The local public health sector is overwhelmed by lack of funding as the governor and lawmakers vie for budget. Outdated equipment and inadequate staff interfere with everything from asthma to syphilis.
After running Sonoma County’s Public Health Institute for nearly 24 hours for several months, Rachel Reese has recently been able to shift down to give microbiologists a vacation. They need it: The two are wearing wrist struts due to repetitive strain injury after processing tens of thousands of COVID-19 tests.
But if the pandemic had begun a year from now, this lab might not have existed.
In 2019, Reese’s boss tells her Santa Rosa lab needs to shut down To save money. The review was discontinued because the first COVID-19 case occurred in California.
“Public health laboratories are expensive. To be honest, I think there was a great chance that they would be closed,” Reese added with a diplomatic smile. “It feels like we’ve proved our importance. I’m doing it. “
California’s county and city public health departments are expanding to the limit throughout the pandemic.
Even before COVID-19, there was rarely enough money to do what was needed to protect people’s health, and the pandemic emphasized the risk of long-standing underinvestment, California. Michel Gibbons, Executive Director of the Health Enforcement Association, said.
That’s why many health leaders were shocked and worried when Governor Gavin Newsom didn’t include a new cash injection for public health last month. Proposed budgetDespite the state’s $ 76 billion surplus. Instead, he included money to study future public health spending.
Currently, Newsom and state legislators are arguing over how much money to spend rebuilding California’s public health system.
Congressman suggested At least $ 200 million Each year, we provide new funding to the local health sector and an additional $ 100 million to local nonprofits to improve health equity.Legislature Budget plan Allocate approximately $ 5.1 billion for public health, compared to $ 4.6 billion proposed by Newsome. When asked if he would support the addition of Congress last week, Newsom did not speak to the public health sector and instead advertised his irrelevant efforts to enhance health care.
Congressmen are expected to vote on the bill early next week and continue negotiations with Newsom. The governor must sign the budget by June 30th.
The extra money will be used to hire more public health workers, buy new equipment and modernize computer systems. Many of these are outdated, so lab staff needed to fax early COVID-19 test results.
“This year was a very tough year for so many people,” said Kelly Coropy, director of the Long Beach Department of Health and Human Services. “If we didn’t have to spend too much time begging for resources and had the ability to respond (previously), it would have been much better. A real disappointment to the people of our community. The benefits have come. “
Behind the scenes of public health
The greatest success of public health is invisible and tends to be difficult to measure. Consider a case of food poisoning that was never achieved due to careful restaurant inspection, or an outbreak of syphilis that was prevented by rapid contact tracing and case investigation.
The county public health laboratory does more than just test samples of infectious diseases. They examine local crustacean neurotoxins, mite Lyme disease, animal brain rabies, West Nile virus blood samples, and dangerous E. coli in milk.
Public health agencies operate clinics to register births and deaths and to test and treat syphilis, HIV / AIDS, and other sexually transmitted diseases. Some have organized nutrition classes for diabetics. Others provide home inspections to detect lead paint or asthma triggers.California Public Health Service Scrutinize 39 forensic alcohol laboratories To ensure the accuracy of the drunk driver’s or worker’s test.
Their budget was often a simple goal of cost savings, as much of this work is done quietly away from the public.
“Who went to the restaurant today and said,’Thank you, public health’?” Coropy said. “Most people don’t think along those lines.”
California’s public health funding is so fragmented and associated with certain illnesses that it is necessary to modernize critical laboratory equipment, maintain computer systems, and save lives in a pandemic. It is difficult to maintain a good and experienced staff.
Since 1999, 11 regional laboratories in California have closed or merged to save money, according to the California Institute of Public Health Board of Directors.
“Most of our public health work is based on relationships and people,” said Adrian Casalotti, head of government and public relations for the National Association of County and Municipal Health Officials.
“Reductions (of the budget) mean fewer people work in the health sector, which is certainly not enough in the event of a crisis.”
Local agencies are funded by the federal government, the California Public Health Service, and “Realignment” dollarCalifornia began donating to the county in 1991 to take over previous state-owned programs, including public health.
Public health funds Nationwide declining or leveling off For decades, California is no exception.
As California recovered from the Great Recession, the state cut its general public health resources by 64% between 2007 and 2016. According to the legislative analyst office, the increase in federal funding meant that the total savings during that period were about 11%.
