Post-Pandemic Public Health Funding: ‘Now Is Absolutely The Opportunity’

Speaker 1: 00:00 Even with vaccination rates climbing the battle against COVID-19 goes on Los Angeles has just seen a spike in cases fueled by the Delta variant and hospitalization rates among black Angelenos have also been on the rise. The pandemic continues to reveal gaps and inequalities in our critical care system. Advocates who have long been calling for increased funding for public health departments say now is the time to seize on an influx of pandemic funding because it won't be there forever. KPBS health reporter. Matt Hoffman spoke about this with San Diego county health officer, Dr. Wilma Wooten and health and human services, agency, director, Nick meshy, own Speaker 2: 00:42 Pre pandemic. I mean, would you guys say that you guys were underfunded by the state or what was it like before the pandemic even happened? Speaker 3: 00:48 Well, absolutely all health departments across the nation before the pandemic and it things differ from jurisdiction to jurisdiction, but in general of the topic of the underfunding of public health is decades old tragically Speaker 4: 01:05 Public health funding is more episodic. It is when, when there's a crisis, then funding will flow versus using our adage in public health prevention, investing the dollars and building the infrastructure. I don't think there's any community across this country that would say they have the adequacy of their public health industry. Speaker 2: 01:26 Hm. And like, what's like the real world impact on that. Like, like pre pandemic, like, cause there's some things that you guys can't do that you wanted to do or like, how was it, how does that budget, um, not increasing affect your guys's ability to control public health in the county? Speaker 4: 01:38 You know, we're different in San Diego and that we take a very holistic approach to the wellbeing of 3.4 million. So we look at the social drivers for health. We'll look at the issues around housing and public health will look at more recently and harm reduction, the interplays between behavioral health and public health. And so we're an integrated in terms of how we operate, but how we bring our community together. Unfortunately, when you talk about public health funding, uh, it's the fidelity to the public health topic. So the funding streams come, but it's focused on dealing with Ebola or it's focused on childhood obesity or lead poisoning and, and the realities, all these things kind of come together in a community. And so we have to harmonize the funding on all these sources and then look where there's gaps and kind of go after funding. And that's just the sad reality of how public health operates this country. Speaker 2: 02:35 And then you talked about like, um, kind of funding being like reactive. So then the, the pandemic hits and I know supervisor Fletcher was talking about like, like the counties that a good financial position, but that they might've had to spend a ton of ton of money, which you guys it's been a ton of money, but like what, what was the influx of cash that eventually came to you guys? I mean, were you worried that there wasn't going to be this like influx of cash? And then when you did it, when you got that money, it was that to pay existing bills. Is that to build more infrastructure, kind of, how did that work? Uh, this county Speaker 4: 02:59 Is financially healthy and strong, uh, and the funds weren't coming down yet from the state. So our charge and we gave to our team was do what's right to protect the public's health. Now, when we stood up T3, if you remember, that was the, you know, you always got it right. Testing, chasing, and treating, right. That was, uh, for the stimulus money that was over a hundred million dollars. And that's it as far exceeded cause then we did vaccinations. Right? So the idea here was, had we not made the investment, we would have had far worse outcomes, I think in our county, for sure, but across the country or our state, I should say. And so we, we quickly realized that we had to not just get the type of resources met, but they had to be in the right investment for the right interventions because timing was critical. And then you guys had a big, Speaker 2: 03:51 Big scale up. And not only in terms of like hiring staff, like we talked about contact tracers doing these testing sites in the vaccination sites, which came later. But I remember we were talking too about, you guys were trying when, when the testing push was going on, didn't have the infrastructure to do all the testing and there was a backlog on the equipment for that. So it seems like you guys have scaled up quite a bit. Are you guys on a scale down now in terms of shrinking back or cause I know that the American rescue plan was passed, which gave some more dollars for you guys. And some people say that, you know, th that, that the health department are doing fine now, but you guys are going to be scaling back down operations or is there a hope that you can keep, you know, a, at a higher level of, of staffing and all that? Or how does that kind of play out? Speaker 3: 04:26 What we've, we're scaling down, uh, based on the need is not just, uh, a process that is arbitrary looking at the data, our total number of daily cases in our case rate, uh, is, are coming down. So we are looking at the staffing that's involved. How can those staff now go back to their prior, uh, responsibilities, but also how can we glide slope testing and vaccinations back to our public health centers. Uh, but we address the needs that are in front of us. And that way we can