Going into Uncertain Times for Public Health Funding

By Brian Kennedy and Dr. Patrick Jones

Since the outbreak of COVID-19, public health has been in the forefront of everybody’s mind. But what is it exactly and what does spending on its activities look like in Benton and Franklin Counties?

Spending on public health comes in a variety of forms. Largely comprised of the workings of the Benton-Franklin Health District, the programs and services provided are far reaching within the community. Not only is the health district taking lead on providing COVID-19 testing, but it is tasked with contract tracing of those infected, epidemiology, response and support for long term care facilities, and coordinating with hospitals and health care facilities in the allocation of COVID-19 resources. Further, with much information swirling around, the health district serves as the central source of definitive information to the public about the current state of the pandemic, symptoms to be on the lookout for, how and where to get tested, and ways of keeping  safe.

Despite the COVID-19 pandemic taking center stage right now, the public health covers a wide swath of programs and services, ranging from keeping vital records such as birth and death certificates, to program services like Women, Infant, and Children (WIC). For a complete look at all the services provided visit here.

Knowing just exactly what public health does is important so we can evaluate the trends. Indicator 6.5.1 shows how funding for public health has changed over time. The Washington State Auditor’s Office keeps track of all local government expenditures using the Financial Intelligence Tool (FIT). Here we can look up any government entity, ranging from city and county governments to health and park districts. Using this tool, we can analyze how government spending has changed overtime in key areas such as public health.

In 2018, there was a total spending of nearly $10.1 million on public health services across Benton and Franklin Counties. While this includes any spending done by county and city governments within the two counties, a vast majority, 94%, comes from the Benton Franklin Health District. While $10.1 does sound like a lot of money, this accounts for just 3.1% of the roughly $339.8 million in total government expenditures carried out by all cities and counties within the metro area.

As the graph depicts, spending per capita between Benton and Franklin Counties and the State are not only quite different but they are moving in opposite directions! In 2018 per capita spending was just $35.1, almost half as much as it is statewide, at $62.8. In addition to the current, large discrepancy locally, spending has dropped by $4.3 per resident within the two counties, falling at a cumulative annual growth rate of about 1.3% since 2010. Washington on the other hand has grown by about 1.4% per year.

Indicator 3.1.1 shows the per capita personal income earned locally and statewide. This trend measures the total personal income (TPI) earned by all residents, including wages, investments, pensions, and government transfer payments. It is clear there are great differences in the levels of income locally and those across the state, largely swayed by the metro areas west of the Cascades. Because of this, we can look at public health expenditures per $1,000 of total personal income allowing us to account for the differences between the state and here. In other words, this approach allows a comparison beyond a per capita basis. If incomes are lower in a particular jurisdiction than in the benchmark, we would expect local government expenditures to be lower as well

In 2018, about 80 cents were spent on public health per every $1,000 of personal income in Benton and Franklin Counties. Here, the Washington average is about $1 per $1,000 TPI. So when accounting for the income difference, the two counties are still trailing the state but, in this case, not nearly as much. The State is only about 25% higher than the two counties as opposed to nearly double.

Because King, Peirce, and Snohomish Counties alone account for over 50% of the population the westside metro areas heavily influence the state rates. Other Eastern Washington Metro areas may provide better benchmarks.

Walla Walla Trends Indicator 4.4.6 and Yakima Valley Trends Indicator 7.5.1 track similar data and show that Benton and Franklin Counties fund public health at a higher rate than comparable eastern Washington metro areas. Walla Walla County comes quite close, however, falling behind Benton and Franklin Counties by just $0.7 per capita and $0.1 per $1,000 TPI in 2018. However, Yakima County falls well short of Benton and Franklin Counties by $24.6 per capita and $0.6 per $1,000 TPI in the same year. So, while it looks like locally public health isn’t being funding well, compared to some other Eastern Washington metros, the region is doing well.

In the uncertain times we are facing, keeping an eye on funding for public health allows residents to see if we are well equipped to handle times of crisis. While funding has slowly declined overtime following this trend into the future will be important to watch. The additional dollars that have flowed to the public health in the wake of the pandemic will undoubtedly produce higher expenditures in 2020. (They won’t show up in the Trends for another year, however.) A big question will remain whether these increases will be sustained into 2021 and beyond. From all the forecasts we read, the virus will be with us in 2021 and perhaps 2022. And virologists tell us that other viruses may not too far behind. Will this crisis lead to an increased appreciation of public health, and consequently its funding?