November 7, 2010
In an era of belt-tightening and limited public funding, Kandi Buckland is a realist.
She knows there’s no going back to the high-cotton days of 2001, when the agency she oversees — the El Paso County Department of Health and Environment — received $9.56 in per-capita funding from the county and had the equivalent of about 250 full-time jobs.
But after eight consecutive years of budget cuts, she concedes the health department could stand to be a lot healthier. The county’s per-capita contribution has dropped to $4.49, one of the lowest in Colorado, staffing is down to about 170 full-time positions, and programs that include sexually transmitted disease surveillance, meth-lab cleanups, teen suicide prevention and air and water quality monitoring have been axed or truncated.
“We haven’t just cut the fat; we’ve cut off the limbs,” Buckland said recently. “I can’t say we’re healthy. I truly believe as a local health department, we should be doing some of the services we lost. But we’re not on total life support.”
The El Paso County Board of Health is scheduled to hold a public hearing at 2 p.m. Nov. 15 to discuss adoption of the Department of Health and Environment’s budget for fiscal year 2011. The meeting is scheduled to take place in the Pikes Peak Regional Development Center hearing room at 2880 International Circle.
Because of the nation’s economic downturn, it’s been a difficult few years for health departments everywhere. The National Association of County and City Health Officials in Washington, D.C., reports that from January 2008 to December 2009, U.S. health departments lost 23,000 jobs, or about 15 percent of their work forces, and a third are operating on lower budgets this year compared with 2009.
El Paso County’s health department was already dealing with cuts well before then, having lost about $1.3 million in county funding from 2002 to 2006. County funding to the department dropped from about $5.1 million in 2001 to about $2.8 million this year. The department has also had to deal with cuts from the state, plus the loss of some contracts and grants.
“I think you’re on the most extreme end of the spectrum in terms of cuts, and with what I’ve seen with these kinds of reductions that have had to be made in order to accommodate those cuts, eventually some chickens will come home to roost,” said Robert M. Pestronk, executive director of the national association, known as NACCHO.
So far, those chickens have managed to stay away, but public health officials say it’s a matter of time.
“When things are going well, you can survive on a very lean budget,” said Martha Rudolph, executive director of the Colorado Department of Public Health and Environment. “But when you’re faced with a public health crisis, which will come in some fashion, where you do not have the resources to respond — that’s when you really see what the cuts can do.”
'Kind of scary'
Faced with an ever-shrinking budget, county health department officials have had to be as strategic as possible in figuring out which services to either cut, reconfigure or farm out to other entities while trying to preserve the basic functions of a health department.
“I think over the years, back in 2002 and forward as the budget cuts came, we looked at services, and if our partners could do it, we moved those out to the community,” Buckland said.
So the department’s sexually transmitted disease program and air quality monitoring operation, for example, were cut. The state took over some limited air quality monitoring and STD investigation functions. Peak Vista Community Health Centers has taken over well-child checks and prenatal care, and an HIV health care clinic and refugee health care clinic, among other programs.
But it’s not an optimal situation for the state to help fill the gap, Rudolph said. It’s more efficient for counties to provide their own services, she said, because they’re closer to the issues and the state doesn’t always have the people to take up the slack.
“And in some cases, the counties can be much more responsive (to a public health problem). El Paso County is close to Denver, but it’s still an hour away to respond to something,” she said.
Rudolph also noted that El Paso County’s health department is the only one in Colorado to receive such support from the state health department.
“We’ve had other counties talk to us about functions that they’re providing, but at this point, we’ve been able to work with them, or they decided it really is something they want to do locally,” Rudolph said. “So really, it’s El Paso County that’s struggling more than other counties.”
And although there have been no serious or apparent consequences from the department’s cuts, Pestronk and Rudolph believe some could eventually emerge.
“We had a fabulous STD program,” she said, citing an example. “I think it will take time to see if the cut has impacted the STD rate. What we have seen is concern from the public — folks who might need to access help. Not everyone has primary care.”
El Paso County Commissioner Sallie Clark, who is on the county Board of Health, also worries about people who might be moving into places that housed meth labs, now that the health department has gutted its program.
“When a meth lab’s been in a house, it’s really up to the homeowner to make sure it’s clean,” Clark said. “No one is overseeing it to make sure. Nobody is verifying that it even gets done. That’s kind of scary from a consumer standpoint.”
The return of online restaurant inspections
Despite the cutbacks, the health department continues to perform some critical functions, such as septic system and day-care facility inspections, emergency preparedness and communicable disease operations, which includes a tuberculosis clinic.
The department, armed with a federal grant, also was at the forefront of an effort to immunize the public against the H1N1 “swine” flu virus late last year and into 2010, and it works with the county Department of Human Services on a cooperative program to prevent child abuse.
The department is even beefing up its food-safety efforts and has added more positions to help meet the state’s mandate of twice-a-year inspections of food establishments. That includes about 2,500 restaurants and grocery stores in the county.
“We were pretty much at once a year, and some probably were longer than that,” Buckland said.
The department also plans to relaunch its online access to inspection reports by the end of the year.
But what the department is doing now may change in the face of further funding cuts and a legislative mandate for health departments statewide to assess community needs and eventually develop a set of basic services they all should provide.
“We’re excited about that,” Buckland said. “It’s mandated, but it’s also very much needed. Over the past eight years, this department has experienced so many cuts, so it’s important to take a look at what issues are affecting the health of El Paso County. Will it change some of the programs we’re currently doing? We don’t know, because we don’t have the data. Public health services should be based on data.”
She expects the county assessment to be finished by the middle of next year.
The Board of Health will hold a public hearing Nov. 15 to consider a budget that anticipates a $150,000 increase in funding from the county, a $66,191 decrease in state funding, a 2.5 percent salary increase and a drawdown of about $395,000 from what is essentially a rainy-day fund to keep expenses in line with revenue.
The additional $150,000 from the county represents anticipated savings from the relocation of many county operations, including the health department, to the former Intel building in northwest Colorado Springs.
At a meeting before county commissioners a few months ago, Buckland said it was critical that the department receive an increase in per-capita funding from the county, but Clark isn’t optimistic. That, coupled with further cuts in funding from the state, concerns Buckland, especially because most other funding sources, such as grants and fees, are tied to specific uses.
“It’s very concerning when we lose money that allows us discretion, and we’ve got some very concerning reductions possible in our future” Buckland said. “I don’t think we’re anywhere close to being done with challenges.”