$10 per person is simply not enough to deal with a public health crisis

July 20, 2020 2:24 pm

Gov. Doug Ducey speaks about the latest COVID-19 data at a news conference June 25, 2020, in Phoenix. Photo by Ross D. Franklin/Associated Press | Pool photo

Public health data shows what experts warned us about Arizona’s mid-May re-opening, which ran contrary to public health guidance: The COVID-19 pandemic in Arizona is much worse. It’s more important than ever to face an urgent truth—Arizona invests just $10 per person for state public health funding and by this measure ranks 49th in the nation, according to the State Health Access Data Assistance Center

If we want to weather COVID-19 and future health crises, we need to treat public health as a priority, and fund it with more than $10 per person from the state legislature. 

The data are stark. No Native nation, county, city or town is untouched. As of July 20, there have been 145,183 confirmed COVID-19 cases and 2,784 deaths in Arizona. Public health officials agree that the increase in cases represents community transmission, not the increased testing across the state. 

But even with increased testing, many report long waits to get tested and receive results. Large hospital systems have neared ICU capacity. The state is bringing in 600 “critical care and medical-surgical nurses” from out of state to help. Hospitals in Phoenix requested refrigerated trucks to provide additional morgue space. Tucson funeral homes are at capacity. In mid-June, one county health official described the situation as “super-concerning and super-scary.”

Some have criticized state leadership for re-opening too quickly on May 15, ignoring criteria from experts and those published by the White House, which was keen to see states re-open quickly. But the problem is deeper than Gov. Doug Ducey’s approach. 

The COVID-19 crisis has revealed the upside-down funding priorities in Arizona. In Arizona, our current public health funding is just half what it was a decade or so ago. In 2007, Arizona invested $20 per person for public health. That investment plunged after the 2008 recession and never returned.

Just imagine if it had and the public health system didn’t have to play catch-up during a pandemic.

The COVID-19 crisis has drawn attention to just how important public health funding really is.  Public health programs promote wellness and reduce future costs by preventing the need for future medical care. Public health infrastructure is important for general community health, but it is essential in an emergency. A well-funded public health system has the resources, capabilities, and workforce to address the urgent needs that arise in a crisis and advocate for evidence-based approaches. In their 2018 report, the Trust for America’s Health stated that investment in public health is needed “[to] make sure each community will be prepared, responsive and resilient when the unexpected occurs.”

Public health and health care workers have worked heroically during the COVID-19 crisis. But if public health funding had been even at its previous levels, we may have started out better positioned to address the crisis. As a state, we could have supported early robust outreach on social distancing and hand-washing; early contact tracing of infected individuals; and monitoring programs for those in self-quarantine. Looking forward, if a vaccine becomes available, a well-funded public health department could implement a major vaccination effort.

This crisis will cast a shadow. Some of us will lose loved ones or know someone affected. We will need to provide support for the health care workers and advocate for their protections during a crisis. We will need to make sure the essential workers that we relied on—like farmworkers, grocery clerks, and delivery personnel—receive improved compensation, benefits and workplace protections.

The significant increases in cases means that, as a state, we are playing catch-up. We are lagging in our ability to implement testing programs, identify hot spots, coordinate with employers and schools, implement robust contact tracing and support people who test positive for COVID-19 as they quarantine. 

Short term immediate investment is necessary, but not enough to fully protect Arizona from the decision to re-open without clear guardrails or from the next pandemic. Let’s work together to address the crisis by taking protective actions as individuals and communities (for instance, trivial inconveniences like wearing masks in public) and ensure that Arizona invests in public health. Ten dollars per person in state public health funding is simply insufficient.

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Bryna Koch, MPH
Bryna Koch, MPH

Bryna Koch, MPH is a Doctoral candidate at the University of Arizona, where she studies the intersection of public health and immigration. She is also a Public Voices Fellow with The OpEd Project.