Editorial: State must boost funding for vital public health agencies

By The Herald Editorial Board

The Snohomish Health District, which is responsible for providing a range of public health services to the more than three-quarters of a million people in Snohomish County, out of necessity has gotten good at asking for financial support.

Last year, desperate to make up a shortfall in funding that threatened its ability to offer basic services, the district began a public campaign to the county’s more than 20 cities and towns, asking each, as well as the county, to provide an allocation of $2 per capita to support the district’s public health work. The agency is not supported by its own tax revenue and is not a county department.

Of the 35 public health districts and county health departments in the state, Snohomish Health District routinely ranks near the bottom in terms of per capita support.

Those pitches were mostly successful and convinced about two-thirds of the county’s cities and towns to include that allocation in their 2017 budgets. The health district, in making that ask, has arranged to prepare regular presentations to show how the district is using those investments in each city, and will be making the same request for 2018.

Now the Snohomish Health District is joining its fellow health district in making a pitch for increased financial support from the state. Statewide, there is a combined biennial shortfall of $400 million in core public health services. The state Department of Health, recognizing the financial constraints the state faces in amply funding K-12 education as well as resolving a mental health services crisis and other needs, made a resonable request of $60 million, $50 million of which was to be allocated among the local health agencies, $6 million for Department of Health programs and facilities and $4 million to develop pilot programs to modernize public health delivery.

Gov. Jay Inslee further trimmed that modest request to less than $24 million, splitting $20 million among the local agencies and $3.8 million for the state agency. The governor also outlined $5.9 million, separate from public health agency spending, for his initiative to address environmental lead exposure, particularly at local school districts.

Budget realities have to be considered, but the Legislature, as it hashes out its own spending plans in the House and Senate, should not consider providing less than the governor has outlined.

Washington state ranks near the middle of the rest of the nation in per capita spending on public health needs, according to the latest annual report from the Trust for America’s Health, a nonprofit, nonpartisan public health advocacy organization. Washington ranks 23rd for the 2014-15 fiscal year in per capita spending, $38.20 per person. The median spending level is $33.50. Washington is outspent by other Northwest states, such as fourth-ranked Alaska at $126.80 per person and seventh-ranked Idaho at $94.70. Oregon ranks 31st, spending $26.60 per person.

This spending makes a difference.

Ideally, local health districts should be balancing their programs between prevention and response to outbreaks. With the shortfall in funding, Snohomish and other districts have had to redirect money away from prevention — where it can have the greatest cost effectiveness — in order to head off a public health disaster during outbreaks of disease. A continued lack of funding threatens to jeopardize even that response.

As of early February, Snohomish County led the state in flu deaths at 33 of the states 148 deaths.

Dr. Gary Goldbaum, director and health officer for the Snohomish Health District, speculated that influenza vaccination rates may have been lower in this county than others this season.

Likewise, childhood vaccination rates have fallen in the state. Snohomish County’s sexually transmitted disease rates have increased, 126 percent in one year for syphilis alone. And E. coli infections continue to crop up, closing a Monroe daycare in July after two girls were hospitalized with the bacterial disease.

We’ll take the opportunity here to thank Dr. Goldbaum, who announced his retirement in October but has remained at his post while a new director is hired. Goldbaum has led the agency during a time of budget cuts and faltering support at all levels.

Since his arrival in 2007, the Snohomish Health District’s staffing has fallen from more than 225 full-time equivalent positions to 137, but the agency has continued to meet its daily responsibilities while being a leader in the state for health initiatives, including a county vaping ordinance that provided a model for a state-wide law and a prescription drug take-back program that mandates funding from the pharmaceutical industry. The take-back program, in the midst of its launch, is only one of two in the state and a handful across the nation.

A state budget that begins to make necessary investments in public health would be fitting recognition of his career and the work of all public health employees in the state.