As well-worn as the old saw is — about ounces of prevention and pounds of cure — the advice is too often ignored. And it’s especially apt when applied to how the Snohomish Health District’s current financial straits are limiting the preventive work it can do.
The health district is the independent countywide agency responsible for providing a range of public health services. Beyond issuing birth and death certificates, reviewing septic system plans, offering immunizations and issuing food handler cards, the district is responsible for responding to outbreaks of disease, addressing chronic health threats including childhood obesity, teen tobacco use and sexually transmitted diseases, monitoring tuberculosis and administering nutrition assistance to women and children and offering parenting classes, among many other services.
And it’s being called on to address new health threats in the community, in particular, opioid addiction. The district has organized needle exchanges and distribution of naloxone kits to treat heroin overdoses; it’s establishing a drug take-back program that will be supported by pharmaceutical companies; and it’s working with doctors to limit over-prescription of pain medications.
The district also is working to set up a system with local emergency rooms to report opioid and other drug overdoses, not only to provide useful data, but to direct those with addictions to treatment.
But as the county’s population continues to grow and as new health issues arise, the district’s revenue sources are flat, if not declining, and are less and less predictable.
The district’s programs are supported by state and federal grants, state and county funding and revenue from licenses, permits and service fees. But much of the revenue it receives is dedicated to specific programs, limiting the flexibility the district has to address other health issues.
And unlike other public districts, the health district has no taxing authority.
Overall district revenue has been on a steady decline since the recession in 2008 and has not recovered as other health districts in the state have. Of the 35 health districts in the state, Snohomish ranks 34th in per capita spending at $22 a person. That’s compared to $116 per person in Seattle-King County and a national average of $41 per person.
Since 2008, Snohomish Health District has laid off 74 full-time equivalent employees, reducing its staff to 143 FTEs. Tacoma-Pierce County, with a population similar to Snohomish’s nearly 750,000, spends $36 per person, and has maintained a staff between 220 to 230 FTEs.
The layoffs are likely to continue in the future. As early as 2018, the health district is likely to exhaust its reserves and would need to cut programs.
The state has a responsibility to provide for the health of all residents. And Snohomish district officials are working with the state Department of Health, the state Association of Local Public Health Officials and other health districts to outline the state’s basic expectations for health districts and also secure stable funding for the districts in the state budget.
As we’ve seen with public education, that may take some time.
In the short-term, the Snohomish Health District has begun meeting with the county’s city and town councils, requesting that each make room in their budgets to provide a grant of up to $2 per person based on their population.
Everett, with a population estimated at 108,300, would be asked to provide up to $216,600 in 2017. Index and its 165 residents are being asked for $330. The county, while it already provides some per capita funding, would increase its rate to $2, boosting what it pays the district by about $890,000. The result would be a $2.4 million increase in revenue for the district if all communities participate.
As health district officials make their presentations this summer to each city, they also are offering to work with cities and towns to outline specific programs tailored to their communities. As well, the district is committing to annual reports to each city on what their investments have helped provide.
No local government is enjoying a particularly flush time right now. Even $2 per person will require some choices as cities write their budgets. But the request is modest and would be a cost-effective use of public money.
Unless the nation is extremely fortunate, with the arrival of Zika in Florida we could see the grave costs of Congress’ refusal to timely increase funding for research and a preventive response to the mosquito-borne virus.
We face similar consequences here, including increased costs of treatment and a human toll in lives, health and the community’s vitality, if we balk now at paying for that ounce of prevention.