If you want to discover a big reason why the United States leads the world in health care costs, follow the money. Treatment, facilities, equipment and workers represent a mountain of cash. Meanwhile, disease prevention is an eroding foothill, because public health services get short-shrift.
A stunning 86 percent of health care spending goes to treating people with chronic ailments, which can last a year or two or a lifetime, according to the Centers for Disease Control and Prevention.
Sustained policies and public education campaigns have reduced smoking, so we know prevention works. But obesity remains high. Diabetes, heart disease and some cancers are preventable; as are shorter-term conditions such as measles, mumps and the flu.
In this country, public health is left largely to the states. And in this state, it is left it is left largely to counties. Cities used to chip in, but not after funding disappeared in the wake of Initiative 695 ($30 car tabs). Backfill from the state has been flat ever since and does not account for inflation. Tobacco settlement dollars, a logical funding source, were swept into the state’s general fund.
From 1998 to 2008, Spokane County was able to keep funding for the Spokane Regional Health District at par, but funding has eroded since the recession. On a positive note, this has caused the agency to become more efficient, but that only goes so far. SRDH has had to rely on assistance from the Panhandle Health District in Idaho and Tacoma’s health district during the mumps outbreak. But like wildfires, when resources are shifted to putting them out, prevention suffers.
Health districts are in similar straits across the state, so they worked with the state Department of Health to identify the core services only government can provide. Now they would like $60 million from the Legislature to fund them. The governor’s budget sets aside $24 million. The House and Senate budgets are works in progress, and basic education funding looms large.
The Legislature is considering bills that would raise funds for public health. One would tax vaping devices at the same level as tobacco products. Another would tax sugary beverages.
If the SRHD were to get sufficient funding, it would spend it on the prevention. The district has identified three areas of need:
Sexually transmitted diseases: Rates of gonorrhea, chlamydia and syphilis are up. The district has had to shift funds away from prevention to investigations, and even those have been scaled back.
Preschool immunizations: Spokane is in the bottom third of Washington counties for children 19 to 35 months old, with an immunization rate of 42 percent. The statewide rate is 58 percent, which lags the national rate of 71 percent.
Chronic diseases: The district has been training people in low-income housing to help their neighbors manage and prevent conditions. Ten housing units are on the waiting list for training.
Public health funding is a matter of paying now or paying a whole heckuva lot later. Prevention must become a priority.