Oregon county health officials say need is dire for stable public health funding post-pandemic

Many of Oregon’s county health officials are asking for a little extra consideration from lawmakers this year as they decide where to allocate funding.

Two counties, Wallowa and Curry, have no public health staff and rely solely on the Oregon Health Authority to meet their needs. With the fifth anniversary of the initial COVID-19 lockdown this week, perhaps nothing is a bigger reminder of the need for a stable funding source for public health infrastructure.

Sarah Lochner, the executive director of the Oregon Coalition of Local Health Officials, told OPB that not only is the state not ready for the next pandemic, counties are in dire need of stable funding just to deal with the everyday public health needs of the communities they serve — from vaccinating against whooping cough and measles, to providing needed treatment for alcohol and substance use disorder, to preventing HIV, hepatitis C, syphilis and other communicable diseases.

Jackson County public health worker Tanya Phillips said because grants are often available only when the health of a particular population declines, the system sets up a kind of unreliable boom-and-bust cycle for funding, which does not support healthy communities long term.

Phillips and Lochner join us to share the impact that unpredictable and insufficient funding is having in Jackson County and around the state.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: This is Think Out Loud on OPB, I’m Dave Miller. As we mark the fifth anniversary of the first COVID-19 lockdown in Oregon this week, many of the state’s county health officials are asking for a little extra consideration from lawmakers. They say the pandemic was just the most dramatic reminder of the necessity of a robust public health infrastructure, one that Oregon simply does not have.

Sarah Lochner is the executive director of the Oregon Coalition of Local Health Officials. Tanya Phillips is a public health worker in Jackson County. They both join me now. It’s great to have both of you on Think Out Loud.

Sarah Lochner: Thanks, Dave. Glad to be here.

Tanya Phillips: Yes, thank you so much.

Miller: Sarah, first – we’ve talked a fair amount recently about the possibility of cuts to Medicaid and what that could mean for Oregon’s version of the largely federally-funded program, the Oregon Health Plan. More than 1.4 million Oregonians, more than a third of our state’s population, get their healthcare coverage through OHP, so it’s a huge component of the public’s health. But you’re talking about something different here. What do county level public health departments do?

Lochner: County public health departments, many of them will be affected by Medicaid cuts. About seven local public health departments also run federally qualified health centers, which provide Medicaid services for many people. But public health does so much more than that. They often, especially in rural communities, provide a number of clinical services to the general public without charging your insurance, regardless of payer, regardless of income.

And they do a whole suite of other things to help keep all of us safe and healthy. This includes drinking water, restaurant inspections, hotel and pool inspections, and providing more of a global lens at what is happening to the health of the community. During the pandemic, people became familiar with epidemiology. But that also continues to be a need today, because we have any number of other communicable diseases that public health needs to track.

Miller: Measles, bird flu, syphilis, and on and on.

Lochner: Exactly. So keeping an eye on those diseases and the health of the community is a solid chunk of what local public health does.

Miller: Tanya Phillips, can you give us a sense for the range of work that you do, yourself, in Jackson County?

Phillips: Oh, that is a good question. For Jackson County, I am their health promotion and preparedness manager. I oversee all of our health prevention implementation programs – that ranges from HIV prevention, alcohol and drug prevention, tobacco prevention, I think, problem gambling, as well as mental health promotion and prevention. I also supervise our immunization clinic and our public health preparedness program, which, for us, is really what Sarah just talked about. We’re responding to pandemics, outbreaks, anything of that nature.

Miller: Ideally, would one person be doing all the things you’ve just outlined?

Phillips: Yes. Ideally, I wanna say, “No,” but in many counties, yes, that does happen, where you have a communicable disease nurse that does communicable disease investigations. They could also be giving immunizations. I have multiple staff that work in different programs because of the amount of funds that we receive, so sometimes you’ve got staff working in multiple programs. Myself, as a manager, you definitely see counties where you have one manager that does supervise a very large amount of different programs. So, yes, it is common.

Miller: The first of the four priorities that Sarah Lochner’s group, a Coalition of Local Health Officials, has put forward to lawmakers is “public health modernization.” What does that mean, Tanya?

Phillips: For us with modernization, Oregon did take a look at how do we modernize our public health system? A lot of the time we weren’t really … Yes, acute diseases are still important, but it’s also looking at and being able to look at, address and fund different public health strategies that look at chronic disease – stuff that’s way more upstream.

We know that we can look at different zip codes in Oregon, across the U.S., and look at those zip codes and be able to determine life expectancy. So, it is looking at how we can improve our healthcare system but also our built environment, so that our communities are as healthy as can be?

Modernization did just that, but also, looking at those core functions of public health such as communicable disease, health promotion and prevention programs, how do we stabilize that? But also, how do we try and help fund our public health system, so not only that it’s stabilized but that we have enough staff to actually do the job, and in the case of an outbreak of measles or the next pandemic, we, as a system, are prepared to respond to that?

Miller: Sarah, specifically, the ask to lawmakers is $25 million over two years for this piece of this, for the public health modernization. What do you think would be different in Oregon in terms of public health if lawmakers said, “Yes”?

