Substantial, long-term funding has eluded local public health departments and with a spotlight on the pandemic, some argue now is the time to change that.
"The topic of the underfunding of public health jurisdictions has been decades old," said San Diego County Public Health Officer Dr. Wilma Wooten. "Now is absolutely the opportunity."
Wooten said the public health department has not seen a decrease in funding like some others have, but that’s due in large part to a team of grant writers who secure state and federal dollars.
"We really have robustly gone after federal funding to support the various programs and the public health priorities," Wooten said.
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San Diego County Health and Human Services Agency Director Nick Macchione said funding from the state and federal government is typically reactive.
"When there’s a crisis, then funding will flow versus using our adage in public health: investing the dollars and building the infrastructure," Macchione said. "I don't think there’s any community across the country that says they have the adequacy of their public health infrastructure."
At the height of the pandemic, the public health arm of the health department more than doubled their budget and nearly doubled staffing.
"That was just for COVID-19," Macchione said. "What’s on our plate? Everything. Homelessness, getting to zero from HIV and (tuberculosis) and hepatitis — it’s all those things — malnutrition. It’s all those — and have we doubled ourselves in all those things? No. So to answer your question, do we need far more resources for public health? Absolutely yes."
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Macchione said the pandemic could be the eye opener for state and federal officials, similar to how the Sept. 11th attacks on the World Trade Center prompted a major shift.
"Think about how security and how the airports changed and just the whole nature of the awareness the pandemic and COVID-19 has done and will do the same for us in this country — and we hope it’s for the good," he said.
He added the pandemic revealed gaps in the way people have access to resources.
"We’re ending a pandemic with COVID-19 but there’s another pandemic and it’s the health inequities — and it is a pandemic because when you look at it and COVID-19 just shined a light on it — to see how different parts of our county, different parts of our state, different parts of our nation were living — and some of them were not living well," Macchione said. "It was no surprise when people did not have food security or a job and therefore if they were sick had to go to work or felt forced to go to work because they had no ability to take care of their families and those unfortunately were enablers of viral spread."
The county made early investments in programs to build trust with communities that they were not connecting with. They hired promotoras, also called community health workers, to get the word out in Latino communities.
"We put our money where our mouth is and provided those contracts so that communities would have individuals that looked like them going out and conducting that outreach," Wooten said.
The state later provided one-time grants for similar outreach programs, but officials want to keep them going long term — especially if another crisis happens.
"We did the right thing and we did it on our own," Wooten said. "We didn't wait for funding but most jurisdictions cannot or won’t do that but there needs to be resources to allow for that surge up."
In general, Macchione said root issues need to be addressed, not just being reactive to situations like the mental health crisis and rising numbers of encampments on San Diego streets.
"It’s those social determinants: so it’s housing, it's helping people with jobs, it is in fact that training of bringing folks forward," he said. "So those are things that you don't think about in the realm of public health, but if you were to address that you would really improve the public's health!"
Wooten said the public health department needs to maintain a trained workforce and have the right infrastructure to be completely effective and nimble.
"So for us in San Diego it’s our registry, our immunization registry or our surveillance system and our laboratory systems and IT systems that we are looking to improve upon," said Wooten. "That’s not a small dollar amount — that’s a large dollar amount."
The pandemic is winding down, but not the public health department. Officials are reallocating resources to address mental health challenges and people living on the streets.
"There’s other needs that were put on pause and then others things that are beginning to rise unfortunately and so — we’re again — where public health goes into action is where the need is and immediately shifting those resources there," said Wooten.
Officials from the governor’s office said they recognize investments in core public health functions have stayed the same or decreased over the last decade, and are currently conducting a review to assess the state’s public health response. Any gaps would be addressed in the 2022 budget.
