Officials Say Greatest Public Health Threat Is Funding, And Missouri Is 50th Among States

Apr 22, 2016

The greatest threat to public health in the face of bioterrorism, viral pandemics and natural disasters may actually be less of a headline-grabber: An insufficient budget.

Speaking on KCUR’s Up to Date on Friday, the former chief medical officer of the U.S. Department of Homeland Security said that while various programs are in place to protect against biological weapons and disease outbreaks, the system could still break down at the state and local level.

“Funding for public health has been decreasing over really the past five or six years,” said Dr. Alex Garza, who held the government post from 2009-2013. “We know at the federal level that it’s going to be the locals that are going to shoulder the burden. Unless they’re well prepared and ready and well resourced, it’s going to be difficult.”

And, he told host Steve Kraske, “I think they could be better resourced.”

Kansas City’s top public health officer agreed. Dr. Rex Archer said that Missouri ranks 50th among all the states (plus the District of Columbia) in what it spends on public health.

Archer also said Kansas City alone receives $10 million less in public health funding from its state than the average U.S. city of its size, leaving its citizens vulnerable in the event of a crisis.

“You don’t decide to wait until the fire starts to hire the firefighters to prepare to put out the fire,” Archer said.

Both officials said that while governments at all levels have detailed plans to respond in the event of an attack — some of which could not be discussed publicly — bioterror is not the most prevalent threat.

“I try not to pigeonhole it as bioterrorism, because the greatest bioterrorist is Mother Nature, by far,” said Garza, who now is associate dean for public health practice at Saint Louis University. And too often, he said, funding shortfalls leave governments more reactive than pro-active to the threat of disease.

As an example, Garza cited the increased funding for mosquito control that followed the outbreak of West Nile virus a decade ago, only to be followed by a decline in funding once attention to that disease dissipated. He said continued funding for such programs would have provided a better defense against today's looming threat — the Zika virus.

“We all jump through hoops to prepare for the latest infection instead of building this very robust and stable system so we don’t have to ramp up, that we can just handle it as it comes along,” Garza said.

Archer warned that if the city were hit with two significant disease outbreaks at the same time — say, widespread shigella infections and group of measles cases — the system would be “over capacity” and unable to “manage the events well.”

Still, both officials pointed to the general success of public health work. Garza, highlighting the success rates of vaccinations and other programs, said this effectiveness sometimes makes public health its own worst enemy." Archer pointed out that the city does “public health surveillance,” including monitoring test results at local labs and hospitals and watching for spikes in ambulance activity in particular neighborhoods.

Archer encouraged citizens not to let conversations about preparedness for public health crises scare them, but rather to use them a reason to pursue greater investment.

“Fear is a mind killer. It often leads people to either fight or flight or freeze or some inappropriate response,” Archer said. “Talking about the reality of things and that we can do better and that we can change – we have a lot of infrastructure that needs to be reinvested in this country and built back up. We can save lots of lives through disease prevention.”

Garza was in town to be honored Thursday at the 2016 Alumnus of the year at the University of Missouri-Kansas City. 

Brian Ellison is a host/contributor at KCUR, and co-host of the political podcast Statehouse Blend. He can be reached at brian@kcur.org or followed on Twitter @ptsbrian.