8/28/08

Seeing red: Fewer services, more fees for Snohomish County public health

by Beckye Randall

The Snohomish County Health Board is considering budget cuts, personnel layoffs and fee increases to offset a projected shortfall in the Health District’s 2009 budget.

At the direction of the Snohomish County Council, the health district has used reserve funds to prop up its operating budget over the past few years. Past funding sources have either remained flat during that time or gone away completely, leaving a $4.4 million deficit for the coming year.

Cities and counties used to share the responsibility for financing public health initiatives, with local cities contributing approximately $7.50 per person each year. In 1995 the legislature voided that direct funding, replacing it with a portion of motor vehicle excise tax revenues, just under 3 percent, earmarked for public health funding. Initiative 695, passed in 1999, eliminated the state’s car tax and its funding projects. Even though the initiative was found to be unconstitutional, the state legislature bowed to public pressure and made the tax cut permanent.

“Years and years of flat funding from the state and this county brought us to this point,” said Dr. Gary Goldbaum, director of the local public health agency. “Our budget situation is no surprise to the county, because Snohomish Health District has informed them step by step for the past four years that this day was approaching.”

All five members of the Snohomish County Council sit on the health district’s Board of Health, along with two elected officials from each city within its jurisdiction.

County executive Aaron Reardon has urged cities to pick up the slack once again with a contribution of $3.74 per resident to the health district. City leaders within Snohomish County, faced with their own shrinking budgets, appear hesitant to come to the health agency’s rescue.

At risk are a number of programs designed to provide a health safety net for the county’s most vulnerable citizens, including immunization programs, prenatal care, sexually-transmitted disease clinics and prevention, and monitoring for West Nile virus.

“Impending cuts to programs and staff at Snohomish Health District could negatively affect the health of the community for years,” said Goldbaum.

“Interrupting or terminating core public health services will hurt the community,” Goldbaum continued. “I can safely predict that dismantling our public health network through insufficient funding will lead to more chronic disease, more low-birth-rate babies, greater spread of communicable diseases, and a heavier load on emergency responders and hospital emergency departments.”

By the end of 2008, up to 90 public health staff members could lose their jobs. The first round of layoffs is scheduled for November 1. Unless Snohomish County approves additional funding, a second round will be implemented on January 1, 2009.

Support of local public health is the responsibility of counties, according to state law (RCW 70.05). The Health Board meets monthly, and its meetings are open to the public. The next meeting is on September 9, beginning at 3 p.m. in the auditorium of the Rucker Building, 3020 Rucker Ave., Everett. The health district’s Web site can be found at www.snohd.org.

SIDEBAR

The November layoffs would affect the following programs, significantly impacting the community’s health:

• First Steps/Home Visit (cut 95%) – Increased maternal tobacco, alcohol, other drug use; basic human needs unmet (food, housing, health care referrals); birth outcomes poorer (increased infant mortality rate, low birth weight, fetal alcohol syndrome) and medical costs dramatically increased; school readiness diminished, jeopardizing workforce development.
• First Steps/Nurse-Family Partnership Home Visit Referral Clearinghouse (cut 100%) – Relationships with First Steps community partners jeopardized; basic human needs unmet (food, housing, health care referrals).
• Parent-Child Health (cut 100%) – Workforce development and school readiness jeopardized; birth outcomes poorer (increased infant mortality, low birth weight); basic human needs unmet (food, housing, health care referrals).
• Vaccine Preventable Diseases (cut clinic hours 40%) – Reduced public health emergency response capacity and clinical expertise; reduced access to protection against vaccine-preventable disease; reduced access to immunizations; increased active tuberculosis due to untreated latent TB infections.
• Childcare Health Program (cut 100%) – Nonregulatory on-site child care consultation unavailable; decreased capacity for communicable disease prevention and control in child care settings; annual, low-cost, required training for child care providers limited; advocacy for child care health and safety issues compromised.
• Tobacco Prevention (cut position) – Increased tobacco use, especially among adolescents; fewer smokers quit.
• Water/Wastewater (increase fees) – Increase risk to public health from failing septic systems; increase in out-of-compliance drinking water systems; increased risk for waterborne disease; impeded response to inquiries, problems, and emergencies.
• Food & Living Environment (increase fees; cut West Nile virus program 100%) – More food establishments unpermitted or with unsafe food handling practices; increase in foodborne disease; delayed detection of mosquito-borne disease; increased risk of student exposure to unsafe and unhealthy conditions, resulting in increased illness and injuries at schools.
• Solid Waste & Toxics (increase fees)
• Sexually-transmitted Disease Clinic (cut 100%) – Increased number of infections in the community; less effective investigations; more imported travel-related diseases.
• Sexually-transmitted Disease Clinic Investigation/HIV Counseling and Testing (charge fees) – May discourage some high-risk clients from testing.
• Tuberculosis Control (charge fees; reduce clinic hours; cut positions) – Increased risk of contracting tuberculosis in Snohomish County.
• Vital Statistics (charge fee)