CHARLOTTE, N.C. (AP) — Americans are losing a vast array of people and programs dedicated to keeping them healthy. State and local health departments responsible for invisible but critical work including inspecting restaurants, monitoring wastewater for harmful germs, responding to outbreaks and other tasks to protect both individuals and communities are being hollowed out.

The Trump administration is cutting health spending on an unprecedented scale, experts say. It’s pulled $11 billion of direct federal support and eliminated 20,000 jobs at national health agencies that in part support local public health work. It’s proposing billions more be slashed.

Public health leaders said the cuts are reducing the entire system to a shadow of what it once was and threatening to undermine even rou

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