Public Health's Uncertain Future

10/23/2009

What do immunizations, tuberculosis, and birth control have in common? In King County those health issues fall under the purview of one agency – Public Health. The agency quietly operates in the background until a threat like a pandemic flu surfaces. Like many public agencies, shrinking revenue has forced Public Health to make cutbacks. And it's not just in King County. A recent study by a Washington state think tank shows most local health agencies have reduced staff or eliminated programs for lack of funding. Earlier this year King County considered cutting back funds to track infectious diseases. It was saved at the last minute. Even so, the agency's future remains shaky.

It's easy to take for granted that whenever you eat out the food will be safe. Food safety is Chris Skilton's job.

Skilton: "I suspect that if I put a probe in there, I will like get an accurate temperature, maybe close to 170."

Skilton is a health inspector with Seattle and King County Public Health. On a recent afternoon I meet Skilton at a Pioneer Square restaurant. In the kitchen's hot station he uses an infrared thermometer to gauge the temperature on a pot of beef sauce. Then he sanitizes a temperature probe, dips it into the pot for a more accurate read.

Skilton: "There you go, 183... right where we want to see it."

Skilton visits at least four restaurants a day. He's one of 37 inspectors responsible for ensuring food safety at more than 10,000 restaurants in King County. That includes espresso stands, hot dog carts and food courts.

Skilton: "We used to have a motto on pins years and years ago, 'Public Health, when we do our job nothing happens.' I thought that was wonderful. We're invisible until we're needed."

A lot of Public Health's work happens out of sight. Occasionally, the agency comes to the spotlight during a crisis. This past spring, it was swine flu. Public Health coordinated the county's response and monitored the outbreak. This fall, it's distributing vaccines for the H1N1 virus, and preparing the county's medical response to the flood threat in the Green River valley.

Public health was created in the 19th century. Its mission back then was to find out what's causing illnesses or deaths in the community and to prevent those illnesses from happening.

Fleming: "In the 19th century early on, a primary cause of early death in this country was infectious disease – diarrhea in infants, tuberculosis in adults were diseases you contracted by eating unsafe food or water that had not been properly prepared."

Dr. David Fleming is director of Seattle and King County Public Health. He says initially Public Health's job was to regulate garbage and sewage, and make sure the community has clean drinking water.

Fleming: "As a consequence, mortality in this country dropped dramatically and life span has increased over 40 years in the last five generations."

Today, prevention is still the main mission of Public Health. Infectious diseases remain a constant threat to people's health. The list includes HIV/AIDS, sexually transmitted diseases, and of course, pandemic flu. But these days Public Health's challenge also includes chronic diseases such as diabetes, obesity, and asthma.

Fleming: "Our bottom line job is the same, but the way we accomplish it needs to change as specific diseases that we're trying to prevent change."

And it's not just the diseases that have changed. Funding for public health has been shrinking. In 2009 Public Health's budget was nearly $60.5 million. The proposed budget for 2010 is about $9 million less. This new economic reality is forcing the agency to make some tough decisions.

Fleming: "Right now we do spend a lot of time on a year to year basis deciding what's the next set of programs that we're going to cut."

The reduction means some community clinics for low–income people will be closed, and some services like family planning will be limited in some areas. That's in addition to cuts and other cost saving measures already made to some health programs.

Fleming says Public Health needs a predictable, stable source of funding to continue its mission long term. There were attempts this summer to raise taxes to help fund public health and human services. But those plans died in the County Council's Budget Committee. It's now up to the incoming County Executive to address Public Health's uncertain future.

I recently went to a political forum for candidates running for King County Executive. The event was at a Chinese restaurant in Seattle's International District. I ask the candidates how they plan to provide stable funding for public health. Susan Hutchison says Public Health is a state–mandated service and should come from the county's general revenue. She says there will be no tax increases for public health. Instead, she'll focus on cuts.

Hutchison: "Public health is a budget priority, and so when we make our cuts, our cuts are going to be focused on cutting waste, streamlining government, making government more efficient. And as you know, government has grown by more than twice the inflation rate in the past decade so it's very important that we prioritize and make sure we provide services that we are required to."

Beyond cuts, Hutchison doesn't offer suggestions for additional funding sources. Her opponent, Dow Constantine, also believes that raising taxes is not the answer. Constantine says the long–term solution goes beyond the county, and should involve the State Legislature.

Constantine: "The Legislature is the source of all revenue authority and sets up the system by which government provides what services. As I begin my term, I'm going to be bringing together 39 cities in King County, along with the state of Washington, discuss which services are provided by whom and where the authority comes to provide those services and public health needs to be right at the top of that list."

Looking into the future, Public Health's job is never done. Prevention efforts have saved lives. But it doesn't stop; the work is ongoing.

Back in Pioneer Square, health inspector Chris Skilton writes up a report before heading out to the next restaurant. The agency's food inspection program is supported through restaurant permit fees. But his unit is not completely immune to cuts or layoffs. Still, Skilton is philosophical about all the uncertainty.

Skilton: "We have the perfect storm potential this fall. We have two kinds of flu. We have potential for flooding in South County. We have political climate change."

And all these unknowns will unfold in the next several months as the new County Executive takes office.

Skilton: "I wonder where we'll all be, those agencies and those people that I work with now, when there's somebody new in office. Certainly we're cursed with living in interesting times."

Good times or bad, Skilton says one thing is certain – when it comes to Public Health, the community will always need their services.

I'm Ruby de Luna, KUOW News.

© Copyright 2009, KUOW