The public health infrastructure in Missouri: An ongoing crisis

In the past 15 years alone, the line item in the state budget that provides support to local public health agencies for essential public health services has diminished from nearly $10 million in FY 2002 to a little over $3 million in FY 2018.

As a member of the board of directors of the largest voluntary public health organization in the state of Missouri and a concerned advocate for public health, I remain appalled at the continuing dissolution of the public health infrastructure in our state.

In the past 15 years alone, the line item in the state budget that provides support to local public health agencies for essential public health services has diminished from nearly $10 million in FY 2002 to a little over $3 million in FY 2018.

This nearly 66 percent reduction has resulted in Missouri’s ignominious ranking of 50th in the nation in the amount of per capita general revenue support for local public health. Similarly, Missouri has been only minimally successful in competing for and receiving federal funds to provide or augment essential public health activities. The state of Missouri receives a per capita amount of $18.98 per person in CDC infrastructure support, yielding a ranking of 42nd among states in the nation.

This critical loss of funding comes at a time when health outcomes in the state are worsening by the year.  According to Trust for America’s Health, key health indicators in the state point to a serious crisis now and for the near future.

  • Missouri ranks 10th in the nation in the rate of diabetes and 10th in the prevalence of obesity, a major risk factor for both diabetes and cardiovascular disease, the second leading cause of death in the state behind cancer.
  • Missouri ranks fifth among states in the prevalence of tobacco use.

These facts combine to forecast higher rates of premature death due to these risk factors for chronic disease now and in the years to come.

Risk behaviors among Missouri’s youth reflect similarly dismal indicators with 13.1 percent of youth, 10-17 years of age, reported as obese and 11 percent considered current tobacco users. High rates of sexually transmitted diseases and AIDS among youth reflect the failure of disease prevention messages and education.

Because of the decreased funding and high rates of preventable disease in our state, the local public health agencies are forced to focus their attention and be reactive as opposed to proactive. Instead of working on the prevention of disease, local health efforts are expended on reacting to outbreaks that occur. Such outbreaks include recent ones related to hepatitis A, mumps, restaurants serving contaminated food products or recent outbreaks throughout Missouri of whooping cough, an entirely preventable illness among children.

Compounding the increase in preventable disease and the significant reductions in financial support for public health infrastructure is the fact that the public health workforce is similarly challenged.  A survey of recent Master of Public Health graduates in the state disclosed that the majority chose to seek careers in other states and not in Missouri, principally due to the low pay scale in the state and the lack of realistic promotional opportunities and career advancement.

Missouri can and must address these dire facts and once again reach the fulfillment of the motto of the great state of Missouri: Salus Populi Suprema Lex Esto, i.e., The Health of the People is the Supreme Law.

Citations:

Trust for America’s Health. (2017) A Funding Crisis for Public Health and Safety: State-by-State Public Health Funding and Key Health Facts, 2017; http://healthyamericans.org/.

Missouri Public Health Workforce Survey of Recent Graduates, Missouri Public Health Association, unpublished, (Draft) 2017.


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HCF's Local Health Buzz Blog aims to discuss health and health policy issues that impact the uninsured and underserved in our service area. To submit a blog, please contact HCF Communications Officers, Jennifer Sykes, at jsykes@hcfgkc.org.

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