Chronically low state funding for Missouri’s local health departments is hampering their ability to respond to the novel coronavirus.
Even outside of a crisis, agencies are stretched to cover vast arrays of duties, including vaccinations against deadly disease and fighting the opioid epidemic as well as garden-variety restaurant inspections and water testing.
Now, agencies in a state ranked among the worst for per-person public health spending must also help people get tested for the new virus and trace potential infections while also telling people and elected officials how to stay safe and slow the spread.
In interviews this week, leaders of county-level health departments across the state told the News-Leader it’s stressing their limited staff and revealing gaps left untended by lean budgets.
“If you don’t have enough funding at the local level, you don’t have enough staff to respond when there’s a pandemic like this,” said Audrey Gough, administrator of the Shelby County Health Department in northeastern Missouri. “There’s only so much a person can do in a day.”
Randall Williams, the state’s top public health official, said his department is doing everything it can to help local agencies and expressed confidence they are prepared for the emergency.
“We have a saying in public health,” he said. “We don’t let what we can’t do keep us from what we can do.”
Officials in Stone County, west of Branson, are living that statement daily.
Department Director Pam Burnett said her nurse has been working past 10 p.m. some nights trying to get people tested. Burnett herself has been taking calls late and into the early morning, some from officials trying to respond to the crisis and others from anxious residents trying to survive it.
“They’re worried that their family’s going to get it,” she said of the latter group. “They’re worried that their neighbor is having a party and want someone to tell them not to. It’s a lot of things.”
The hard work is the norm at Burnett’s department, where employees juggle multiple titles — the emergency planner is also the environmental health specialist, for example — and do their best with what they have.
She’d like to do more to fight child abuse and neglect and maybe have more than one person working on obesity and heart disease in a county with high rates of both, but there’s just not enough money.
That hard truth also means the department has struggled to keep up its volunteer program, which Burnett said would be critical now to meet the demands of the crisis.
“That’s going to be crucial at this time to get to people in their homes, especially older people,” Burnett said, “and we just didn’t have the money for a staff member to work on that.”
Charla Baker, administrator of the Laclede County Health Department in Lebanon, knows the feeling.
She could really use someone who specializes in talking to the public about health issues right now.
In addition to fighting the virus, she and others are also trying to contain all the false information spreading across the internet about it.
“Social media has been very difficult for us to battle,” Baker said. “There’s a lot of rumor control that has to be done.”
But the department’s “health educator” position was eliminated some years ago amid a reduction in state funding, Baker said.
She and others find time in their own packed schedules now and it works OK, she said.
“But boy, in a situation like this, it would be nice to have a position dedicated to that,” Baker said.
The decline in state aid to local agencies stretches back to the early 2000s, but the big drop came in the years after the 2009 financial crisis, when declining revenues meant an outlay of roughly $9 million shrank by nearly two-thirds.
Departments still receive federal money, but that’s usually for specific, supplemental programs prescribed by Washington.
The state money, on the other hand, can be used for more basic needs, like dealing with contagious diseases, hiring investigators and education.
“It’s badly needed and what the state is spending is insufficient,” said Bert Malone, a board member with the Missouri Public Health Association. “And it becomes most evident right now.”
Some departments, including Springfield’s, have been able to compensate thanks to money from their cities and counties.
Clay Goddard, the director of the Springfield-Greene County Health Department, said the money he gets that way has made it possible to have dozens of people under quarantine and partner with hospitals to get hundreds tested at a mobile clinic.
But that doesn’t mean he rests easy.
“We’ve got highly-trained staff, but the truth is I still don't have enough people,” he said. “It's going to be an uphill battle.”
He worries even more about departments that have far less support.
“You can’t do collaborative partnerships if you don’t have staff to collaborate,” Goddard said.
Gough, the Shelby County administrator, knows that well.
Without the money for protective equipment, test kits and additional staff, she can’t set up a test site that could help contain the disease, which has already infected one person in the rural county of around 6,000.
“It’s those types of things that limit your ability to respond,” Gough said.
Malone and others said they’ve tried to get the funding restored since, but efforts have been unsuccessful to date.
Kevin Gipson, who used to run Springfield’s health department, said “competing priorities” were always in the way, and he understood why.
“A good day in public health is something doesn’t happen,” he said. “You don’t have women marching on Washington because their kids didn’t get pertussis. It’s not a sexy thing.”
But Malone said the current crisis should be a "wake-up call" to Missouri and other states in a similar situation.
"This whole pandemic shows how (a lack of funding) has really hurt local public health departments' ability to respond," he said.
Some help is on the way.
The federal government is sending billions to help state and local public health agencies with the cost of the crisis, according to the National Conference of State Legislatures. At least some of the money is earmarked specifically for fighting the virus, though, and so it's clear it will help with departments' ability to provide other services or prepare for future crises in advance.
And with the state budget up in the air due to the virus's impact on the economy, getting a boost there could be tricky.
In the meantime, though, local public health officials said they'll pull together and make do with what they have.
Burnett, the Stone County director, said she did not worry that her department's efforts won't be enough.
"I’ve got a great staff that we work with, and I have full faith that everyone’s going to step up," she said.
That doesn't mean it'll be easy, though.
"It is going to test us all," she said. "We’ve had our breakdowns. It’s just really hard to hear all the stories nationally and locally. It just kind of wears on you, and sometimes with those limited resources where you want to do more and you just can’t.”