Back in October, I had the privilege of attending the 2017 Washington State Public Health Association Conference held in Wenatchee, WA.
Why did I go, you ask? Well, I thought that I would learn a "thing or two" about how public health works in that state, and maybe meet a few of the kind folk who had something to do with it. After three days of listening, learning and sharing ideas, I came away refreshed; being present in that setting with a number of brilliant people who've invested considerable energy in supporting health and happiness in their communities, now that was truly inspiring... Of course, as with many human pursuits, their work is not a simple affair.
The Washington State context proves difficult for those supporting public health: In 2017, a budget ask to the state legislature of $60M to support state-funded public health services was ultimately reduced to an approval of only $12M. That $12M will be shared among 35 Local Health Jurisdictions (which include both county, city and multi-city health departments) among other public health partners. With limited funding provided by the state, and at the mercy of the various municipal authorities in raising additional operating funds, and with significant challenges mounted by the current federal administration to the publicly-funded subsidies provided by the Affordable Care Act, significant pressure is being placed on these public health professionals and institutions to deliver more services with fewer resources. A recent news article about budget reductions for the Spokane Regional Health District relays the sort of pressures that public health departments face, and the arguments used to support appropriate funding for their work.
It's difficult witnessing how public health departments have had to reinvent themselves in the face of these pressures—I remember distinctly two seminars during the conference discussing how these departments can work more closely with non-profit foundations and private entities (gingerly coined "Public Health 3.0") in supporting their service efforts in light of the financial and mandate constraints put on them, and another seminar about how the Washington State Public Health Association is working to persuade state lawmakers in assigning more specific funding for core public health services. While these conversations show resilience and adaptation in the face of adversity, it was hard not to feel somewhat defeated while listening to the different ways they had to improvise in order to meet their mandates without adequate and stable funding for their programs. The public health association's Public Health is Essential campaign worked to bring these issues to the attention of state lawmakers, but ultimately the campaign did not result in the desired level of funding they were seeking (though, to the campaign's credit, they were sincerely thankful for what they did end up getting.) Regardless, the campaign showed something that may be more important for the future of public health in the state—that public health leaders can organize and bring forward a common message about the importance of their work and the impact they have on residents. It also builds an argument for a more formal sharing of accountability and performance among all public health service providers beyond the narrow lens of any single, local public health administrator and the elected municipal officials they answer to.
This is momentum that can be built on. Another seminar presentation that I attended showed how different health departments had collaboratively determined population health improvement and surveillance goals when developing a "Regional Health Improvement Plan", which extends the more commonly known concept of a Community Health Improvement Plan to a region. This is getting closer to the kind of "shared accountability" that I think is desired. I was curious to know if there was a state-wide vision or plan that provided a framework for shared accountability, and found a few documents on the Washington State Health Department's webpage. The State Health Improvement Plan is expiring soon (as it covers the period from 2014 to 2018), and I'd like to know how well the state has tracked on this plan. After all, a well-intentioned plan shouldn't simply be an intellectual exercise...