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[](https://www.celinegounder.com/) # [What I Can & Can't Say on TV](https://www.celinegounder.com/) Subscribe Sign in # War, Oil Shocks, and Public Health: Could the Iran Conflict Trigger Another Lost Decade for Prevention? ### How rising oil prices and recession risk could lead to another round of public health budget cuts — weakening the systems meant to prevent the next pandemic. [](https://substack.com/@drcelinegounder) [Dr. Céline Gounder](https://substack.com/@drcelinegounder) Mar 14, 2026 11 5 Share - [When the economy reaches the health department](https://www.celinegounder.com/i/190899622/when-the-economy-reaches-the-health-department) - [When recessions weaken public health](https://www.celinegounder.com/i/190899622/when-recessions-weaken-public-health) - [Why the Iran war raises economic concerns](https://www.celinegounder.com/i/190899622/why-the-iran-war-raises-economic-concerns) - [Why public health and prevention funding disappears after crises](https://www.celinegounder.com/i/190899622/why-public-health-and-prevention-funding-disappears-after-crises) - [The question we should be asking](https://www.celinegounder.com/i/190899622/the-question-we-should-be-asking) - [Question for readers](https://www.celinegounder.com/i/190899622/question-for-readers) #### When the economy reaches the health department After the 2008 financial crisis, U.S. public health departments lost about 50,000 workers. Epidemiologists. Public health nurses. Community health workers. These layoffs did not make national headlines. But their effects became clear a decade later, when COVID showed how fragile many health departments had become. *** **This newsletter examines how policy decisions and economic forces shape the public health systems we rely on.** *** [I remember that time well.](https://www.celinegounder.com/p/when-budget-cuts-meet-civil-service) I was an Assistant Commissioner at the New York City Department of Health and Mental Hygiene. I was asked to prepare plans to lay off about 20% of our staff in one year, with more cuts in subsequent years. That experience taught me something important. Economic crises do not only affect markets or government budgets. They can quietly reshape the systems that protect public health. [](https://substackcdn.com/image/fetch/$s_!neHj!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F606a550d-d7ed-4a89-adb2-7f618aecbc96_1408x768.png) Illustration created by Gemini Nano Banana Pro. [Now, another economic shock may be forming.](https://www.instagram.com/reel/DV01UcBumsx/?igsh=MWZkM3M3YzI0aG8ybg%3D%3D) The war between the United States and Iran has disrupted oil flows through the Strait of Hormuz. This narrow waterway normally carries about one-fifth of the world’s oil supply. Oil prices have already risen [above \$100 per barrel](https://www.ft.com/content/e5d1f192-c9f1-448f-9aa4-528d6e867cd2), and analysts warn they could climb much higher. [If oil reaches \$150 per barrel](https://www.theatlantic.com/economy/2026/03/oil-price-200-barrel/686354/), gas prices in the United States could rise above \$5 per gallon. When gas gets that expensive, households often cut spending elsewhere in the economy. After the 2008 recession, public health spending in many places fell by 15-20%, adjusted for inflation. Researchers later called this period a “lost decade” for the public health workforce. If economic pressure grows again, the same pattern could repeat. The effects might not become clear until the next public health emergency. #### When recessions weaken public health The 2008 financial crisis did more than disrupt markets. It also weakened the systems that prevent disease. As tax revenues dropped between 2008 and 2010, state and local governments faced large budget gaps. Public health departments rely heavily on these funds, so they were hit especially hard. Between 2008 and 2012, real public health spending fell in many places. Budget cuts soon led to job losses. By 2014, local health departments across the United States had lost about 50,000 employees. Many of the jobs lost were key public health roles: - epidemiologists - public health nurses - laboratory scientists - environmental inspectors - health educators These workers investigate outbreaks, track diseases, and run vaccination programs. When these jobs disappear, health departments lose both staff and expertise. In some places, agencies were left doing only basic regulatory work, such as inspections, instead of prevention programs. At the same time, recessions create new health risks. After the 2008 recession, mental health problems