City Funding for Public Health

1. City Fundingfor Public Health Chelan-Douglas Health District 2008 Barry Kling, MSPH, Administrator

2. Background • To deal with the Health District’s 2009 budget deficit, the Board of Health recently eliminated programs and cut staff. • In the course of this discussion, the Board developed a proposal for an additional $1 per-capita of annual public health funding from cities and counties. • I’m here today to explain this proposal.

3. Background, continued • We do not come to you with a sense of entitlement. We know that your budgets are as tight as anyone’s. • But we also know that you care about basic public services for your constituents, and you care about their health. • So please bear with us for a few minutes as we explain our situation and our proposal.

4. Public health services are basic to any viable community – at least as fundamental as police and fire services.

5. Here are some of the things we do that make a difference to the people of your city: • Controlling Tuberculosis and other contagious diseases. • Keeping food safe through restaurant inspections. • Protecting at-risk children through public health nursing visits and supplemental foods (WIC). • Disease outbreak investigations, to find and stop the source of infection. • Smoking prevention. • Surveillance for new health threats.

6. More things we do that make a difference to the people of your city: • Safe landfills to protect air and water. • Safe septic systems to prevent disease, protect groundwater. • Drinking water protection. • Immunizations to prevent disease, for children and for adults. • Dealing with illegal dumps and similar waste issues. • Preparedness for health emergencies.

7. These are science-based services. We know they work. And we know that in the long run (and often the short run) they save more money than they cost.

8. The funding crisis in basic public health services is real. • Funding for basic services has been essentially flat for about a decade. • As populations have grown and inflation has occurred, our funding base has eroded significantly.

12. Cuts are nothing new. • Because funding for our basic programs has been tight for some years, and because our board consists of elected officials like you who do not tolerate waste, we have taken many measures to become as efficient as possible. • We continue to work on that, but we believe your local health department is a good steward of its funds and is not the kind of wasteful government program that can be cut without consequences.

13. But we are no longer talking about small incremental changes. • At the end of 2008, our staff will be 25% smaller than it was at the beginning of the year. • In 2000 we had 12 public health nurses in our maternal/child health programs. Now we have three. • We have reached a tipping point, and basic services are now at risk.

14. For next year we have had tocut the following services: • Eliminate immunizations for about 4,000 children and adults. • Eliminate over a thousand home or office visits by public health nurses to vulnerable children and parents, affecting over 200 families. • There is solid research showing that every dollar spent on this service saves $2 to $3 down the road by preventing diseases and problems like juvenile delinquency.

15. Not just a local problem. • It isn’t due to some local management deficiency. • It is happening to many local health departments statewide. • Budget deficits for local health departments statewide total over $30Million for 2009 • It will happen to several more in 2010

16. More cuts to come. • These problems do not yet reflect the current economic downturn, or likely federal cuts due to the deficit. • Most of the funds we get from the state are federal pass-through dollars, and the state funds we do get are threatened by the state deficit. • We have not seen the end of this problem. • We are not asking to be insulated from all cuts.

17. What we are asking • We are asking that you, and the other cities in the Health District, contribute one dollar annually for each of your residents, beginning in 2009. • The two counties are being asked to add a dollar for every resident in unincorporated areas of the District. • At this point, the counties have said that they will do this only if all the cities participate.

18. What else are we doingabout the problem? • Continued efforts to do our jobs more efficiently • Part of a statewide effort by public health and local elected officials to establish a sustainable funding base for local public health statewide. WSAC has again made this a top legislative priority for the next biennial state budget. • We are also asking the legislature to grant health districts the same kind of revenue generating options that hospital districts and similar public entities have had.

19. We are working toward systematic solutions. • We are not looking to the cities to solve all or most of the problem. • But we are asking you to be an important part of the solution.

20. Contact information: Barry Kling, Administrator Chelan-Douglas Health District 200 Valley Mall Parkway East Wenatchee, WA 98801 509-886-6480, cell 264-7045 barry.kling@cdhd.wa.gov