Coronavirus is here. And Michigan’s public health system is underfunded.

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Michigan has the lowest rate of public health funding in the Midwest, and local governments may strain to provide other services in the wake of the coronavirus. (Shutterstock image)

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Coronavirus has come to Michigan, and the state’s first line of defense is a public health system that experts say is chronically underfunded.

Michigan lawmakers this week approved $75 million to fight the virus, but experts say long-term disinvestment in public health could mean other priorities fall by the wayside as staffers focus on coronavirus. 

“It’s all been way beyond 9-to-5, and it has been for several weeks now,” said Susan Ringler Cerniglia, spokeswoman for the Washtenaw County Health Department.

Earlier this week, the agency had ordered 15 of the 57 cases tested statewide for the new coronavirus. All so far in Washtenaw have been negative.

“We don’t have cases yet, and you have to ask: How long can we keep doing this?” Ringler Cerniglia asked.

That may soon be put to the test. Coronavirus, which has killed more than 4,700 people and sickened nearly 128,000 worldwide, arrived in Michigan this week after nearly two decades of shrinking public health funds.  So far, 12 cases have been confirmed in Michigan.

State funding for core health services dropped 16 percent from an “inflation-adjusted high point of $300 million” in 2004, according to the Citizens Research Council of Michigan, which in 2018 analyzed Michigan’s public health funding dating to 2003. 

By 2017, Michigan spent $128.3 million, or $12.92 per capita, on overall public health funding, according to the council’s report. In contrast, New York, Idaho and Hawaii spent $90 to $115 per capita, while Maryland and Oklahoma spent around $40 per capita. 

“No one comes out against public health as a concept, but people generally pay attention to it only when there’s a crisis,” said Tim Michling, a health policy research associate at the council and author of the report.

Michigan ranks near the bottom in the country — 43rd — on public health funding, according to America’s Health Rankings, an annual report by United Health Foundation, a Minnesota-based nonprofit that works to improve public health. 

Michigan also had the lowest rate of funding in the Midwest in 2014, the last year available in an analysis by Kaiser Family Foundation, a California non-profit organization focused on national health issues.

Local public health departments not only are on the frontlines during outbreaks. They also test food and water, monitor environmental hazards and battle everything from obesity to drug epidemics to underage drinking. 

When local public health departments’ resources are diverted to a crisis, it could put those other programs at risk.

“It's kind of an all hands on deck” situation during crises, said Meghan Swain, executive director of Michigan Association of Local Public Health.

“We've always asserted that we can do the day-to-day stuff, but …. now you're pulling all your staff to focus on this ... and it starts to put a strain on the other program areas.”

We've always asserted that we can do the day-to-day stuff, but …. now you're pulling all your staff to focus on this ... and it starts to put a strain on the other program areas.” -- Meghan Swain, Michigan Association of Local Public Health


With nurses diverted to coronavirus monitoring in Washtenaw County, its public health education staff that normally would work on youth tobacco prevention or food access for low-income residents are now answering phone calls about coronavirus, Ringler Cerniglia said.

A supplemental spending bill passed by the Legislature this week includes $10 million for coronavirus response and an additional $15 million for future coronavirus response efforts. The bill also includes $50 million in federal funding for state and local “preparedness and response activities.”

The money will be used for education, virus monitoring, testing, tracing the origins of viruses, “infection control” and “continuation of critical state government functions,” according to a House analysis of the legislation.

Two years ago, the state increased essential local public health funding from $40.9 million to $51.4 million. The money is earmarked for immunizations, hearing screenings, control of infections and sexually transmitted diseases and more.

The increase came after state funding for local health remained relatively unchanged for nearly two decades from $39.9 million in fiscal year 2000 to $40.9 million in fiscal year 2018.

Lawmakers say the budget is appropriate. 

“We’ve done a pretty good job of making sure that we’re on top of the issues. Have we been somewhat frugal? You bet,” said Sen. Curt Vanderwall, R-Ludington, chair of the Senate Health Policy committee. 

“But I also think we’ve done a really good job in leadership over the last several decades to make sure that the state has been prepared. When monies need to be ready and available we have reacted very quickly, and we did that again this week.”

Rep. Hank Vaupel, R-Handy Township, said lawmakers are pushing for more public health spending. 

“It’s a matter of a finite amount of money to go to an expanding need in so many area,” he said. 

“We realize it’s an issue as the cost of health care keeps going up rapidly,” Vaupel said. “So the problem has been defined; the solution not so much. But it’s on the front burner.”

Even before coronavirus seeped into Michigan with the first confirmed cases, the public health system had been in high gear since January.  

More than 400 people had been flagged by the U.S. Centers for Disease Control and Prevention for special monitoring by local health departments.

That means local public health nursing staff must divert their focus on immunizations and tracking communicable diseases to monitoring potential cases for at least 14 days.

Departments also are diverting staff to answer phone calls about coronavirus and answering emails from worried consumers and developing materials for organizations in their counties. 