increased. Depression and anxiety rose as unemployment grew. Suicide rates also increased in several countries. Economic stress was also linked to rising opioid use and alcohol-related deaths. The opioid crisis grew fastest in regions that lost many jobs during the recession. Financial strain also changed everyday health behavior: - people delayed medical care - prescriptions went unfilled - preventive visits declined - food insecurity increased - housing became less stable These problems build slowly but can harm population health for years. In short, recessions hit public health systems from both sides. Governments cut prevention programs at the same time that health risks in the population increase. At first, these changes may go unnoticed. After 2008, the damage to public health systems received little attention. But the effects became clear a decade later. When COVID arrived, many health departments were already struggling after years of budget cuts, hiring freezes, and reduced preparedness programs. [](https://substackcdn.com/image/fetch/$s_!3lzp!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Ff3b8868b-9c09-4dde-844e-8ad80363b614_1408x768.png) Illustration created with Gemini Nano Banana Pro. #### Why the Iran war raises economic concerns The question now is whether another economic shock could start the same cycle again. The current crisis involves a familiar risk: an energy shock. When oil prices rise quickly, it works like a tax on households. People spend more on fuel and less on other goods. Several past recessions followed oil shocks, including: - the 1973 Arab oil embargo - the 1979 Iranian revolution - the 1990 Gulf War - the 2008 oil price spike The pattern is similar each time. Energy costs rise, inflation increases, consumer spending falls, and economic growth slows. It is still unclear whether the current disruption will cause a recession. But economists are watching closely. [](https://substackcdn.com/image/fetch/$s_!K5tJ!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fa8de7ad8-63ac-4d87-9e2a-316df431a5b7_1408x768.png) Illustration created using Gemini Nano Banana Pro. #### Why public health and prevention funding disappears after crises Public health holds a strange place in government budgets. Prevention programs create large long-term benefits by keeping people healthy. Yet they are often treated as optional spending. Some critics, including voices in the “Make America Healthy Again” movement, argue that public health has failed at prevention. Prevention has always been the core of public health. The problem is not that we fail to understand prevention. It’s that governments and taxpayers repeatedly choose not to fund it. These are the programs they cut first. The result is a repeating cycle: investment grows during emergencies and fades once the crisis passes. #### The question we should be asking The United States is not yet in a crisis like the one in 2008. Domestic oil production is higher today, and banks are more tightly regulated. Still, warning signs are visible: geopolitical conflict, rising energy prices, slowing economic growth, and large federal deficits. If these pressures lead to a recession, the budget choices made in the next few years could shape public health systems for the next decade. Having lived through layoffs in a health department, I know how quickly economic shocks become real. Budget crises soon turn into hiring freezes, program cuts, and fewer people working to stop disease outbreaks. Public health systems rarely collapse all at once. They weaken slowly — budget cycle by budget cycle — until the next epidemic shows what years of quiet cuts have taken away. #### Question for readers If another economic downturn happens, what should governments protect first: short-term fiscal stability, or the prevention systems meant to protect us from the next pandemic? Let me know in the comments. Systemic is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. [](https://substack.com/profile/103932107-larry-rosen) [](https://substack.com/profile/9443073-kelly-grey) [](https://substack.com/profile/803530-wayne-a-morris) [](https://substack.com/profile/13948557-craig-spencer) [](https://substack.com/profile/5214181-mike-phelan) [11 Likes]()∙ [5 Restacks](https://substack.com/note/p-190899622/restacks?utm_source=substack&utm_content=facepile-restacks) 11 5 Share Previous Next #### Discussion about this post Comments Restacks Top Latest Discussions [The \$100 Heart Scan Many Cardiologists Say Could Prevent Heart Attacks](https://www.celinegounder.com/p/the-100-heart-scan-many-cardiologists) [New heart guidelines encourage