Assembly subcommittee hears CDPH state of public health; director flags H5N1, behavioral health and equity gaps

Dr. Bridal Pahn, the newly appointed State Public Health Officer and director of the California Department of Public Health, told the Assembly Budget Subcommittee on Health that California has made measurable gains in population health but faces mounting, complex threats that require continued investment.

"Public health aims to promote health and well-being and to prevent illness and death before they occur," Pahn said in opening testimony. She said pandemic-era investments improved data and workforce capacity but warned that a large portion of one-time federal COVID funding will expire in 2026.

Why it matters: Pahn framed public health spending as preventive investment that saves lives and stabilizes health systems. She highlighted several immediate and medium-term risks — infectious disease (including H5N1 bird flu and other re-emerging pathogens), climate-driven wildfires, worsening behavioral-health trends, and persistent racial and ethnic disparities — and tied them to budget planning for 2025-26.

Key points from the report and Q&A: - Disease trends and outbreaks: Pahn said COVID caused a temporary decline in life expectancy and that, while life expectancy has rebounded, other causes of premature death have risen. She listed road injury, homicide, drug- and alcohol-related deaths, and suicide among the main drivers of premature mortality and noted that drug overdose deaths reached an all-time high in 2023, becoming the fifth leading cause of death overall. - H5N1 and response capacity: Pahn and CDPH staff described a "One Health" response linking animal and human health agencies. CDPH staff told the subcommittee they are using enhanced surveillance, genomic sequencing, farm-worker monitoring, testing and distribution of PPE and medicines, and close coordination with local health departments and partners such as the Department of Food and Agriculture. - Behavioral and mental health: Pahn and witnesses emphasized the state’s investments such as the Children and Youth Behavioral Health Initiative and Behavioral Health Services Act prevention funding as central to addressing violence, overdose, and young-adult mental-health hospitalizations. Pahn said increased social isolation is a documented independent risk factor that affects behavioral outcomes. - Vaccination and data: Pahn called vaccines "a shining example of public health success," noting that strong school immunization requirements and federal programs help prevent large outbreaks. She described California's immunization infrastructure as a critical defensive layer against re-emergent infectious diseases. - Equity and social determinants: Pahn emphasized the role of social determinants — income, housing, education, and race — in shaping health outcomes and singled out persistent disparities affecting Black and Indigenous Californians, including higher homicide rates and worse perinatal outcomes.

Committee members asked Pahn and CDPH staff whether federal-level policy changes could threaten state programs. Pahn said CDPH is "tracking all of the changes very closely" and coordinating with federal, state and local partners, but offered no definitive estimate of funding loss.

The subcommittee opened public comment on the State of Public Health report but received no speakers at that time. The hearing then proceeded to other budget topics, as scheduled.