In the decade before Michigan and its largest city became the latest hot spot for the deadly coronavirus,
officials were steadily, and at times dramatically, cutting back on
their first line of defense against pandemics and other public health
emergencies.
Approaching
bankruptcy, Detroit disbanded most of its public health department and
handed its responsibilities to a private nonprofit. When the department
reopened in 2014 in the back of the municipal parking office, its per
capita budget was a fraction of other big cities’, to serve a needier
population.
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In
Ingham County, home to the capital city of Lansing, then-Public Health
Director Renee Branch Canady sat down at budget time every year for
seven straight years to figure out what more to cut.
“It
was just chop, chop, chop,” Canady said. By the time she left in 2014,
all the health educators, who teach people how to prevent disease, were
gone.
What
happened in Michigan also played out across the country and at the
federal level after the 2008 recession, which caused serious budget
problems for governments. But as the economy recovered, public health
funding did not, a review of budget figures and interviews with health
experts and officials shows.
A
shortfall persisted despite several alarming outbreaks, from H1N1 to
Ebola, and has left the U.S. more vulnerable now to COVID-19, experts
say. In normal times, public health workers are in the community,
immunizing children, checking on newborns and performing other tasks. In
a health emergency, they’re tracing outbreaks, conducting testing and
serving as “first responders” when people fall sick — efforts that are
lagging in many states as the coronavirus spreads.
“Our
funding decisions tied their hands,” said Brian Castrucci, who worked
with health departments in Philadelphia, Texas and Georgia and is now
president of the de Beaumont Foundation, a health advocacy organization.
The
cuts came under both Democratic and Republican administrations. While
there is no single number that reflects all federal, state and local
spending, the budget for the federal Centers for Disease Control, the
core agency for public health, fell by 10 percent between fiscal year
2010 and 2019 after adjusting for inflation, according to an analysis by
the Trust for America’s Health, a public health research and advocacy
organization. The group found that federal funding to help state and
local officials prepare for emergencies such as the coronavirus outbreak
has also fallen — from about $1 billion after 9/11 to under $650
million last year.
Between
2008 and 2017, state and local health departments lost more than 55,000
jobs — one-fifth of their workforce, a major factor as cities struggle
to respond to COVID-19.
“It
definitely has made a difference,” said John Auerbach, Trust for
America’s Health CEO and a former public health director in
Massachusetts.
New
York has seen the most COVID-19 cases in the U.S., but numbers are
surging in places such as Detroit, where those testing positive nearly
tripled in the week between March 28 and Saturday, when officials said
the city was approaching 4,000 cases, with 129 deaths. A more robust
health system could have done more earlier to track down and isolate
people who were exposed, said the city’s former health director, Abdul
El-Sayed.
State
spending on public health in Michigan dropped 16% from an
inflation-adjusted high point of $300 million in 2004, according to a
2018 study.
Some
of the funding problems, Canady and other public health advocates
believe, stem from a fundamental belief in smaller government among
Republican governors, including former Michigan Gov. Rick Snyder, who
called for “shared sacrifice” after the state’s auto-dependent economy
was battered by the recession.
In
Kansas, then-Gov. Sam Brownback ran what he called a “red-state
experiment” to cut taxes. State spending on its Public Health Division,
outside of federal funds, dropped 28% between 2008 and 2016.
The
cuts meant a “shifting of responsibility for services from the state
level to the county level,” Democratic Gov. Laura Kelly said in an
interview. “And we saw that in public health.”
In
Maine, then-Gov. Paul Le Page’s administration stopped replacing public
health nurses who were dealing with families in the opioid crisis. The
number of nurses fell from around 60 to the low 20s before the
Legislature tried to reverse the action.
Although agencies often receive emergency funding when a crisis strikes, the infusion is temporary.
“Decisions
are made politically to support something when it becomes an epidemic,”
said Derrick Neal, a public health official in Abilene when Ebola
surfaced in Texas. “And then as time passes, the funding shrinks.”
In
Oklahoma, state funding for the Department of Health still hasn’t
returned to its levels of 2014, when a combination of slumping oil
prices, tax cuts and corporate breaks punched a giant hole in the
state’s budget. When state revenues later improved, the money went to
other priorities.
“It’s
much easier to cut funding for public health than it is to start taking
away benefits from people or access to care for people,” said former
state Rep. Doug Cox, an emergency room doctor.
Castrucci
said the problem with providing more money only at times of emergency
is it doesn’t allow time to recruit and train new workers.
“We waited until the house was on fire before we started interviewing firefighters,” he said.
For
most people, the new coronavirus causes mild or moderate symptoms, such
as fever and cough that clear up in two to three weeks. For some,
especially older adults and people with existing health problems, it can
cause more severe illness, including pneumonia, and death.
___
Associated
Press reporters David Eggert in Lansing, Michigan, Paul Weber in
Austin, Texas, John Hanna in Topeka, Kansas, and Sean Murphy in Oklahoma
City contributed to this report.
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