doctors to treat cholesterol earlier. But many cardiologists say the real breakthrough may be a simple scan that can…](https://www.celinegounder.com/p/the-100-heart-scan-many-cardiologists) Mar 13 • [Dr. Céline Gounder](https://substack.com/@drcelinegounder) 11 3  [Fact Check: Does Saturated Fat Really Cause Heart Disease?](https://www.celinegounder.com/p/fact-check-does-saturated-fat-really) [“The problem is that there is no good evidence that saturated fats drive cardiac disease.](https://www.celinegounder.com/p/fact-check-does-saturated-fat-really) Jan 8 • [Dr. Céline Gounder](https://substack.com/@drcelinegounder) 59 14  [The Only Diet Rule That Actually Matters](https://www.celinegounder.com/p/the-only-diet-rule-that-actually) [What a new study in the Journal of the American College of Cardiology says about the fat vs. carb wars](https://www.celinegounder.com/p/the-only-diet-rule-that-actually) Feb 28 • [Dr. Céline Gounder](https://substack.com/@drcelinegounder) 13 2  See all ### Ready for more? © 2026 Dr. Céline Gounder · [Privacy](https://substack.com/privacy) ∙ [Terms](https://substack.com/tos) ∙ [Collection notice](https://substack.com/ccpa#personal-data-collected) [Start your Substack](https://substack.com/signup?utm_source=substack&utm_medium=web&utm_content=footer) [Get the app](https://substack.com/app/app-store-redirect?utm_campaign=app-marketing&utm_content=web-footer-button) [Substack](https://substack.com/) is the home for great culture This site requires JavaScript to run correctly. 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- [When the economy reaches the health department](https://www.celinegounder.com/i/190899622/when-the-economy-reaches-the-health-department) - [When recessions weaken public health](https://www.celinegounder.com/i/190899622/when-recessions-weaken-public-health) - [Why the Iran war raises economic concerns](https://www.celinegounder.com/i/190899622/why-the-iran-war-raises-economic-concerns) - [Why public health and prevention funding disappears after crises](https://www.celinegounder.com/i/190899622/why-public-health-and-prevention-funding-disappears-after-crises) - [The question we should be asking](https://www.celinegounder.com/i/190899622/the-question-we-should-be-asking) - [Question for readers](https://www.celinegounder.com/i/190899622/question-for-readers) After the 2008 financial crisis, U.S. public health departments lost about 50,000 workers. Epidemiologists. Public health nurses. Community health workers. These layoffs did not make national headlines. But their effects became clear a decade later, when COVID showed how fragile many health departments had become. **This newsletter examines how policy decisions and economic forces shape the public health systems we rely on.** [I remember that time well.](https://www.celinegounder.com/p/when-budget-cuts-meet-civil-service) I was an Assistant Commissioner at the New York City Department of Health and Mental Hygiene. I was asked to prepare plans to lay off about 20% of our staff in one year, with more cuts in subsequent years. That experience taught me something important. Economic crises do not only affect markets or government budgets. They can quietly reshape the systems that protect public health. [](https://substackcdn.com/image/fetch/$s_!neHj!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F606a550d-d7ed-4a89-adb2-7f618aecbc96_1408x768.png) Illustration created by Gemini Nano Banana Pro. [Now, another economic shock may be forming.](https://www.instagram.com/reel/DV01UcBumsx/?igsh=MWZkM3M3YzI0aG8ybg%3D%3D) The war between the United States and Iran has disrupted oil flows through the Strait of Hormuz. This narrow waterway normally carries about one-fifth of the world’s oil supply. Oil prices have already risen [above \$100 per barrel](https://www.ft.com/content/e5d1f192-c9f1-448f-9aa4-528d6e867cd2), and analysts warn they could climb much higher. [If oil reaches \$150 per barrel](https://www.theatlantic.com/economy/2026/03/oil-price-200-barrel/686354/), gas prices in the United States could rise above \$5 per gallon. When gas gets that expensive, households often cut spending elsewhere in the economy. After the 2008 recession, public health spending in many places fell by 15-20%, adjusted for inflation. Researchers later called this period a “lost decade” for the public health workforce. If economic pressure grows again, the same pattern could repeat. The effects might not become clear until the next public health emergency. The 2008 financial crisis did more than disrupt markets. It also weakened the systems that prevent disease. As tax revenues