While schools might need directions on disinfecting water fountains and doorknobs, faith-based groups might need advice on whether to suspend communion or shake hands at services, said Leigh-Anne Stafford, health officer with the Oakland County Health Division, which this week logged two of the first 12 confirmed cases in the state. (The others were in Ingham, Kent,, Oakland, St. Clair, Washtenaw and Wayne counties.)

For now, Stafford said, Oakland County’s public health staff has been able to absorb the added load by reprioritizing. In Saginaw County, where they have not yet had a confirmed case, they’re preparing for that possibility, said Cari Hillman, its emergency preparedness coordinator. 

“Every second of my day is full, as I’m sure everybody here is now, and now it’s even fuller,” Hillman said.

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Robert J McElroy, MD
Fri, 03/13/2020 - 9:23am

The one voice I've heard that really knew what he was talking about was Donald McNeil a writer with wide experience with epidemics for the NYT in his talk on the Rachel Maddow Show Friday March 12th. The Federal government starting with the President, but also the CDC and FDA has made a dangerous situation even more dangerous. Senator Curt Vanderwall's comments suggest he is clueless and has little understanding of the pandemic.

David Waymire
Fri, 03/13/2020 - 9:37am

Tax cuts have consequences.

Fri, 03/13/2020 - 10:21am

One of these days you are going to have to look pass grabbing other people's money and asking what are we getting or what should we be getting for spending.
Do you remember the swine flu, "It is estimated that 11–21% of the then global population, or around 700 million–1.4 billion people contracted the illness — more in absolute terms than the Spanish flu pandemic. However, with about 150,000–575,000 fatalities, it had a much lower case fatality rate of 0.01-0.08%."?
How do you compare our current situation to 2009-2010? How do you compare the media reaction and the public reaction [millennials?] to then and now?

Robyn Tonkin
Fri, 03/13/2020 - 1:23pm

I think it's a poor analogy to compare the swine flu to the Spanish Influenza, the "Spanish Lady" as it was termed for some reason. As a young wife and mother, my grandmother lived through the Spanish flu. it was a terrifying experience of sudden death sweeping through entire families. She told me of a man who got on the cars, as they called it, in Detroit, healthy, and was dead when his body got to the Downriver. The Spanish flu, which made two trips around the world, changed public policy and social habits forever. Do you think it is healthy to sleep with a window open, or do you think night air should be shut out? Your opinion was formed by the aftermath of the Spanish flu.

I think people like Duane don't understand being part of an orderly, obedient population. I would suppose he reveres the men who fought in WWII and Korea, but does not realize that in civilian life, as well as in military service, they believed in a chain of command. On a spring day in the 1960's, I went, after church, to the down town area of my small town. A long bank of tables were set up under the trees in the schoolyard, covered by white tablecloths and holding thousands of tiny cups containing a sugar cube with pink fluid on it. I took the dose of polio vaccine I was handed by the nurse in a starched white uniform. To not participate in this national effort, unthinkingly, and unquestioningly, would never have occurred to my father. He felt it was a duty, and an honor, as serving in the South Pacific had been.

Duane, you don't seem to see that we are all in this together, and what money is for is to provide for the common welfare. We've had decades of total selfishness now, where has that gotten us? Public health, that bolsters and raises the general level of health in the population, was a priority of the society in 20th century America. It needs to be a priority again.

Fri, 03/13/2020 - 7:09pm

Very well said Robyn. We are all in this together, and as you follow Bridge you will see many commenters who are "out for themselves". They remember the "good old days" and love to remain in their fantasy world.

Keep reminding us of our selfishness and need to be in this together.

Sat, 03/14/2020 - 7:04pm

I appreciate I how my remarks can be frustrating, it is most likely because it is from a different perspective.
The inclusion of the swine flu with today’s Covid -19 is for three reasons, first is to put the present into perspective by reminding people both are part of the same virus family, Coronaviridae, and to look for similarities, second is putting covid-19 impact into context of recent history [when millions were infected and 10s of thousands dying] so people weigh their actions, and third is to encourage doing what America does best, thinking in different ways. We need to open people’s thinking by raising questions of how does politics/media influence the public mindset and harm that maybe creating, how to mitigate that, how to focus on desire results?

Let me add a bit about those soldiers and the chain of command, whether in WWII, Korea, [I will include] Vietnam and each of the wars since then, the success of our military structure has been dependent on the diversity of perspective that the American soldiers brought to the ‘chain of command.’ [Many of those soldier did question the 'chain of command' and did change practices, they knew that what was happening in the mud in the middle of a firefight or on in the area between battles and how that reality wasn't appearing in the planning session to those at the top of the 'chain of command.'] They brought ideas that turned command expectations into successes. Those soldiers and the American culture they were nurtured in is what is meant when we heard of is what has made America ‘great’, why we should be open to an ever changing approaches/actions to the current problem of Covid-19. In such a widely happening situation relying on the states and counties are practical incubators for practical innovation and validation.
My comment to David was that we shouldn’t be to start by using the Covid-19 as an excuse to create new taxes, it should be to develop and validate effective practices and then identify the cost to implement them broadly. We should be about establishing desired results and validating the methods achieving them rather than blindly giving money to government.