Lochner: That additional funding would allow local public health to beef up its communicable disease response. Right now, we have the third highest death rate for Hepatitis C and the fourth highest prevalence rate in the country. And this money would allow us to do more active outreach to the houseless community, for example, to help test people for Hepatitis C and then link them to treatment through Medicaid or through federally qualified health centers.

It would also, in that communicable disease realm, allow us to do a lot more to reach folks with congenital syphilis – that’s when moms pass an infection to their babies when they’re pregnant – and link them to the antibiotics that it takes to cure the mom, but also prevent them from passing that disease to their baby.

And, just to touch a little bit more on public health modernization, it’s really this radical idea that every community in Oregon should have baseline funding that could help support them in areas where some communities have higher rates of congenital syphilis than others. It’s flexible funding, so that they could direct more funding toward that. And maybe other communities are struggling more with Hepatitis C, so they could focus more on that. It’s flexible funding to support the needs of public health.

Miller: The other biggest specific ask is $25 million over two years to go towards addiction prevention. How much is that happening in counties around the state these days?

Lochner: It’s really not happening very much. Right now, all we have for alcohol and drug prevention in the state is a $5 million-a-year federal grant, and that money is divided by 36 counties, nine tribes and nine community-based organizations. So that money does not go very far. Most counties don’t even have one full-time person doing alcohol and drug prevention.

This $25 million that we’re asking for would allow every county to have at least one full-time person and larger counties would have more. That would allow us to really start to tackle the addiction crisis at the root cause and help give young people skills, coping mechanisms and better decision-making skills, so that they don’t become addicted; and that at the very least, they delay use of alcohol and drugs, and best-case scenario, they never use.

Miller: Another specific ask would put about $3 million a year, so that the state would match Medicaid funding for two home outreach programs for families with babies or young kids: CaCoon and Babies First! What do these programs do?

Lochner: These are nurse home visiting programs, where nurses identify folks who have had a new baby. They visit them in their homes and identify what other supports and medical care that those folks need. Usually, they’re lower income individuals, usually on Medicaid, so these folks don’t necessarily know what specialized services are out there or what other social services they could qualify for or access, and that nurse helps connect them.

They also help with things that we might think of as basic, like parent-child bonding, making sure that the baby has a safe sleep space set up. Some parents keep the baby in bed with them, and nurses want to make sure that babies have a crib so that they have a safe space to sleep for a tiny, tiny human.

Also, making sure that they’re up to date on their vaccines and they feel comfortable getting vaccinated, answering any questions and helping parents deal with the complications that come with having a child, and having a child who might have special medical needs.

Miller: Tanya, money for programs is one thing, but that money is only going to work if you have people who are trained to do this work all across the state. Is that the case in Jackson County? Do you have a workforce that can do this work?

Phillips: That’s a really good question, too. Right now, yes, I would say we have that workforce, but one of the most … let me go back. Sometimes when you’re looking at funding, we may have the staff in place. One of the important things is, even when we have the staff in place, we want to be able to provide them with development so that they can still grow and learn the newest public health science that is out there. So sometimes, when we’re looking at budgets, you have to choose, especially when there’s smaller budgets – do you choose having a staff be employed full-time to implement this work? And then with that, you have to choose, well, sorry, you can’t go to these to the trainings, you can’t continue some of your education.

That’s the decision sometimes that we’re having to make and they’re not always the decisions that we want to. But when your budgets are small and they’re not able to provide enough for full-time staff or trainings, or even implementing some of those public health strategies that cost money, you’re having to choose between those things. And that’s ideally not what we want.

Miller: Sarah, I want to, in the time we have left, just move to the bigger picture here, apropos of the pandemic. It was a time when previously relatively established and agreed-upon aspects of public health became highly politicized. There have always been some people who were opposed to the idea of vaccines, but COVID changed that. It made it much more prevalent, much more common, and push-back against public health authority guidelines became something that I’d never seen the extent to which that became a reality, in my life. What does that mean going forward for public health departments or authorities?

Lochner: It’s one of our biggest challenges. The ability to effectively communicate facts and recommendations to the public in the face of so much misinformation and distrust coming out of the pandemic is something we are still grappling with, and we’re really trying to rebuild trust with public health. And I think bringing in the next generation of the workforce, homegrown from the local community, who already have roots established in that community, who are trusted messengers …

Miller: So it’s not Anthony Fauci, for example. It’s somebody in Medford, it’s in Ashland ...

Lochner: Right, people who are already embedded in the community, and giving them that public health training and knowledge, and then utilizing them to help us deliver the public health messages.

Miller: Tanya, in the last minute, have you had people who say simply, “I don’t trust you anymore”?

Phillips: I wouldn’t say there’s people that come out that say they don’t trust public health. As an agency or a local health department, there’s a lot of misinformation that is out there and looking at the funding, that’s been one of the harder parts of public health. We might have funding to fund staff to provide the vaccinations, but having staff to do that outreach and education and build those relationships, we don’t necessarily have. Nor do we receive funding to be able to combat the misinformation with best practices, the science of public health. We just don’t have that capacity to combat the misinformation on the scale that it’s on.

Miller: Tanya and Sarah, thanks very much.

Lochner / Phillips: Thank you.

Miller: Tanya Phillips is a public health worker in Jackson County. Sarah Lochner is the executive director of the Oregon Coalition of Local Health Officials.

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