dropped between 2008 and 2010, state and local governments faced large budget gaps. Public health departments rely heavily on these funds, so they were hit especially hard. Between 2008 and 2012, real public health spending fell in many places. Budget cuts soon led to job losses. By 2014, local health departments across the United States had lost about 50,000 employees. Many of the jobs lost were key public health roles: - epidemiologists - public health nurses - laboratory scientists - environmental inspectors - health educators These workers investigate outbreaks, track diseases, and run vaccination programs. When these jobs disappear, health departments lose both staff and expertise. In some places, agencies were left doing only basic regulatory work, such as inspections, instead of prevention programs. At the same time, recessions create new health risks. After the 2008 recession, mental health problems increased. Depression and anxiety rose as unemployment grew. Suicide rates also increased in several countries. Economic stress was also linked to rising opioid use and alcohol-related deaths. The opioid crisis grew fastest in regions that lost many jobs during the recession. Financial strain also changed everyday health behavior: - people delayed medical care - prescriptions went unfilled - preventive visits declined - food insecurity increased - housing became less stable These problems build slowly but can harm population health for years. In short, recessions hit public health systems from both sides. Governments cut prevention programs at the same time that health risks in the population increase. At first, these changes may go unnoticed. After 2008, the damage to public health systems received little attention. But the effects became clear a decade later. When COVID arrived, many health departments were already struggling after years of budget cuts, hiring freezes, and reduced preparedness programs. [](https://substackcdn.com/image/fetch/$s_!3lzp!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Ff3b8868b-9c09-4dde-844e-8ad80363b614_1408x768.png) Illustration created with Gemini Nano Banana Pro. The question now is whether another economic shock could start the same cycle again. The current crisis involves a familiar risk: an energy shock. When oil prices rise quickly, it works like a tax on households. People spend more on fuel and less on other goods. Several past recessions followed oil shocks, including: - the 1973 Arab oil embargo - the 1979 Iranian revolution - the 1990 Gulf War - the 2008 oil price spike The pattern is similar each time. Energy costs rise, inflation increases, consumer spending falls, and economic growth slows. It is still unclear whether the current disruption will cause a recession. But economists are watching closely. [](https://substackcdn.com/image/fetch/$s_!K5tJ!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fa8de7ad8-63ac-4d87-9e2a-316df431a5b7_1408x768.png) Illustration created using Gemini Nano Banana Pro. Public health holds a strange place in government budgets. Prevention programs create large long-term benefits by keeping people healthy. Yet they are often treated as optional spending. Some critics, including voices in the “Make America Healthy Again” movement, argue that public health has failed at prevention. Prevention has always been the core of public health. The problem is not that we fail to understand prevention. It’s that governments and taxpayers repeatedly choose not to fund it. These are the programs they cut first. The result is a repeating cycle: investment grows during emergencies and fades once the crisis passes. The United States is not yet in a crisis like the one in 2008. Domestic oil production is higher today, and banks are more tightly regulated. Still, warning signs are visible: geopolitical conflict, rising energy prices, slowing economic growth, and large federal deficits. If these pressures lead to a recession, the budget choices made in the next few years could shape public health systems for the next decade. Having lived through layoffs in a health department, I know how quickly economic shocks become real. Budget crises soon turn into hiring freezes, program cuts, and fewer people working to stop disease outbreaks. Public health systems rarely collapse all at once. They weaken slowly — budget cycle by budget cycle — until the next epidemic shows what years of quiet cuts have taken away. If another economic downturn happens, what should governments protect first: short-term fiscal stability, or the prevention systems meant to protect us from the next pandemic? Let me know in the comments.