According to state budget data, spending on public health began to increase in California in 2017, with total funding increasing by 19% between 2017 and 2020. Since the pandemic began, more than $ 4 billion has flowed to state and local public health agencies, paying for contact tracers, test kits, protective equipment, and Sonoma County’s new $ 10,000 test sample refrigerator. “
Dr. George Rutherford, an epidemiologist at the University of California, San Francisco, who served as a state health officer in the mid-1990s, said California’s public health workforce should be expanded. The county, which lacks trained health workers, has been forced to train city librarians and other civil servants to work as contact tracers in emergencies, he said.
“Maybe you need twice as many people as you have,” Rutherford said.
Andrew Neumer, an associate professor of population health and disease prevention at the University of California, Irvine, said the county needed an infectious disease specialist who could “take action in an emergency,” but at a time when there was no crisis. Said that we need to look at other illnesses as well.
Almost everything except the COVID was attached to the back burner
Riverside County, like most states, is tracking an increase in sexually transmitted diseases such as chlamydia and syphilis, especially in the desert areas of the county, said Kim Salwatari, director of public health.
However, her department can only handle cases that are considered high risk, including pregnant women.According to Mr. Saruwatari, the agency is about Chlamydia 12,000 reports Every year, her staff can only investigate about 10% of them.
This means more outbreaks that could have been prevented. “What’s happening is that we’re responding to the incident, not standing in front of it,” Saruwatari said.
Riverside County has nine infectious disease investigators, about the same number employed in the late 1980s, but the population has more than doubled since then.
Salwatari, who has worked in this department for about 20 years, has witnessed several programs and his position has disappeared. Riverside County once had a health education program for 25 people, which disappeared in 2007 when the economy slumped. Thirty nurses taught classes and county programs for schools and senior centers were disbanded during the Great Recession. Some people filled other positions instead.
Five years ago, the county also lost state funding for its asthma program. This helped ensure that people were being treated and allowed them to self-manage their condition to reduce asthma attacks. Around the same time 15% of all adults He was diagnosed with asthma in Riverside County.
In the spring of 2020, Imperial County was one of the first areas to face a surge in COVID-19 infections and hospitalizations. At some point in the pandemic, the county had 100 people working in epidemiology, thanks to federal and state emergency assistance. However, prior to COVID-19, only four people were assigned to the unit.
Janet Anglo, Director of Public Health at Imperial, said:
Meanwhile, her preventive care worker transformed into a COVID-19 case investigator and contact tracer. Pregnant women’s health, nutrition and dental health programs have been placed on the back burner.
According to Anglo, the staff has just begun to return to their regular posts and there is a lot to do.
The consequences of this one-year suspension will be seen in the coming months and years, but of particular concern to Imperial County. Rank at the bottom In California, there are social and economic factors such as health behaviors such as lack of exercise and smoking, access to care, unemployment, education and poverty.
On Long Beach, Colopy said it manages more than 100 individual grants, each requiring a series of paperwork to maintain the city’s public health sector.The city once offered diabetes education classes in five languages, but when the five-year grant is over, the classes are 12% of adults in the city I have been diagnosed with an illness.
Lori Williams, director of public health in Stanislaus County, said he expects chronic illness to worsen due to the large number of people. Skipped medical While they are evacuating to their place. Diabetes, Alzheimer’s disease, obesity and sexually transmitted diseases require additional monitoring, she said.
Public health is expanding, but the dollar is not.
Health officials in some counties said a new team was needed to address the medical inequality that became apparent during the pandemic. We also want to create a public dashboard for other infectious diseases.
The role of public health is also expanding to include public safety as well as housing that affects physical and mental health.
For example, the crowded housing in Madera County was the only and most important factor in predicting the COVID-19 case rate there. The county’s director of public health, Sarah Bosse, said walking and cycling are dangerous because of crime, and it is difficult to maintain a healthy diet and physical activity in areas where convenience stores are the only shopping option. It was.
Local health leaders are wondering as budget negotiations in Sacramento prolong. Do we need another pandemic to finally get the money they need?
Dr. Sarah Cody, Director of Public Health in Santa Clara County, said: .. “We … need to have a common understanding that public health is the backbone of community health.”
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