“When public health is effective, the public isn’t thinking about it,” says Metropolitan King County Council member Joe McDermott, head of the panel’s budget committee this year.
It’s true. Prevention is not sexy. Fewer people care when the system works. However, the Ebola scare sweeping the world should be a wake-up call. Why wait for an outbreak to happen here? We need strong, robust public-health departments nationwide to keep communities safe.
As Judy Stone’s bluntly worded Oct. 6 blog post for Scientific American points out, a dysfunctional U.S. Congress continues to politicize public health while its members slash federal funding to local governments. The result is weaker capabilities to monitor and respond to diseases and infections that know no borders. See the sorry state of emergency preparedness funding in the chart below from the Centers for Disease Control and Prevention’s “2013-2014 National Snapshot of Public Health Preparedness” report:
Here in Seattle and King County, an invisible infrastructure is working its magic and keeping us all relatively safe. Next time you see a public-health worker, give him or her a pat on the back. The work they do is essential and up against a chronic funding gap that can no longer be ignored, as stated in Monday’s Seattle Times editorial.
In the next biennium, the public-health department faces a $30 million budget shortfall. For the prevention division, composed of staff members devoted to minimizing communicable diseases, this means a potential loss of $4 million affecting the department’s capacity to conduct disease investigations, combat obesity and tobacco use, inform the public and collect data to identify health trends.
“We’re able to respond, but I’ve got to say we are at a very thin place,” warns Interim Director Patty Hayes.
The editorial board encourages the council to prioritize about $4 million to keep prevention services whole, but McDermott says that will be a challenge due to a chronic shortage of revenue (to understand the “structural gap,” here’s a short King County video featuring budget director Dwight Dively) and to the fact that 73 percent of the county’s discretionary funds is tied up in justice and safety programs. Public health and human services represent just 5 percent of expenditures.
The chart below breaks down how funding is divvied up in the general fund budget. (Keep in mind the $30 million shortfall takes into account public health funding from local, state, federal and grant sources.) About 24 percent of general funds, or about $6.5 million, is spent on prevention services. This is the division that controls communicable diseases, collects data and informs the public among other duties. About 51 percent of funding, or $13.6 million, goes toward Community Health Services in the county’s various clinics. This money helps to pay for primary care, dental care, maternal support services (MSS), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and family planning. These services are at risk of being severely cut or changed by January 2015.
In the chart below, Public Health is showing how the budget gap has been exacerbated over the years. In 2000, voters repealed the state motor-vehicle excise tax, which had been a major source of funding for public-health services. While the cost of doing business keeps increasing, state and general funds have simply not kept pace. Federal funds are also way down, despite the passage of the Affordable Care Act.
To address its funding woes and the major problem of direct services through the county-run clinics, County Executive Dow Constantine and Public Health — Seattle & King County have wisely entered into partnerships with other health providers such as UW/Harborview Medical Center and Neighborcare Health for primary-care services and Planned Parenthood for family planning services. Still, thousands of patients — mostly women, children and infants — are at risk of falling through the cracks.
More must be done at the local, state and national level to ensure prevention efforts are not overlooked.