw said her department is trying to find ways to fund key areas.
“We continue to work, especially with our federal partners who provide almost all of the funding in this area, to talk about the importance of the fund for public health preparedness and prevention,” Wagau said. “(It’s) a fund delegated only for activities like this, which right now is potentially facing a national cut, which obviously would have a terrible impact on Chicago.”
“We are working to deal with it on that front,” she said. “We’re also working with (the city budget office) and City Hall to make sure we have the resources we need to maintain, for example, our emergency preparedness warehouses, our minimum staffing requirements, all in service of the described of you preparing for the next public health emergency.”