Editorial: Public health may see better funding, reforms

By The Herald Editorial Board

That public health in Snohomish County and for the state’s other county-level public health districts has been poorly funded for years was clear long before our now year-long battle with the coronavirus pandemic.

That was evident four years ago when the Snohomish Health District — hit by funding cuts that followed the 2008 Great Recession — took its case closer to home and pleaded for additional funding from the county administration and each of the cities and towns, seeking an allocation of $2 per resident to supplement funding of the long list of services it provides to prepare and respond to disease and facilitate prevention work.

And we might have taken the hint — but didn’t — about the necessity of adequately funding public health two years ago, when a measles outbreak, centered mostly in Clark County but also felt here in Snohomish County, added to the public health work load at a time of smaller staffs and reduced support.

Consider for a moment what’s expected and what’s provided by state funding:

Among services Snohomish Health and other county-level health agencies are expected to provide are: tracking and responding to disease in the community, including sexually transmitted diseases, opioid addiction, tuberculosis and hepatitis; recording birth and death certificates; recording and keeping health statistics; inspecting restaurants and issuing food-worker cards; testing drinking water and wells; inspecting septic systems; and providing health and nutrition services to children and youths. And that was before covid-19.

Washington state’s per capita spending on public health, according to a report by the Trust for America’s Health, ranked near the nation’s middle at 23rd for the 2014-15 fiscal year; $33.50 for each resident. More recently for 2019, that ranking improved to 19th, with per capita spending now $46 for each Washington resident; that’s not Missouri’s miserable $7 a person, but it’s not New Mexico’s $140 each either.

So no one — in particular public health agencies — were fully prepared for the pandemic. And funding hasn’t been the only concern.

“The pandemic has laid bare the underfunding and structural problems in our local and state public health system,” Sen. June Robinson, D-Everett, said in a recent interview with The Herald Editorial Board.

One of covid’s silver linings, then, has been the attention refocused on public health funding, delivery of services and its administration. After earlier attempts to increase funding and adopt reforms fizzled, legislation passed the House this week that offers structural reforms, but will require a funding commitment from the Legislature as it adopts a budget for the next two years.

House Bill 1152, which passed the House on Monday, would add a layer of four regional service centers — two in Western Washington and two in Eastern Washington — to support the work of county-level agencies, establish a state-wide advisory board to oversee the state system and also mandate some changes for some county health districts.

Along with the system’s inadequate funding, the pandemic also revealed problems with politics in some counties, notably Spokane County, where that agency’s health officer was fired, reportedly in a disagreement over covid restrictions. Initially, the legislation sought the creation of nine regional districts, with those regional authorities taking greater authority over county agencies. But that proposal brought push-back from county health departments and some Republicans in the House, the Spokesman-Review reported.

The legislation has since been amended to allow county-level districts to maintain much of their control and decision-making, but would require that — with one exception — each county add non-elected members to the county boards of health. Snohomish County lobbied for that one exception, excused from the requirement because — while its 15 board members are all elected officials — it is comprised of three representatives each from the county council and city councils in five districts.

Snohomish County’s lobbying for an exemption is understandable; the relationship between the county Board of Health and the district and its employees has generally worked well, particularly during the pandemic. But the county Board of Health would serve the residents it represents even better if it included non-elected members, including those with medical and health services expertise and from the county’s Native American tribes.

Just such a restructuring, in fact, was recommended in a 2016 report by the Ruckleshaus Center, which was jointly requested by the county Board of Health and health district staff.

Among other provisions in the legislation:

The four regional districts would establish regional centers that would coordinate shared services, resources and equipment with the county-level agencies, Robinson said Tuesday. (Rather than pursue separate Senate legislation, Robinson has been keeping in touch with the sponsor of the House legislation, and said she largely supports what was voted out of the House.)

“For example, Snohomish, Skagit, Whatcom and Island counties, if they wanted to share epidemiology work might hire an epidemiologist or two, who could be housed within an existing local health district,” she said.

Four regional health officers, employed and paid by the state, also would also be available to county districts, providing backup and acting as liaisons with the state Department of Health.

Those structural changes are contingent on a minimum level of funding for public health. On top of current statewide funding of about $30 million, additional funding would be split: about 65 percent for the shared regional centers and the remainder allocated locally by the state Department of Health.

But the eventual funding goal is actually higher, Robinson said, as much as $250 million in coming years. That will depend on a pending revenue forecast and the fate of tax proposals, including a tax on sugary soft drinks and on health insurance coverage that will be part of budget discussions.

“We won’t get there right away, but that would be the goal,” she said.

The reforms in the House legislation will next get a hearing before the Senate’s health committee, on which Robinson is a member. Funding and revenue discussions are also ahead.

In the meantime, Snohomish County should dust off its copy of the Ruckleshaus Center report and consider how it might best prepare for increased funding and other reforms.