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By The Associated Press and KHN

Local and state public health departments in the United States work to ensure that people have healthy water to drink, their restaurants don’t serve contaminated food and outbreaks of infectious diseases don’t spread. Those departments now find themselves at the forefront of fighting the coronavirus pandemic.

But years of budget and staffing cuts have left them unprepared to face the worst health crisis in a century.

KHN, also known as Kaiser Health News, and The Associated Press sought to understand the scale of the cuts and how the decades-long starvation of public health departments by federal, state and local governments has affected the system meant to protect the nation’s health.

Six takeaways from the KHN-AP investigation:


Since 2010, spending for state public health departments has dropped by 16% per capita, and for local health departments by 18%. Local public health spending varies widely by county or town, even within the same state.


At least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a skeletal workforce in what was once viewed as one of the world’s top public health systems.


Nearly two-thirds of Americans live in counties that spend more than twice as much on policing as they spend on nonhospital health care, which includes public health.


More than three-quarters of Americans live in states that spend less than $100 per person annually on public health. Spending ranges from $32 in Louisiana to $263 in Delaware.


Some public health workers earn so little that they qualify for government assistance. During the pandemic, many have found themselves disrespected, ignored or even vilified. At least 31 state and local public health leaders have announced their resignations, retired or been fired in 15 states since April.


States, cities and counties whose tax revenues have declined during the current recession have begun laying off and furloughing public health staffers. At least 15 states have cut health department budgets or positions, or were actively considering such cuts in June, even as coronavirus cases surged in several states.


Contact AP’s global investigative team at


This story is a collaboration between The Associated Press and KHN (Kaiser Health News), which is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.

Copyright 2020 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Independent probe coming after Fort Hood soldier death

AUSTIN, Texas (AP) — U.S. Army officials announced Friday they will begin an independent review of the command climate at Fort Hood following calls from members of Congress and community activists for a more thorough investigation into the killing of a soldier from the Texas base.

Secretary of the Army Ryan D. McCarthy said he was directing the review and that it will be conducted by an independent panel of congressional representatives selected in collaboration with League of United Latin American Citizens. The panel will examine claims and historical data of discrimination, harassment and assault.

The review comes in the wake of the death of 20-year-old Spc. Vanessa Guillen, who investigators say was bludgeoned to death at Fort Hood by a fellow soldier. She was last seen in April and was listed as missing for six weeks before the Army released details. The soldier suspected in Guillen’s slaying, Spc. Aaron Robinson, died by suicide on July 1 as police were trying to take him into custody.

“The Army is deeply saddened and troubled by the loss of one of our own,” McCarthy said Friday during a press conference.

In a separate press conference Friday, U.S. Rep. Sylvia Garcia, D-Texas, said McCarthy had also agreed to back calls for the Department of Defense to conduct an inspector general’s investigation into the death of Guillen. She said the independent review of Fort Hood’s climate showed military officials were listening.

The Texas congresswoman and others met with McCarthy after dozens of lawmakers joined a letter demanding a full accounting of the circumstances surrounding Guillen’s death.

“This is the military ‘me too’ movement,” Garcia said.

President Donald Trump acknowledged Guillen’s death in an interview with Noticias Telemundo on Friday. He said he had heard of the sexual harassment and assault allegations in the Army and was expecting a report by Monday, when he said he would say more.

“I thought it was absolutely horrible,” Trump said.

Story continues

Natalie Khawam, who is representing the Guillen family, said Friday that she hopes to find support in members of Congress and President Trump for the I Am Vanessa Guillen bill that she will be presenting this month. If passed, the bill would allow for active duty service members to file sexual assault and harassment claims to a third party agency, instead of their line of command.

“Vanessa Guillen dedicated her life to serving our country,” Khawam said. “America looks forward to Congress passing our bill and the President singing it into law so this injustice never happens to another soldier ever again.”

Questions over Guillen’s disappearance still loom.

Guillen’s family has said Robinson, the soldier accused of killing her, sexually harassed Guillen at Fort Hood, but they have not given specifics of what they were told.

Guillen was assigned to work in an armory room at Fort Hood on April 22, when she was last seen walking to a parking lot, according to the Army. On April 23, the U.S. Army Criminal Investigations Division learned of her disappearance and began investigating.

Investigators began interviewing people who had been in contact with Guillen on April 28, according to a timeline provided by the Army. That day, Robinson, of Calumet City, Illinois, was identified as a “person of concern” based on information that he provided investigators during his interview, Army officials said.

The Army was receiving 20 to 30 tips per day about Guillen’s whereabouts, officials said, and it took more than a month to get cell phone records requested for the investigation.

Phone records helped lead investigators to Cecily Aguilar, a civilian now charged with one federal count of conspiracy to tamper with evidence. Investigators believe she helped Robinson hide Guillen’s body. Aguilar, 22, of Killeen, Texas, near Fort Hood, is currently in custody at the Bell County Jail.

The Army said a contractor not involved with the investigation found human remains June 30 in the woods near the Leon River. The remains were later identified as Guillen’s.

Later that day, Robinson, who had been confined at Fort Hood for reasons that were not related to the Guillen investigation, ran away unnoticed from the barracks, according to the Army. After being confronted by police later that night, Robinson died July 1 by taking his own life.

The Army says the gun Robinson used was not issued by Fort Hood, but it’s unclear where he got it.

Army officials said 52 agents from multiple military and civilian law enforcement agencies have conducted more than 300 interviews investigating Guillen’s killing. That has lasted for more than 170 days, and Army officials say that has led to forensic examinations of more than 50 phones.


Acacia Coronado is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues. Associated Press reporters from around the world contributed to this report.

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