The recessionary forces at play in the US (and globally) from 2008 forward have had a significant effect on the viability of public sector health programs. Although the medical sector has continued to show real growth in both services and revenue, public health programs have been in severe decline. The contributing factors for this decline are primarily associated with state and municipal tax revenue declines and the requirements that these entities maintain a balanced budget. This requires very difficult policy and budget choices for both legislators and executives in those public sectors. Since most state and local public health programs are funded through tax funded appropriations, they are particularly vulnerable to reductions. These programs must compete with fire and public safety entities for appropriations and are less visible and appreciated by the general public than fire and police protection. Therefore, they have often been more proportionately reduced than other funding needs in the public sector.