Public health agencies across the country are widely underfunded, according to a recent report from Kaiser Health News. Utah is one of many states that spends less than $100 per person in public health funding, according to the report, spending about $79 per person.
It’s left many state and local health departments scrambling to address the wide range of tasks they’re charged with, on top of a pandemic that’s required a nearly full-force effort.
And while health department budgets in Utah have increased over the years, they often haven’t matched the rise of inflation.
The Bear River Health Department, for example, had an overall budget of $10.3 million in 2015, according to Deputy Director Todd Barson. This year, it’s up to $12.4 million, plus an additional $2 million in funding through the federal CARES Act. But expenses over that time have nearly doubled, for things like vaccines and other supplies, increasing from $1.6 to $2.8 million over that same period.
Joseph Miner, executive director of the Utah Department of Health, said that’s because public health is often low on the list of government spending priorities.
“Public health is in the business of prevention,” Miner said. “And it's difficult to prove you're preventing things if everything is going well, so it’s not understood why you're even necessary.”
The work during a pandemic, like monitoring outbreaks and contact tracing, continues year-round for a range of other diseases, on top of other critical tasks — from overseeing wastewater treatment to registering births and deaths. Miner said it’s similar to the relationship someone has with their primary care doctor, only public health’s patient is a population.
“Just like a physician would do with a patient, you do a history and physical examination of your community,” he said. “What are the leading cause of death? What are the leading causes of disability?”
But the lack of funding has meant that during the pandemic, many of those efforts typically undertaken by a public health department to keep a community healthy have been severely slowed, if not halted altogether.
Salt Lake County’s Health Department, for example, has had to curb a number of its disease prevention programs, according to Executive Director Gary Edwards.
Edwards said people who would normally manage the cardiovascular disease or tobacco prevention programs have shifted to manning the phone lines answering questions about the pandemic response guidelines or going out to help businesses understand what they need to be doing to comply.
“So as we're not doing primary prevention efforts, there are fewer opportunities for individuals to address conditions that will prevent disease,” he said. “Then you're having to rely more on the health care system to deal with that challenge.”
Limited funding has also meant the response to the pandemic itself was hampered. In Northern Utah’s Bear River Health District, which confronted a major coronavirus outbreak at a meat packing facility in Hyrum, public health officials raced to track down everyone involved
Barson said the outbreak occurred as the state began moving into the yellow, low risk phase and amidst Memorial Day celebrations. Both signaled to people their risk of catching the virus had gone down. It also meant his 110 employees were scrambling to keep up.
“I don't know how well we could have prevented that,” Barson said. “But [with more resources] certainly we could have done a quicker response with our contact tracing and been better prepared for the kind of support services for those folks.”
Miner also pointed to the state’s lack of personal protective equipment early on, which led to widespread conservation efforts intended to protect health care workers who needed it most.
Those concerns over PPE supplies were also partly to blame for early guidance to avoid wearing masks. And while the science is clear now that masks are effective at preventing the virus’ spread, Miner said that initial failure — which happened on a national scale — led to widespread shut downs.
“In retrospect, if we had had a very good stockpile of personal protective equipment, then we wouldn't have had nearly the concern that the health care sector could be overwhelmed,” he said. “We wouldn't have had to close down elective medical procedures. We maybe wouldn't have even needed to close down businesses — just stress mask use, physical distancing and hygiene.”
Correction 4:25 p.m. MDT, 7/22/20: A previous version of this story misspelled Todd Barson's name. The story has been corrected.
Jon Reed is a reporter for KUER. Follow him on Twitter @reedathonjon