PHACTS: The time is now to fund public health

By the Public Health Action Coalition Team of Spokane

Does Spokane have the public health district it deserves?

Sadly, the answer is a definitive no. Even as the hardworking staff members at Spokane Regional Health District commit their time and lives to protecting our health, two problems keep the district from fulfilling its mission: too little money and too much politics.

What is public health anyway? The role of the Spokane Regional Health District, and all public health agencies, is to prevent illness, injury and early death for all who live in, or travel through, their service area. Public health is the third leg of the public safety stool with fire and police, but before the COVID-19 pandemic, most folks paid it little mind unless they needed a birth certificate or septic system. While much of what public health does is invisible, it is there, day in and day out, preventing the spread of infectious diseases and ensuring a safe environment.

Counties are the ultimate provider and responsible party of public health services within their borders. They must convene a board of health, hire health and administrative officers, prevent disease, promote health, provide for a safe environment and more. All of these are mandates from the state, and they all take money.

Where does that money come from? Local health agencies in Washington are funded haphazardly. Some funds come in the form of grants or fees for services. Some come from inconsistent local, state and federal sources. Yet, not enough are guaranteed or stable. The bottom line is the current funding for public health is not sufficient.

The state’s public health system currently needs another $225 million per year to fully fund the most basic and essential public health services, according to the Foundational Public Health Services report to the Legislature (October 2020). Twenty years ago, public health’s predictable and dedicated funding through the vehicle excise tax was eliminated by Initiative 695 ($30 car tabs). Since then, funding has been a simulated roller coaster, with sporadic one-time monies in response to specific crises (9/11, H1N1, opioids), which were not maintained afterward. This has made maintaining a trained professional workforce, keeping up with technology, and sustaining needed community programs all the more challenging.

Meanwhile, boards of health and health districts have had to make difficult choices about what necessary technologies to forgo and which programs and employees to eliminate due to limited and restricted funding.

When tough choices have had to be made, enter politics, the creator of winners and losers. This has led to fierce competition for scarce money and disagreement over priorities, sometimes by board of health members lacking public health expertise, which has created political friction and distrust.

The Legislature has heard from public health leaders for a decade that the system is crumbling and needs financial stability to do its job effectively. The pandemic demonstrated you can’t starve the public health system for a generation and then be surprised when it struggles to cope with a global crisis. While some “I told you so”s might be fitting, actions speak louder than words. And actions are underway.

What’s happening now? Legislators have proposed ways to sustainably fund public health. Senate Bill 5149 would fund public health by taxing health insurance plans, starting at $1.54 per month per person starting in 2022, and gradually increasing to $3.07 per month per person in 2026. It is an equitable and broad-based funding source, which would be paid by insurance companies on behalf of 5,427,004 (or more than 70%) of Washington’s 7.5 million residents. This is a reasonable amount to invest so that public health can immediately respond to current emergencies while preventing future disasters.

Lawmakers have proposed modernizing and reorganizing the state’s public health system to ease political tensions and to enhance decision-making. One such proposal – House Bill 1152 – would mandate that local boards of health are composed of at least 50% health experts, to balance out the voices of elected officials. This balance would help ensure that decisions regarding the health of our community are based on science rather than politics.

A healthy community needs adequate funding for public health, in addition to sound decision-making regarding public health issues. SB 5149 and HB 1152 support these efforts. We encourage your support as well.

The Public Health Action Coalition Team of Spokane (PHACTS) is a group of local leaders and community members who support an effective, equitable, transparent, supported and inclusive public health system in Spokane and throughout Washington state. This article was written by PHACTS Steering Committee members Jim Sledge, DDS and former State Board of Health member; Pam Kohlmeier, MD, JD, FACEP; Amber Lenhart, health policy consultant; and Priyanka Bushana, Ph.D. candidate in neuroscience.