Washington is drastically underfunding basic public health services that hampers monitoring and preventing the spread of infectious disease, according to state Health Secretary John Wiesman.
One of the most basic jobs of a health district is monitoring infectious diseases ranging from chlamydia to tuberculosis. Health care providers are required to report cases of a number of diseases to the local health district.
From there, public health workers are expected to contact the person who was diagnosed so they can determine the likely source of infection, find other people who may have been exposed, and reach out to them to see if they have symptoms.
STD rates have been rising in Washington for several years, but Wiesman said most health districts have had to prioritize syphilis and HIV, and don’t have the staff to follow up on chlamydia or gonorrhea infections.
“There are hepatitis cases that we’re not following up on. There are sexually transmitted diseases cases that are not being followed up on,” he said.
The Department of Health received $58 million from the state general fund and $81 million in other state funds for fiscal year 2016, and has a $1.2 billion operating budget for the 2017-19 biennium, almost half of which comes from federal funding.
Two-thirds of that funding is passed along to local health departments and community groups for services.
Wiesman said the department was short $350 million per biennium to be able to adequately perform its key work.
It’s not just disease monitoring. Programs and funds to help people quit smoking have been eroding for years. The $622 million in tobacco taxes and tobacco company settlement money the state collects every year goes into the general fund and is not earmarked for health programs.
Suicide prevention is also underfunded, Wiesman said. Washington has expanded its local suicide hotline call centers, but 30 percent of calls to the National Suicide Hotline are still routed outside the state, leaving people in crisis talking to workers who may be less familiar with local resources. The state has no call centers in Eastern Washington.
Health workers have been pushed to respond to opioid overdoses and addiction, with the result being that they have little time for prevention work that can help build healthier children and families and prevent addiction and other health problems before they start.
“Prevention is much cheaper,” he said. “We have experts who know how to do this work. We have the right knowledge and tools to do it. But there simply isn’t enough funding to fund enough workers to actually carry out all the work.”
Washington has 35 local health agencies, most serving individual counties. Those agencies receive funding from the Department of Health, as well as other state and federal dollars, and fees for services provided.
Disease monitoring starts at the local level, but Wiesman said state underfunding is causing problems for health departments around the state.
Mumps outbreaks in Spokane and King counties in 2017 pushed local capacity, he said, taking experts off of monitoring other diseases or doing other work. If public health were adequately funded, Wiesman said those outbreaks would likely have been smaller because workers would have had more resources to trace people exposed to the virus quickly.
“Time is of the essence when you have an outbreak,” he said.
With the rise of people choosing not to vaccinate their children, more outbreaks of childhood diseases like measles and mumps are likely, he said.
Washington state’s budget has been stretched for the past several years trying to make up a significant funding gap in the state’s education system. With the state Supreme Court ruling last week that the Legislature had met its funding obligations, Wiesman said he’s hopeful Washington can focus more funding on health and human services.