OXFORD, N.C. -- North Carolina has spent fewer and fewer dollars on public health over the past decade, and local health officials say inconsistent funding has led to reduced staff and resources, which likely worsened the fallout from the pandemic.

Data from Kaiser Health News show spending for the state's 85 local health departments dipped by more than 27% between 2010 and 2018.

Lisa Macon Harrison, vice president for the National Association of County and City Health Officials and health director for Granville-Vance Public Health, said most departments rely on a patchwork of disease-specific grant funding and federal dollars from the Centers for Disease Control and Prevention.

"There's also not a full appreciation of the mandated services and restrictions our system asks of us, and the lack of flexibility," Harrison pointed out. "We have to sometimes be able to pivot and be as nimble as we'd like to be in situations like we're in now, where we are managing change every single week."

According to research by Trust for America's Health, public health represented just 2.5% of all U.S. health spending in 2017.

The report also found, nationwide, public-health surveillance infrastructure for detecting infectious diseases and environmental threats hasn't kept up with current technologies and are in dire need of upgrades.

Meanwhile, the state's population grew to an estimated 10.5 million people as of July 1, 2019, the fourth year in a row North Carolina has grown by more than 100,000 people, according to the latest data from the U.S. Census.

Jason Baisden, senior program officer for the Kate B. Reynolds Charitable Trust, said policymakers should view public health as a critical part of the state's healthcare safety-net infrastructure.

"Investments today in our public health infrastructure and things like housing have dividends for improved health," Baisden asserted. "And we believe, lower cost, in the long-term, and it's a discussion that North Carolina and North Carolinians need to have."

Harrison noted she's grateful more residents are becoming aware of the services their local health departments provide as COVID-19 vaccinations ramp up, but she argued communities need long-term, sustainable solutions.

"But it also calls our policymakers to action to make sure that we are able to not only survive as an infrastructure through this pandemic response and vaccination program, but that we thrive enough to prevent it from happening again," Harrison contended.

She pointed out in addition to meeting residents' basic health needs and providing immunizations, public-health departments work to prevent the start and spread of outbreaks, monitor food safety in restaurants and other public places, keep drinking water clean, and respond to natural disasters and emergencies.

At the start of the pandemic, at-home caregivers in Washington state saw their wages go up with a boost from hazard pay. Two years later, inflation is erasing the pay bump.

Wages actually have gone up for caregivers from $19 per hour in May 2020 to $19.26 today, but inflation means the purchasing power of their pay now is actually $17.46.

Gwen Goodfellow, an at-home caregiver, said the increase was welcome at first.

"Having the hazard pay was really nice. It made us feel more comfortable to do, like, grocery orders instead of going to the store and allow us to be a little bit more protective," Goodfellow acknowledged. "Then, as time went on, the cost of things went up, and it's not a bonus at this point."

Goodfellow's union, Service Employees International Union Local 775, was instrumental in negotiating hazard pay for caregivers. Hazard pay was offered to essential workers who were in vulnerable positions as COVID-19 spread.

Goodfellow looks after her mother and a friend, as well as taking care of her son, and pointed out caregivers are struggling.

"Good pay for caregivers is really important," Goodfellow asserted. "I mean, we help seniors, we help people with disabilities. I know my situation isn't unique. I hate to say it, but sometimes it feels like I kind of almost chose poverty so that I could care for my family."

Goodfellow added benefits beyond pay are important as well, such as affordable health care, retirement and paid time off which does not inhibit her ability to pay the bills.

The baby-formula shortage has hit families in Arkansas hard, and one Little Rock resident aims to alleviate the stress on parents by creating an interactive document, which shares where to find formula in the state.

Supply-chain disruptions and a recent product recall have been connected to the empty store shelves parents have encountered.

Allison Grigsby Sweatman, a clinical social worker in Central Arkansas, was inspired to create an interactive spreadsheet to help families find formula after hearing from people she works with about the challenges they are facing trying to feed their babies.

"The way that this has affected families with babies who have been depending on formula, it cannot be overstated the crisis this would create in a family system," Sweatman explained. "I've heard about families spending every free moment that they have trying to get the formula that they need for their child."

The Food and Drug Administration and Abbott announced Monday night they reached a deal to resume operations at a shutdown Michigan plant, with production possibly able to restart in the next two weeks.

As of May 8, nationwide out-of-stock rates for baby formula continued to climb and stood at 43%.

Sweatman pointed out the shared spreadsheet is broken down by county, showing where people can find the formula at a store in their county or someone in their community who has formula to give away. She added contributing to the formula finder is one way to give back to your community.

"What an organized approach to meeting this need can offer is everyone can help," Sweatman emphasized. "There's something everyone can do to help us feed our children right now. Even those who are not directly affected who would turn away because it's just too big of a problem to try to solve, with this they have an opportunity to help."

Sen. Tom Cotton, R-Ark., introduced legislation last week which would require President Joe Biden to submit a report to Congress within 30 days detailing the steps the administration is taking to end the formula shortage.

The gaps in the U.S. health care system were exposed during the COVID-19 pandemic, with racial health inequities laid bare.

On Monday, Philadelphia lawmakers announced $13.8 million in state funding to improve public-health outcomes for all city residents.

In May 2020, data collected by Drexel University showed that Black residents made up 45% of known COVID cases, while white residents made up 15% of cases.

State Sen. Vincent Hughes - D-Philadelphia - said while residents struggled with these public health disparities, community health organizations stepped up to provide resources like testing and vaccines directly to those who needed them most.

"The other thing that was revealed was this incredible commitment by people all across Pennsylvania," said Hughes. "But let's start right here in North Philadelphia, who decided to rise up and say, 'I'm not going to watch the problem, I'm going to make a difference in the problem.'"

Five million dollars of the funding will go toward creating mobile health clinics, along with $3 million in health equity grants and $2 million in grants to address mental health and trauma.

State leaders also announced checks for community health organizations, including $2.8 million for the Pennsylvania School-Based Health Alliance for behavioral health services and $1 million for the Black Doctors Consortium.

Tracy Wood, executive director of the consortium, said people's ZIP codes should not determine their public health.

"We should have access to going to the doctors, getting a physical every six months," said Wood. "Over our past two years of service, administering over 100,000 COVID-19 tests and vaccines, we found access was a major barrier to quality health care."

The Black Doctors Consortium hosted "pop-up" testing and vaccine clinics in Philadelphia neighborhoods with high infection rates and low vaccination rates. In October, the consortium opened a clinic offering primary-care and behavioral-health services in North Philadelphia.