The work of public health is overlooked and underfunded

When a police car races past you responding to a call, or a fire truck is parked on your street to help a neighbor, you know that public safety staff are on the job. Public health employees also protect health and safety, but we don’t wear uniforms or use sirens on our cars.

Public health works every day to prevent disaster, large and small, but this work is done quietly in the background. Public health investigates infectious diseases (like measles and whooping cough) to prevent their spread, inspects restaurants to assure safe food, permits wells and septic systems to assure safe water, and supports new mothers to assure that the first months of a child’s life will be healthy.

Our emergency response work is also often invisible, but always important to the community. Public health staff worked hand in hand with emergency responders during the SR 530 mudslide and flood. Once we knew that hospitals could readily manage casualties, we turned to supporting the Medical Examiner’s Office, helping to confirm who was truly missing and to obtain information to identify human remains. Given the deeply emotional effect of such loss of life in a tightly-knit community, we worked from the start with the Red Cross, Green Cross, and local mental health providers to assure that mental health services were available to survivors, families of the missing and dead, responders, and community members.

Concerns quickly arose about responders (and surrounding communities) being exposed to toxic substances in the mud, so we worked with state and federal agencies to assure that the environment was tested (no bad reports so far) and that systems were in place to monitor responder health. With hundreds of responders on-site, public health staff assured that food handling practices were sound, that hygiene messages were visible, and that the disposal of debris would not pose a threat to the health of workers or those living in the area. And we mobilized our Medical Reserve Corps volunteers to assure medical care would be available to people unable to access care as a result of the slide.

Like volunteers and employees of many other public agencies, public health staff worked tirelessly for three consecutive weeks to address these issues. Fortunately, we had many extraordinary partners who helped support the medical examiner, assure worker safety, monitor the environment, and provide mental health and medical services. As the recovery effort continues, public health is still working, to assure that the environment near the mudslide and the mud removed from the site do not pose a threat to nearby communities. We are also helping with a state Department of Health project to assure residents that well water is safe.

The mudslide created a crisis to which the entire community responded. A much less obvious crisis also deserves a community-wide response. This is the crisis in public health funding.

Unrecognized when it does its work well (who notices when bad things don’t happen?), public health is nonetheless important to everyone. The mudslide demonstrated the value of public health in a disaster, but staff could not have handled more. For the past two decades, funding for public health has plummeted. My own agency, the Snohomish Health District, has seen its funding and staffing cut by more than a third. And we are not unique — King County’s public health department recently announced potential elimination of more than 200 positions next year.

Voters routinely support levies and bonds for education and emergency medical services, and lobby for sufficient fire and police protection. Public health is an equally important public service, which needs to be there when we need it — every day — so we can keep the water and food safe, respond to disease outbreaks, and be there for the next disaster.

Gary Goldbaum, MD, MPH, is the health officer and director for the Snohomish Health District.

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