by Dr. Patrick Jones
If the corona virus epidemic has caused a re-ordering of trusted sources, the likely winner is our healthcare system. While the majority of the attention has been directed to the front-line players, and deservedly so, public health has also been center stage during the epidemic. Many of us have become eager consumers of the latest word from epidemiologists, disease specialists, nurses giving covid-19 tests and public health officers.
But it wasn’t always so. For most of the past decade, public health has walked in the shadows of the public. Professionals in public health were hardy fixtures at city, county, and business gatherings, let the press. Another dimension of the difference shown by a good part of society to public health is reflected in our funding for it. After all, the importance society accords to a particular function is our funding for it.
Trends Indicator 4.4.6 tracks the local funding component of the Walla Walla Department of Community Health over the past decade of so. Expressed in per capita terms, the County’s contribution to the 2018 budget of Community Health amounted to about $34 per resident. As one can easily see, that amount is far lower than the state-wide average of the local funding for health districts, which stood nearly twice as high, at $63 per resident in the same year.
The indicator also expresses the local funding component as a percentage of total county personal income. The thought is that richer counties will naturally show higher per capita levels because of larger local governments , but their “pocketbook share” of this funding may be different. If a personal income in a county is lower than the state average, it is still possible to have lower per capita spending but higher pocketbook shares. Yet, here, too, Walla Walla lags its local government counterparts across the state, with 70 cents allocated to public health out of every $1,000 of personal income in 2018. The state average: about $1 per $1,000 of personal income, or about 50% higher than in Walla Walla.
What do the trend lines look like? Both headed south. Whether measured by per capita or pocketbook share values, local funding for public health has actually declined over the past decade.
Compared to Eastern Washington, however, Walla Walla’s local funding component of public health is actually the best, according to the source of the indicator, the WA State Auditors Office. In 2018, it spent more than Spokane did on public health. And the level of local funding was far higher than that of Yakima, Benton and Franklin Counties. Of course, one takeaway from this comparison is that all eastern Washington hasn’t valued public health as much as west-side counties.
Of course, local public authorities can hardly rely on local funding to conduct the full extent of their activities – environmental health, nutrition, outreach, immunizations, obesity prevention, workplace safety, and importantly, disease surveillance. Some funds come from federal grants as well as from Washington state. (In the case of the Spokane Regional Health Department, these sources are far more important than local ones.) Some revenues for the Community Health department also come from fees assessed to businesses and homeowners.
Still, the prevailing sentiment in our state and nationally has been to de-emphasize the role, and hence, funding, of public health. For example, in one fiscal year, federal funding for the Centers for Disease Control (CDC) dipped nearly $1 billion, from its 2018 level of over $8 billion. In our own state, the for the 2019-2021 biennium funding for the Department of Health decreased by nearly a double-digit percentage. Clearly, public health hasn’t, until now, been a national, state or local priority.
In the aftermath, whenever that occurs, of the corona virus pandemic, it seems likely that this relegation to a low priority will shift. How? All governments will need to pay for any increased public service, except the federal government, which can continue to issue great amounts of debt. An imminent re-emphasis on public health will either come from a greater governmental revenues (taxes) overall, or a re-ordering of budgets. The first approach seems unlikely. So the job of our public appropriators, at every level of government, has just gotten more difficult. But there is likely no other choice.
The U.S. has been told to brace for an extended period of combating this virus. And virologists have told us the corona virus will not be the last pandemic. In the past three months, public health has certainly shown its mettle and value. Since we publicly fund what we value, this indicator tracking local government funding for public health will likely show a significant jump in the height of Walla Walla’s contribution over the coming years.