Surge in communicable diseases, funding shortages threaten public’s health

If you’ve followed the Public Health Insider, you know that we’ve seen a surge of communicable disease outbreaks in places like schools, health care facilities, jails and restaurants. And those are just the most visible ones. As the local health department, it’s our mission and legal responsibility to track down and stop over 50 communicable diseases in King County.

tuberculosis
King County is seeing more tuberculosis outbreaks requiring extensive investigations

From 2014 to 2016, we have seen a 63% increase in the number of annual cases of these reportable illnesses to over 5,500 – the most in recent history. All the while, more people call King County home. We grew by 49,000 people last year – more than twice our historical growth rate – and now have a population of more than 2.1 million residents.

Our staff works incredibly hard to investigate and follow up on all these cases, to protect the public and prevent the spread of disease. Our investigative work has become increasingly complex, with more people in our communities and with new threats, such as Zika and Ebola. We’re also spending more time on outreach and communication to increase transparency that the public has asked for, such as with foodborne illness outbreak investigations.

The King County Auditor’s office has taken a closer look at our efforts and challenges and will be issuing a report shortly. We appreciate the work of their staff and their recognition of the increasing frequency and complexity of disease events that have put exceptional demands on our communicable disease program in protecting the public at a time when resources are not sufficient to meet the needs.

The repeal of the state’s Motor Vehicle Excise Tax in 2000 eliminated our state’s dedicated and consistent public health funding source. Other funding sources have shrunk due to recession-era budget cuts and growing populations even while the costs of stamping out new, complex diseases has risen. In fact, Washington spends far less on public health than many other states — just $38.08 per person — while our neighbors in Idaho spend $54.35.

The lack of dedicated public health funding means that we no longer have the resources to prevent the spread of disease, but can only address it once it has begun. Here’s an example: in King County, there are an estimated 100,000 cases of latent (non-contagious) tuberculosis; one in 10 of these will become active (contagious). Yet, we don’t have the resources to track and treat these latent cases so that they don’t become contagious. The cost to treat someone with latent TB is just $500, that figure grows to $17,000 once it becomes contagious. Prevention saves money!

The Auditor is making administrative recommendations for greater efficiency, which we agree with and are working on. But without additional funding, our communicable disease program does not have enough capacity to meet the demand we’re seeing now. While greater efficiencies always make improvements on the margins, the fundamental problem in our communicable disease unit is a lack of stable and predictable funding that will adequately staff and resource the unit.

In Olympia this year, a statewide coalition advocating for adequate funding for core public health services, like communicable disease control and prevention, was successful in securing a one-time, statewide $12 million investment. Unfortunately, this is far short of the need. The state Department of Health with leaders from across the state had identified a down payment of $60 million to fill the most critical of public health system needs toward an overall need of more than $300 million. Without additional resources, public health agencies across the state may not be able to adequately respond when the next emergency strikes.

Our disease detectives will continue to work every day and night to protect the public. But in an era of flat and declining funds to pay for ever more complex needs, doing more with less to prevent infectious disease is not going to provide the assurance that King County residents expect and deserve. We can all do better.

 

Originally posted on July 17, 2017