COVID-19 Highlights Need to Fund State Public Health

April 01, 2020|9:38 a.m.| ASTHO Staff

If the current COVID-19 pandemic can teach us anything, it’s the importance of having a strong public health infrastructure. State and local health agencies maintain core capabilities critical to promoting and protecting the public’s health, in both times of crisis and calm.

Though often associated with tackling chronic and infectious disease, the significance of the state public health infrastructure extends far beyond that. In many states, state health agencies (SHAs) are accountable for protecting community resources the population relies heavily on, like inspecting and regulating hospitals and emergency medical services, laboratories, nursing homes, and even, in some jurisdictions, solid waste disposal sites and haulers.

This infrastructure depends on its resources and support. This recent brief outlines SHA resource and capacity trends since 2010 based on data from the ASTHO Profile, a comprehensive survey of the structures, functions, and resources of state and territorial health agencies. The most recent survey, fielded in 2019, found that SHAs reduced their spending over the past few years. Per capita, spending by state health agencies was even lower in 2018 than in 2010.

Human resources are also on the decline. Since 2010, the state public health workforce decreased by more than 15 percent. Although much of SHA spending goes directly to local health departments, the local public health workforce has also seen a steady decrease since 2008, according to the National Association of County and City Health Officials. This instability in resources makes it difficult for health agencies to maintain those foundational capabilities of the public health infrastructure.

The Public Health National Innovations Center’s Foundational Public Health Services framework outlines the core capabilities of health departments, like surveillance, communications, policy development, community partnerships, and, notably, emergency preparedness and response. When facing public health emergencies like the COVID-19 pandemic, some of the less commonly used services become the most important. Health agencies best serve their jurisdictions by sustaining these capabilities to address core public health concerns as well as the competencies needed during public health emergencies.

But those resources dedicated to preparedness and response are constrained. In fiscal year 2010, 6.6 percent of SHAs’ expenditures went to all hazards preparedness and response. In fiscal year 2018, agencies could afford to spend just 3.5 percent of their budgets on preparedness. But despite limited resources, SHAs have maintained the infrastructure to prepare and respond to public health emergencies, including capacity for laboratory testing, immunizations, and infectious disease surveillance. SHAs have also developed essential partnerships to ready themselves. According to the 2019 ASTHO Profile, about 29 percent of SHAs share resources with other states on a continuous, recurring non-emergency basis. Since 2012, all-hazards response and epidemiology are the top two shared functions, laying the groundwork for the type of multi-state response that may be needed in the face of a pandemic.

During public health crises, SHAs must also maintain administrative preparedness, which includes the ability to quickly accept and allocate emergency supplemental funding and to rapidly increase the public health workforce. The COVID-19 response will require “a long-term, intense activation at the state level working across the healthcare system,” said Nirav Shah, MD, director of the Maine Center for Disease Control and Prevention, on a recent episode of the Public Health Review podcast. According to Shah, the system will need adequate resources and additional staff to maintain that activation and keep health agency staff from splitting their time, energy, and focus.

Public health infrastructure is more important than ever so that SHAs can continue their charge while mitigating the current challenges. States need consistent resources to respond to emergencies like COVID-19 and to simultaneously keep up their other critical responsibilities. After all: “We will not have served the public’s health if we add to coronavirus simply by taking away from something else,” says Shah.