decrease the number of staffing involved, decrease the number of locations where testing and vaccinations, uh, would be required. Speaker 4: 05:11 Yeah, he's given it another example to that our county nurses were the ones the very first, uh, testing was our county nurses, uh, right at Rosecrans. Then you saw it when we went up to the old Qualcomm side and then we really developed a whole ecosystem right. Of the testing. And then the same group that was doing vaccinations. Well, we have another crisis going on now, the homeless crisis, we're beginning to see the mental health crisis. We're beginning to see this is the consequences of the, of the pandemic. And so it's, it's not that we're scaling glide sloping down and correct to the need. It is also because we need to then reallocate those nurses to help on homelessness, those nurses that help with those children and in home visits that we need to get back. There's other needs that were put on pause and then other things that are beginning to rise, unfortunately. And so we're, again, we're public health goes into action is where the need is medially, shifting those resources there. And I know some people say Speaker 2: 06:10 That like now is like a better time than ever for these health departments to try to ask for funding. Do you guys think that that's the case, or do you think, like you have a window of opportunity now to where that's changed, you know, state lawmakers, minds, or federal lawmakers minds. I know you guys have a lobbying arm here at the county, but do you think like now is the, is the opportunity so to speak or, Speaker 3: 06:26 Oh, absolutely. Now is the opportunity. And there's a lot of efforts going on at the national, as well as the state, uh, level to look at the future of public health. Speaker 2: 06:37 And then, uh, this might not be an easy answer, but what's, what's the best case scenario. Like, you know, uh, the governor says here's a blank check. What do you need? W w w what, what would you guys ask for? What do you do if we Speaker 4: 06:47 Had the blank check, we would both agree that it's really the social drivers of social determinants of health. You know, we were ending a pandemic with COVID-19, but there's another pandemic we've been dealing with and that's the health inequities, and it is a pandemic. And COVID-19 just put the shine, the light on it to see how different parts of our county did parts of our state, that parts of our nation we're living and someone that we're not living well. And it's no surprise when you have overcrowding or people that were not in any type of shelter. It was no surprise when people did not have a food security or a job. And therefore, if they were sick, had to go to work or were, felt forced to go to work because they had no ability to take care of their family. And those were enablers, um, unfortunately of spread of viral spread. So when we really want to look at a root cause if you really want to, um, address, uh, some of the things we keep talking about and having people live longer and happier and healthier lives, it's those social determinants. So it's housing, it's helping people with jobs. 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. And then the only other Speaker 2: 08:05 Question I have is, do you think that, like, whether it be like we were talking about state lawmakers, the federal government, you think they'll be receptive to the calls for more funding? I mean, it sounds like the call has been going on for a long time and there's been no response, but like you said, after nine 11, a lot of stuff changed. Do you think that they'll be receptive to your messaging? Speaker 3: 08:19 Well, I can't say that there's been no response because about a year and a half ago, the state did allocate funding to jurisdictions to support public health needs, infrastructural needs. So that was about a year and a half, two years ago. Again, right now what the governor's doing is evaluating what the needs are, which I think is a practical, uh, next step. But we want to see outcomes from that and funding allocated to a specific public health needs, uh, after the assessment is completed. Yeah. Speaker 4: 08:53 I don't think there's any way going back. Uh, when, when, and I, and I really applaud the governor when through the administration released the healthy places index in the summer, and that is a difficult conversation to have in the midst of the pandemic to say, and these are areas where people historically have not been thriving, and they did that with the intent of, we have to race and go in those areas. Now, fortunately for us, we were already going in those areas, the south bay saturation strategy for testing and what we were already moving eventually into, into vaccination. But now we have that on the table. And so that's going to be an ongoing conversation. And, you know, we have an old adage. You can only live well when you all live well. And so if parts of our county are not living well, there is no other way you're going to live well, because if there's an outbreak here, it impacts here. So I think now with the healthy places index and talking about health equity and how this board of supervisors has embraced racism as a public health crisis and health equity, the heart of that, at least in San Diego, second largest county in the county, and the state is going to continue to elevate that to the, you know, to the state itself. And I don't think that was San Diego Speaker 1: 10:08 County health and human services agency, director, Nick [inaudible] and health officer, Dr. Wilma Wootton speaking with KPBS health reporter, Matt hall,