We all want firefighters at the ready — trained and well-equipped — for when disaster strikes. And when there are no fires, we want to know they are  helping make our communities safe. The images of well-prepared fire response teams comforts us. They symbolize a protected community, a community that has invested in “readiness.”

The same should be true of public health. We want well-trained, well-equipped and adequately funded public health departments to prevent and address health crises. But the remarkable response of our public health professionals today, to the COVID-19 outbreak, should not lull us into forgetting that our public-health system has been dramatically weakened by a decade of underfunding.

As our national leaders consider allocating resources to help fight the spread of COVID-19, they should remember those on the front lines and at our doorsteps — our own public-health department leaders and staff.

In the decade between 2009 and 2018, inflation-adjusted per capita spending by local health departments across Washington fell by 11%. It’s not just about dollars, it’s also staff. Between 2012 and 2018, the local public health workforce in Washington shrank by 3% while the population grew by 9%. This workforce is our most trusted front-line public-health experts — they know us, they know our systems, they know what we have and what we need, and they know best approaches for prevention and response.

We depend on these professionals in an outbreak — as we’ve seen these recent weeks in Washington state and the country. In Washington, they mobilized for last year’s major measles outbreak. Before that we faced the 2009 H1N1 pandemic. Each time, we turned to our health officers, public-health nurses and other public-health professionals who live in our communities.

But this system and these people have been dangerously underfunded for more than a decade. Underfunding means our health departments have gotten much smaller, these professionals are stretched exceedingly thin, and programs that we know will keep our communities healthy and safe are often dramatically pared down.


The measles outbreak in Clark County, Washington, mobilized 89 of their 93 Clark County Public Health Department staff for almost two months in 2019, along with 57 state health department staff. These local agencies are the same departments tasked with monitoring food safety, reducing sexually transmitted diseases, caring for pregnant women and addressing the opioid epidemic.

How much can we expect of our public health heroes, and for how long, when they are so strained?

Respirators and hospital beds are important in the event of an outbreak. At least as important, however, is bolstering our public-health workforce. We need more staff, training, resources and support to coordinate essential services and communication — during times of crisis and in between.

This funding appeal is not new. Public-health leaders have been advocating in Washington and nationally for specific public-health capabilities and programs to protect and promote health in all communities. Recent research indicates only 51% of the U.S. is served by a comprehensive public-health department, and that $32 per person each year is needed — or an additional $4.5 billion dedicated to our health departments in the U.S. — to offer basic prevention services. Yet currently the national average is $13 per person — far less than the roughly $11,000 per person spent on the health-care system that treats us after we’ve gotten sick.

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This foundational public-health funding, like core funding for firefighters and law enforcement, would help assure that our public-health professionals could provide leadership during outbreaks and emergencies, as well as adequately maintain those ongoing functions that we still need and expect.

State and local health departments should be a primary focus of funding support during this outbreak — but ongoing, increased funding of foundational public-health capabilities and programs means that they’ll be there for us when the next problem arises … or, in some situations, doesn’t arise, because they prevented it.