Public health agencies do a great deal to protect communities. Human nature being what it is, most of us take this work for granted.
But this system — which helps protect the public against everything from tainted restaurant food and bad water to toxic lake algae and infectious disease outbreaks — is starting to unravel.
The crisis is at both the state and local government levels, according to state Health Secretary John Wiesman and Thurston County public health Director Schelli Slaughter.
They described a dire situation recently in a meeting with The Olympian Editorial Board. They said the hollowed-out public health system no longer keeps up adequately with communicable disease outbreaks such as syphilis, which is on the rise, or adequately monitors disease trends in hospitals and communities.
A scary example cited by the state Department of Health is the existence of about 100,000 people in King County with latent tuberculosis, which means a patient’s infection is in remission. Due to budget constraints at the county and state levels, these patients are not being actively monitored or screened by public health officers — even though one in 10 cases eventually is expected to become contagious.
Private sector hospitals and clinics are left to pick up the monitoring slack in a system that is getting more limited in its capacity to respond to threats.
Slaughter said her agency was heavily engaged recently with recent toxic algae threats at Summit Lake, leaving little capacity in the agency to take on another crisis.
For many reasons, this funding crisis in public health has gone somewhat unnoticed in Washington. But advocates like Wiesman say bills are coming due for a system that needs modernizing.
The cost to modernize and fill funding gaps is in the neighborhood of $312 million to $344 million, according to a Department of Health report on modernization needs in December.
The health-funding gap worsened during budget cuts of the Great Recession. But it began more than 15 years ago when car-tab fees — which once augmented health programs at the county level — were slashed by an initiative and then by the Legislature. State funding was restored in part by lawmakers, but it’s never kept up at past levels.
Wiesman, who joined the agency four years ago, noted one Great Recession cut — canceling a casualty insurance policy on the state health lab — made no sense. He said he restored coverage when he learned about it.
Knowing that the Legislature already is struggling to pay for K-12 schools and mental health treatment, Wiesman said he initially requested $60 million in new funds over the next two years to start reinforcing state and local agencies’ responses to health threats. But Gov. Jay Inslee proposed $23.9 million in new funding, the House budget offered about $40 million, and the Senate budget provided none, according to the agency’s analysis.
DOH says the governor’s request is enough to fill the most critical gaps in communicable disease monitoring and also the state’s response to outbreaks such as food-borne illnesses, measles, mumps or following up sexually transmitted disease complaints. But Inslee’s proposal relies on tax increases that the Senate has rejected so far and the House has not voted to approve.
There are good reasons not to delay the public health modernization. Many syphilis cases go without follow-up that can halt its spread in the population, despite rising case numbers. As many as half of gonorrhea cases in some counties similarly do not get followed up by local health-department staffers that traditionally interviews patients.
A mumps outbreak that began last October led to about 2,480 investigations in 15 counties — including 34 cases in Thurston County. Ultimately 429 were confirmed infections and 431 were deemed suspected infections. This labor-intensive response, which is what public health systems are designed for, put strain on the state health lab and public health staffing.
Slaughter says Thurston County is rated seventh healthiest in the state, based on different health data. But healthiness varies greatly by zip code.
She and Wiesman are worried about what the future may bring, because many common diseases are easily preventable, yet agencies have too few resources to carry out education and prevention work that could reduce use of tobacco and drugs, while leading to less diabetes and less cancer.
Slaughter noted that her cash-strapped agency recently needed state toxicology help with the Summit Lake algae bloom. But Wiesman says his agency, which used to have six toxicologists to cover the state, is down to about three positions after a federal grant ran out.
Lawmakers and the taxpaying public need to do the math.