On June 20, NACCHO Board member Krista Wasowski, the Health Officer for Medina County, OH, served as a featured panelist for a Congressional virtual briefing, entitled, “Shortchanged: The Impact of Chronic Underinvestment in Public Health.” The event, organized by the Trust for America’s Health (TFAH) and the Coalition for Health Funding (of which NACCHO is a member) highlighted the longstanding gaps in public health capacity resulting from chronic underfunding. Ms. Wasowski was joined by Tekisha Dwan Everette, Executive Vice President of TFAH, and Brian Castrucci, President and CEO of de Beaumont Foundation, on the panel.

The briefing highlighted findings from TFAH’s new report, “The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2023.” The report notes that as public health threats have risen, funding has continued to remain stagnant, making it difficult for local and state health departments to effectively and efficiently be able to address all the health issues their communities’ encounter. Inadequate public health funding prevents numerous evidence-based public health programs that exist from being funded in all 50 states, limiting the ability to address some of the leading health crises among their residents. Chronic underfunding is harming the public health workforce and making leaders rely on outdated data and lab systems to accomplish their mission on top of dealing with limited resources. All panelists emphasized the need for consistent funding for prevention efforts to ensure public health preparedness at all times, not just during public health emergencies.

Ms. Everette made note of some federal policy recommendations in TFAH’s report that would help ensure that the public health infrastructure is ready for the next disease outbreak. Ms. Everette stated increasing the overall CDC funding to at least $11.6 billion in Fiscal Year 2024, modernizing and strengthening public health in every community, investing in the nation’s health security, addressing health disparities and root causes of disease, promoting health and preventing chronic diseases across the lifespan, and investing in primary prevention of behavioral health concerns and deaths of despair are some areas Congress can focus on to guarantee the nation’s public health system is fully prepared to respond to the next public health outbreak.

Krista R. Wasowski highlighted the grassroots efforts of local health departments and the overall impact those efforts have on communities. She emphasized that local public health leaders are the people working directly with residents, providing service provision and strategy. Her department has been on the frontlines for the opioid crisis, the rapid rise of vaping among teens, and COVID-19. But there are numerous lesser-known challenges local public health faces to ensure all health issues are adequately addressed on the ground.

Sustainable funding is one of those challenges. Medina County’s Public Health department funding mix 42 percent from fees and contracts, 33 percent from tax levies approved by local voters, 24 percent from grants, and less than 1 percent from state subsidy provided by the Ohio state legislature. The tax levies are the only funds that are unrestricted, allowing them to spend those funds on any program they deem appropriate. Ms. Wasowski did note that unfortunately not all health departments have unrestricted funds since they need to be raised, such as donations. Funding is not the only restriction, the time and restriction on the specific funds also matters.

Ms. Wasowski further explained that any federal or state decision directly impacts her department’s ability to serve her community. She mentioned that for 22 years her department had maternal and child health grant money, but state priorities on how those funds should be used no longer match what her community needs are in that area, so that specific grant will no longer be funded next year. She must now decide how to maintain that programming and the needs Medina County has. She also described the importance of investing in public health infrastructure and data modernization efforts. For example, during the COVID-19 pandemic, legislators, the media, and Medina County residents all turned to Ms. Wasowski to ask for data on the vaccination status of people hospitalized for COVID-19. She noted that the data systems were unable to talk to each other to identify these cases. Moreover, data She highlighted that the current disease reporting system that the state uses is limited, outdated, and there is no consistency across the states or even the nation. She urged legislators to focus on data modernization to ensure the country is ready for the next public health emergency.

All panelists recognized that one of the most pressing public health issues is workforce recruitment and retention. Tekisha Everette, Executive Vice President of TFAH highlighted a recent survey that found that almost half of local and state health department employees have left between 2017 and 2021, on top of an estimated 80,000 full-time employee shortfall to provide basic public health services in all communities. Brian Castrucci, President and CEO of de Beaumont Foundation added that a loan repayment program for the public health workforce—NACCHO’s top legislative priority for the last few years, could be an important factor if implemented to make a governmental public health position more attractive. They all called attention to Congress’ continual lack of funding that is so critical to the public health infrastructure and the underinvestment into people that are on the frontlines which is harming the health of the country. Adequate resources to serve communities are essential to ensure optimal health.