Congress has poured ten billion dollars into state and local public health departments in response to the coronavirus pandemic, pay for masks, contact detectives and education campaigns to persuade people to be vaccinated.
Public health officials who have budgets with bare legs for years are glad they have the extra money. However, they are worried that it will soon dry up as the pandemic subsides, and the ongoing funding cycle that has plagued the US public health system for decades continues. If the budgets are cut again, they warn that it could leave the country where it was before the coronavirus: unprepared for a health crisis.
“We need funds that we can rely on year after year,” said Dr. Mysheika Roberts, the health commissioner from Columbus, Ohio, said.
When Roberts started in Columbus in 2006, an emergency preparation grant paid for more than 20 staff members. By the time the coronavirus pandemic begins, pays it about 10. Aid money that came through last year helped the department set up its coronavirus response teams. While the funding has helped the city cope with the immediate crisis, Roberts wonders if history will repeat itself.
After the pandemic is over, US public health officials fear they will once again scrape together money from a patchwork of resources to provide basic services to their communities – just as they did after the 9/11 attacks and the outbreak of SARS and Ebola. .
When the mosquito-borne Zika virus torn apart by South America in 2016 and causing severe congenital abnormalities in newborn babies, congressmen could not agree on how much and how much they would have to spend in the US for prevention efforts, such as education and mosquito reduction. The Centers for Disease Control and Prevention has taken money from Ebola’s efforts, and from state and local health department funding, to pay for the initial Zika response. Congress finally allocates $ 1.1 billion to Zika, but then the mosquito season in a large part of the USA was over
‘Something’s happening, we’re throwing a lot of money at it, and then we’re going back to our shrinking budgets in a year or two and we can not do the minimum of things we have to do day in and day out, what else says of readiness for the next emergency, ”said Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents leaders from more than two dozen public health departments.
Public health emergency health funding, which pays for emergency functions for state and local health departments, fell by about half between the 2003 and 2021 financial years, and that is inflation, according to Trust for America’s Health., an organization for public health research and advocacy.
Even the Federal Fund for Prevention and Public Health, introduced by the Affordable Care Act to provide $ 2 billion a year to public health, has been slammed for cash over the past decade. If the money had not been touched, local and state health departments would have received $ 12.4 billion.
Several lawmakers, led by Democratic U.S. Senator Patty Murray of Washington, want to end the boom in legislation it will eventually provide $ 4.5 billion annually in core public health funding. Health departments perform essential government functions – such as managing water safety, issuing death certificates, detecting sexually transmitted diseases and preparing for infectious outbreaks.
Expenditure on public health departments fell by 16% per capita from 2010 to 2019, and spending on local health departments fell by 18%, KHN and The Associated Press found in a July survey.. At least 38,000 public health jobs were lost at the state and local levels between the recession of 2008 and 2019. Today, many public health workers are employed on a temporary or part-time basis. Some are so poorly paid that they are eligible for public assistance. These factors reduce departments’ ability to retain people with expertise.
As a result of these losses, the coronavirus pandemic caused an exodus of public health officials due to harassment, political pressure and exhaustion. According to an annual analysis by the AP and KHN, at least 248 leaders of state and local health departments resigned, retired, or were fired between April 1, 2020 and March 31, 2021. Nearly 1 in 6 Americans lost a local public health leader during the pandemic. Experts believe this is the largest exodus of public health leaders in American history.
Brian Castrucci, CEO of the de Beaumont Foundation, which works for public health, calls the huge influx of cash in Congress in response to the crisis ‘wallpaper and curtains’ because it does not restore the crumbling foundation of public health .
“I’m worried at the end of this we’re going to hire a bunch of contact detectives – and then fire shortly afterwards,” Castrucci said. “We continue to go from disaster to disaster without ever talking about the actual infrastructure.”
Castrucci and others say they need reliable money for high-skilled experts, such as epidemiologists – data-driven detectives – and for technological upgrades that will help detect outbreaks and get information to the public.
In Ohio, the computer system used to report matters to the state prior to the invention of the iPhone. Government officials have said for years they want to upgrade it, but they have no money and no political will. Many departments across the country rely on fax machines to report COVID-19 cases.
The Ohio State Auditor found during the pandemic that nearly 96% of the local health departments surveyed had problems with the state’s disease reporting system. Roberts said workers who interviewed patients had to navigate questions on different pages, which is a huge burden when dealing with 500 cases daily.
The system was so outdated that some information could only be entered into a non-searchable comment box, and officials struggled to retrieve data from the system to report to the public – such as how many people tested positive, a Black Lives Matter meeting attended. , which last summer was an important question for people trying to understand whether protest actions contributed to the spread of the virus.
Ohio is working on a new system, but Roberts is concerned that the state, without a reliable budget, will also not be able to keep it up to date.
“You’ll have to upgrade it,” Roberts said. “And you’ll need dollars to support it.”
In Washington, the director of public health in Seattle and King County, Patty Hayes, said she was constantly asked why there is not a central place to register for a vaccine appointment. The answer comes down to money: years of underfunding have left departments across the country with outdated computer systems that did not have the task when the coronavirus struck.
Hayes recalls a time when her department would do massive vaccination drills, but the system was dismantled when the money dried up after the September 11 ghost faded.
About six years ago, an analysis found that her department was short of $ 25 million annually in what he needed for the core of public health work. Hayes said the past year has shown that it is an underestimation. For example climate change causes more public health concerns, such as the impact on residents when wildfire smoke engulfed much of the Northwest Pacific in September.
In some areas, public health officials may struggle to get the matter more stable because a large portion of the public questioned the mask mandates and business restrictions imposed on public health officials by the pandemic and were often openly hostile.
In Missouri, some land commissioners who were frustrated with the restrictions on public health withheld money from the departments.
In Knox County, Tennessee, Mayor Glenn Jacobs shared a video posted in the fall that showed a photo of health officials referring to “sinister forces.” Later, someone spray-painted ‘DEATH’ in the office of the department. The Health Council was deprived of its powers in March and given an advisory role. A spokesman for the mayor’s office declined to comment on the video.
“It is going to change the position of public health and what we can and cannot do across the country,” said Dr. Martha Buchanan, head of the health department, said. “I know it’s going to change here.”
A KHN and AP survey in December found that at least 24 states were drafting legislation that would limit or remove the powers of public health.
Back in Seattle, local companies raised money and staff members for vaccine sites. Microsoft offers one place, while Starbucks offers expertise to help design it. Hayes is grateful, but she wonders why a critical government function did not have the necessary resources during a pandemic.
If public health were to receive reliable funding, her staff could have worked more effectively with the data and made preparations for emerging threats in the state where the first U.S. COVID-19 case was has been confirmed.
“They will look back on this response to the pandemic in this country as an excellent example of a country’s failure to prioritize the health of its citizens because it has not committed to public health,” she said. “It will be part of the story.”
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KHN senior correspondent Anna Maria Barry-Jester and Montana correspondent Katheryn Houghton contributed to this report.
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Follow Michelle R. Smith on Twitter @MRSmithAP, Lauren Weber @LaurenWeberHP and Hannah Recht @hannah_recht.
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This story is a collaboration between The Associated Press and KHN (Kaiser Health News), which is a national news agency that provides in-depth journalism on health issues. Together with policy analysis and survey, KHN is one of the three most important operational programs at KFF (Kaiser Family Foundation). KFF is a dedicated non-profit organization that provides information on health issues to the country.