Seven months ago, a public health nurse met a single mother of four kids who was scared and ill after leaving an abusive relationship.
The nurse, Adriane Martinez, is one of four nurses countywide who makes monthly and weekly house calls to low-income moms with newborns in the Snohomish County Health District’s First Steps program.
The mom, a woman named Kim, 34, lived in temporary, transitional housing with her three young kids and newborn infant while she searched for a more permanent housing solution.
But her own health complications — namely, kidney disease and high blood pressure — led Kim to miss required appointments with Volunteers of America, which runs the transitional housing program. She faced the prospect of not qualifying for federal subsidized housing of her own because she was so busy meeting with doctors, Martinez said.
“Kim called me all frantic, saying ‘Where do I go, what do I do?’” she recalled.
Over the next few days, Martinez helped Kim get the medical references she needed so she could qualify for the federally subsidized housing she now shares with others near Martha Lake.
“If it weren’t for her, I don’t think I’d have housing,” Kim said.
Such success stories may end soon, however. The Health district says it faces a $4.4 million 2009 budget shortfall that could mean elimination of the First Steps program and a 20 percent workforce reduction beginning in October.
“We are number one on their list for cuts,” Martinez said.
Snohomish Health District’s dire situation isn’t unique. Across the United States, public health departments face dwindling dollars for programs.
“All of us share this challenge: Public health has always been the poor stepchild of medicine,” said Dr. Gary Goldbaum, the health district’s director. “When public health does its work really well, no one knows about it.”
Among the programs proposed for the chopping block:
• Monitoring and testing for West Nile Virus
• Immunization programs
• Childcare health
• Sexually transmitted diseases clinic and STD prevention/intervention
• Healthy Communities, a program the city of Lynnwood is deeply involved with
• Environmental health
To understand the health district’s current pickle, it is important to understand the district’s history.
Until 1995, public health financing was a joint responsibility of cities and counties. Cities contributed $7.48 per resident. In 1995, former state Sen. Phil Talmage sponsored a bill to resolve funding conflicts between cities and counties by transferring a little less than 3 percent of Motor Vehicle Excise Tax revenues from cities to fund local public health.
That change meant cities were no longer responsible for a portion of public health funding.
In 1999, however, voters approved Initiative 695, which eliminated the state’s car tax and, along with it, about 7 percent of the state’s revenues. Though the initiative was later found to be unconstitutional, the legislature made the cuts permanent.
Fast forward to 2008 and a stagnant economy, plus what Goldbaum maintains has been under funding by the state and federal government and you have a crisis, he said.
“It’s the perfect storm,” Goldbaum said: “Fifteen years of flat funding from the county; about three years of flat funding from the state, flat funding from the feds and the economic downturn.”
He said the county council instructed the health district to use reserve funds—the health district’s rainy day fund. The end result, he said, is a $4.4 million hole in a $22 million budget. County Executive Aaron Reardon, in an Aug. 8 letter to mayors and city council chairs, urged cities to kick in $3.74 per resident and proposed the county increase its contribution while everyone works on health district funding reform.
“Later this month, I will extend invitations to representatives of the Health District, cities, the County Council, my Executive team and other community groups to discuss this strategy and our next steps,” Reardon wrote.
City leaders, however, are reluctant to implement Reardon’s tax proposal.
“Right now, we’re focused on our own issues,” said Mountlake Terrace City Manager John Caulfield.
“Frankly, we do not have the $150,000 to pay for that,” said Edmonds Mayor Gary Haakenson, whose city is facing a $5.4 million shortfall from 2009-2010. “I’m sorry that they have to lay off people. But we may have to lay off people, too.”
Dave Gossett, who, like all county council members, sits on the health district’s Board of Health, proposed in an Aug. 15 memo to fellow board members that other options be examined in upcoming meetings.
“I believe there are a number of steps we should consider prior to making any cuts in service to the public of staff layoffs,” Gossett’s memo said.
First, he wrote, the board should examine revenues and expenditures to make sure there’s agreement on just how much of a shortfall there really is.
Secondly, he wrote, the board should examine the health district’s reserve requirements and how much “if any” should be earmarked to offset the shortfall. Third, the health board may want to consider expediting fee increases and, finally, it should look closely at options that don’t involve layoffs or service cuts, including looking at other local funding sources.
The district’s main labor union, the Washington State Council of County and City Employees, represents about 50 health district administrative and clerical support workers.
“The county has historically advocated that the health district spend down its reserve as opposed to increasing any funding,” said the union’s Deputy Director Pat Thompson Aug. 19. “That’s a pattern that’s been established for the past six years. So, the assumption would be that if that’s the case, when that reserve runs out, the council’s responsible for a plan to replace the funding.”
Lynnwood City Councilman Jim Smith, who represents the council on the health board, said the proposed cuts “came as kind of a shock to all of us,” on the board and added that he believes the health district has “not managed its funds wisely.”
“Many of us on the board are not very happy about this,” he said. “This is typical politics where when somebody’s faced with budget constraints, they put out on the chopping block the most popular programs.”
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