Dan Martindale fears pandemics, floods and foodborne illnesses.
In bidding adieu to a four-year tenure as El Paso County Public Health’s director, Martindale minces no words when assessing the challenges his successor will face. The Health Department, he says, is nearing a perilous point in its ability keep the county’s roughly 700,000 people healthy and safe from disease — chronic diseases like obesity, spoiled food at poorly run restaurants or an as yet-to-emerge pandemic.
In short, the agency gets too little money to serve fast-growing El Paso County, he said.
“If there’s an outbreak of any of those diseases — let’s just say measles, mumps — we will be very hard pressed, and have been hard pressed, to come up with the resources to address numerous communicable disease at one time,” Martindale said.
Martindale, 62, plans to retire Friday after a 23-year career at the county’s Health Department — a tenure that saw him climb the ranks from a tobacco education and prevention coordinator to its top post, while working on nearly every facet of the agency.
With a budget this year of about $16 million, it’s being asked to deal with an ever-growing list of demands.
The agency acts as a watchdog, inspecting restaurants for issues that could sicken customers and tattoo parlors for unsafe practices. It works to prevent youth suicides, childhood obesity and smoking, as well as chronic conditions such as diabetes and heart disease. And all the while, it must respond to myriad health emergencies, including well-known diseases, such as listeria or rabies, while preparing for the next viral outbreak.
It helps ensure new mothers have the food and care they need to keep their newborns healthy. It provides immunizations — both for young children and adults, as well as those supplied by the federal government during an outbreak. And it provides government officials with the expertise needed when unforeseen emergencies emerge in their towns. The list goes on and on.
Lately, Martindale said, several aspects of that job have grown more difficult.
The Great Recession took a deep toll on the agency’s budget, and only in the last couple of years have revenues approached those seen in 2006. Almost none of that recent funding relief came from the county or state. Rather, much of it was due to the department’s ability to pursue and secure new grants for specific issues in the community, said Elaine Johnsen, who oversees the department’s budget.
Since 2008, the department’s staff declined from about 200 to about 150. In the meantime, the county’s population has grown by more than 100,000 people — a 17 percent jump, according to U.S. Census Bureau estimates.
That’s a problem, Martindale said, especially if a flu pandemic or another disease outbreak hits the county and requires mass immunizations.
“I just believe with the population this size, we’re just not going to be able to immunize everyone that needs to be immunized,” Martindale said. “You just do the numbers, and they don’t add up.
“Even with that decrease in staff, the public still expects us to keep providing everything we did and more than we did when we had 250 employees (in 2000),” he added. “The fact is, that’s not possible and currently I’d say we are way past capacity and we need to identify other sources to increase our” staff.
Two funding sources have been the slowest to change.
County funding has been essentially flat since at least 2012 at almost $3.3 million, according to budget documents. Same goes for funding passed down from the state, which has been just shy of $1 million for years.
Martindale acknowledges having never asked the county commissioners for extra money — cognizant of the county’s other needs, while preferring to seek grants to boost coffers.
But now, the Health Department’s at a point it no longer can just depend on such grants, he said. Martindale suggested his successor will likely have to seek more county funding, and the department might need help from Colorado Springs officials as well.
Right now, just one relatively small disease outbreak is enough to nearly overwhelm the department, he said. He pointed to an instance this year when dozens of skunks tested positive for rabies. It nearly overwhelmed the agency’s communicable disease program — leaving almost no time to respond to the roughly 60 other diseases the agency must monitor in the community.
Public health funding across the nation has been “chronically” underfunded for decades, said Dr. Jonathan Samet, dean of the Colorado School of Public Health.
Public health spending accounts for only a fraction of health care spending in the U.S. — topping out at 3.2 percent in 2002, before falling to 2.7 percent in 2014, according to a study published in 2016 in the American Journal of Public Health.
“We spend only a few percent of what we spend on health care on public health,” Samet said. “And if you think about it, given the burden of preventable disease, there’s a lot to be gained.
“And if you look at what’s going on, and the problems and challenges that local public health problems face, they never go away. In some ways, they’re rising. So we have much to do. The problems are always shifting.”
Much of that is due to a lack of appreciation for the work of public health workers, said Theresa Anselmo, executive director of the Colorado Association of Local Public Health Officials. No one receives breaking news alerts when someone avoids getting sickened by potato salad, or when someone avoids smoking.
“If I asked you what does public health do, the answer may vary from person to person, and they may say they don’t know,” Anselmo said.
“And that’s because it is really good at doing its job. Meaning it’s good at preventing foodborne illness. It’s good at preventing waterborne illness. We have reducing tobacco use in youth. We have lowering rates of teen pregnancy.
“Those are the impacts of public health, and it’s hard to tell a story about something you’ve prevented.”
El Paso County Commissioner Longinos Gonzalez, who also sits on the county’s Board of Health, acknowledged a need for more public health funding, and said he’d work to get “a little bit more” in 2019. But needs exist across the county, he said.
He successfully fought to add $25,000 to the department’s 2018 budget. And he pointed out that the board recently earmarked $500,000 of its reserves to be used specifically for emergencies.
Taking the reins at El Paso County Public Health on an interim basis will be Susan Wheelan, an 18-year county public health employee who will lead the agency while the county’s Board of Health seeks a permanent replacement.
In the meantime, several other challenges await Martindale’s successor.
Chief among them are the difficulties that many residents face accessing the agency’s services at the county’s Citizens Service Center, which is miles from the county’s most impoverished areas. He cited that as a key reason for opening a Women, Infants and Children office this year in southeast Colorado Springs.
“This is a great building, but the gaps in terms of the needs for our citizens are not necessarily in this area — it’s down south, southeast,” Martindale said.
In addition, the county must be ready for new infectious diseases, while responding to the epidemic of opioid-related overdoses, a growing number of restaurants to inspect and a rise in homelessness, he said.
The key, he said, is whether the department will have enough people to do all of that.
“Something’s got to give,” he said.