Coronavirus is here. And Michigan’s public health system is underfunded.
Coronavirus has come to Michigan, and the state’s first line of defense is a public health system that experts say is chronically underfunded.
Michigan lawmakers this week approved $75 million to fight the virus, but experts say long-term disinvestment in public health could mean other priorities fall by the wayside as staffers focus on coronavirus.
“It’s all been way beyond 9-to-5, and it has been for several weeks now,” said Susan Ringler Cerniglia, spokeswoman for the Washtenaw County Health Department.
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Earlier this week, the agency had ordered 15 of the 57 cases tested statewide for the new coronavirus. All so far in Washtenaw have been negative.
“We don’t have cases yet, and you have to ask: How long can we keep doing this?” Ringler Cerniglia asked.
That may soon be put to the test. Coronavirus, which has killed more than 4,700 people and sickened nearly 128,000 worldwide, arrived in Michigan this week after nearly two decades of shrinking public health funds. So far, 12 cases have been confirmed in Michigan.
State funding for core health services dropped 16 percent from an “inflation-adjusted high point of $300 million” in 2004, according to the Citizens Research Council of Michigan, which in 2018 analyzed Michigan’s public health funding dating to 2003.
By 2017, Michigan spent $128.3 million, or $12.92 per capita, on overall public health funding, according to the council’s report. In contrast, New York, Idaho and Hawaii spent $90 to $115 per capita, while Maryland and Oklahoma spent around $40 per capita.
“No one comes out against public health as a concept, but people generally pay attention to it only when there’s a crisis,” said Tim Michling, a health policy research associate at the council and author of the report.
Michigan ranks near the bottom in the country — 43rd — on public health funding, according to America’s Health Rankings, an annual report by United Health Foundation, a Minnesota-based nonprofit that works to improve public health.
Michigan also had the lowest rate of funding in the Midwest in 2014, the last year available in an analysis by Kaiser Family Foundation, a California non-profit organization focused on national health issues.
Local public health departments not only are on the frontlines during outbreaks. They also test food and water, monitor environmental hazards and battle everything from obesity to drug epidemics to underage drinking.
When local public health departments’ resources are diverted to a crisis, it could put those other programs at risk.
“It's kind of an all hands on deck” situation during crises, said Meghan Swain, executive director of Michigan Association of Local Public Health.
“We've always asserted that we can do the day-to-day stuff, but …. now you're pulling all your staff to focus on this ... and it starts to put a strain on the other program areas.”
We've always asserted that we can do the day-to-day stuff, but …. now you're pulling all your staff to focus on this ... and it starts to put a strain on the other program areas.” -- Meghan Swain, Michigan Association of Local Public Health
With nurses diverted to coronavirus monitoring in Washtenaw County, its public health education staff that normally would work on youth tobacco prevention or food access for low-income residents are now answering phone calls about coronavirus, Ringler Cerniglia said.
A supplemental spending bill passed by the Legislature this week includes $10 million for coronavirus response and an additional $15 million for future coronavirus response efforts. The bill also includes $50 million in federal funding for state and local “preparedness and response activities.”
The money will be used for education, virus monitoring, testing, tracing the origins of viruses, “infection control” and “continuation of critical state government functions,” according to a House analysis of the legislation.
Two years ago, the state increased essential local public health funding from $40.9 million to $51.4 million. The money is earmarked for immunizations, hearing screenings, control of infections and sexually transmitted diseases and more.
The increase came after state funding for local health remained relatively unchanged for nearly two decades from $39.9 million in fiscal year 2000 to $40.9 million in fiscal year 2018.
Lawmakers say the budget is appropriate.
“We’ve done a pretty good job of making sure that we’re on top of the issues. Have we been somewhat frugal? You bet,” said Sen. Curt Vanderwall, R-Ludington, chair of the Senate Health Policy committee.
“But I also think we’ve done a really good job in leadership over the last several decades to make sure that the state has been prepared. When monies need to be ready and available we have reacted very quickly, and we did that again this week.”
Rep. Hank Vaupel, R-Handy Township, said lawmakers are pushing for more public health spending.
“It’s a matter of a finite amount of money to go to an expanding need in so many area,” he said.
“We realize it’s an issue as the cost of health care keeps going up rapidly,” Vaupel said. “So the problem has been defined; the solution not so much. But it’s on the front burner.”
Even before coronavirus seeped into Michigan with the first confirmed cases, the public health system had been in high gear since January.
More than 400 people had been flagged by the U.S. Centers for Disease Control and Prevention for special monitoring by local health departments.
That means local public health nursing staff must divert their focus on immunizations and tracking communicable diseases to monitoring potential cases for at least 14 days.
Departments also are diverting staff to answer phone calls about coronavirus and answering emails from worried consumers and developing materials for organizations in their counties.
While schools might need directions on disinfecting water fountains and doorknobs, faith-based groups might need advice on whether to suspend communion or shake hands at services, said Leigh-Anne Stafford, health officer with the Oakland County Health Division, which this week logged two of the first 12 confirmed cases in the state. (The others were in Ingham, Kent,, Oakland, St. Clair, Washtenaw and Wayne counties.)
For now, Stafford said, Oakland County’s public health staff has been able to absorb the added load by reprioritizing. In Saginaw County, where they have not yet had a confirmed case, they’re preparing for that possibility, said Cari Hillman, its emergency preparedness coordinator.
“Every second of my day is full, as I’m sure everybody here is now, and now it’s even fuller,” Hillman said.
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