The current measles outbreak across several states is highlighting the need for rapid response from local public health agencies. In Nevada, financial investment in public health ranks 50th in the nation. KUNR’s Anh Gray explores what that low investment means for Washoe County.
Nevada spends $6.75 per person on public health. For comparison, the 2017 national median for public health spending is about $38 per capita. And in DC, which spends the most per capita, it’s around $139.
Public health services include administering programs like vaccinations, and right now Sean Murphy is heading into the clinic with his family to get shots for his 2-year-old son. As a parent, he’d like to see more dollars flowing to public health for the sake of his two kids.
“I think health is huge; it should be done before anything,” Murphy says. “That’s our future. What are they going to do? They’re going to get sick. We see the measles outbreak coming out right now, and that’s huge. And I don’t want to see any of my kids get into that.”
For Washoe County District Health Officer Kevin Dick, he’s worried that limited financial resources could hurt the region's ability to cope with a potential crisis.
“What we’re very concerned about is what will happen to us if we get a measles outbreak like what’s happening in Clark County, Washington or back in New York City,” Dick explains. “We don’t have a good public health investment to be able to respond to these types of emergencies right now.”
Even when there isn’t an urgent threat, there are already pervasive issues affecting the community. In Washoe, heart disease, cancer, chronic respiratory disease and stroke were some of the top causes of death in 2016. That’s according to the 2018 Washoe County Chronic Disease Report Card.
“As a result, we are really underfunded in our chronic disease programs and in our programs that address the root causes of those chronic diseases, even though chronic disease is the biggest health burden that we have in our population," Dick says. "So instead of spending wisely, we’ve all heard that an ounce of prevention is worth a pound of cure.”
Right now, more money is spent on health care, which is the treatment of disease, instead of on public health, the prevention of it. Nevada spent about $7000 per person to treat diseases in 2014. That’s based on a Kaiser Family Foundation study.
And what’s happening in Nevada is also happening nationwide. The CDC estimates that chronic disease and mental health conditions account for the bulk of health care costs, 90% of the nation’s $3.3 trillion annual price tag.
Alana Knudson is a leading health policy expert with NORC at the University of Chicago.
“One of the challenges we see accross communities that have, for example, high prevalence of chronic disease, is that you end up having earlier mortality,” Knudson explains. “People’s ability to work decreases. If you want to have a vital community, if you want a community that has promising economic development activity, you need a healthy population.”
But the low state investment in public health is an ongoing challenge. As economic diversification and growth take place in Northern Nevada, Knudson says a healthy community becomes even more essential.
“If we are not investing in prevention and in providing opportunities for people to be healthy," Knudson explains, "we are not going to have an economically viable community.”
Along with addressing chronic disease, public health funding is used in many other ways, on services like air quality management, family planning, and STD prevention. There are also evolving threats in the region, including the transmission of vector borne diseases, like those spread by infected mosquitoes.
I joined the Washoe County Health District on a helicopter ride to release Altosid P35. It’s a biological larvicide that the district is using to target mosquito larvae. Today, they’re focusing on flooded parts of the North Valleys.
Due to environmental changes over time, health officer Kevin Dick says that the mosquito abatement program is becoming more critical to the Truckee Meadows.
“It’s because we have the transmission of West Nile virus disease here, and encephalitis which happens through the mosquito population,” Dick explains. “This is also, in part, a story about climate change that's happening in our region. We didn’t use to have West Nile virus in Nevada, and now we do, so we’re expending that money to try to control the mosquitoe population to reduce the transmission of that disease.”
As the health district is combating emerging issues, Dick says financial resources at the district have been stretched thin. More money could come from a bill that’s up for consideration during this current Nevada Legislative session. Senate Bill 263 proposes to tax and regulate vaping products.
Health lobbyist and president of the Nevada Tobacco Prevention Coalition Michael Hackett is working to get the bill passed. Based on his years of lobbying Nevada lawmakers for a variety of health causes, he says it’s been challenging to get support.
“We've have just not funded these programs in the manner they should be funded. And I think Nevada has always taken more of a reactionary point of view in terms of dealing with these things that until becomes a problem,” Hackett says, “then the legislature or local governments have chosen not to address it.”
But he says he’s starting to see some lawmakers recognize the long-term consequences at stake.
“It’s better in the state's best interest, both from a public health policy point of view, as well as from a fiscal point of view to be more proactive in addressing these issues and not wait for a crisis to happen before you deal with it," Hackett explains. "And so, that's why you're starting to see a gradual shift in mentality.”
Although the primary goal of the vaping tax bill is to curb the increased use of e-cigarettes among youth in Nevada, the potential revenue collected would go to tobacco prevention and general public health. Hackett says that while that money would result in only a minimal boost, it would at least be a step in the right direction.