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.

As Congress reviews budget slashes to health care in President Donald Trump's "One Big Beautiful Bill Act," a new evaluation from the nonpartisan Congressional Budget Office projects 16 million Americans, including 1.8 million Medicaid and Healthy Indiana Plan recipients, would go without health insurance.

If the bill passes as is, said Josh Bivens, chief economist at the Economic Policy Institute, a nonpartisan think tank, health providers would see a sharp increase in what is known as uncompensated care, when people without coverage get sick but are unable to pay.

"And it means hospitals and doctors no longer receive that income stream from Medicaid payments," he said. "And lots of them are going to be forced out of business, and there's going to be closures of hospitals, especially in rural counties."

Republicans question the Congressional Budget Office projections, believing that cutting $715 billion from Medicaid eliminates fraud. They want to add specific work mandates for healthy working-age adults. The GOP bill aims to fund Trump administration priorities, including more immigration raids and border wall construction, and extending tax cuts passed in 2017.

According to the research site KFF, nearly 569,000 Hoosiers are enrolled through the Affordable Care Act's Medicaid expansion.

Bivens said he fears that if the bill becomes law, he sees the measure as a transfer of income from vulnerable families to already wealthy Americans. He noted that the average cuts to Medicaid, which would take effect after the 2026 midterm elections, would be more than $70 billion per year.

"And then if you look at the tax cuts that will be received by just people making over $1 million per year, those are $70 billion as well," he said. "We're going to take $70 billion away from poor families on Medicaid, and we're going to give it to families who are making more than $1 million per year."

Six Nobel laureate economists have signed an open letter opposing cuts to safety-net programs in the budget reconciliation bill, warning the measure would add $5 trillion to the national debt.


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As Congress considers cuts to safety net programs in what Republicans are calling the "One Big Beautiful Bill Act," a new analysis from the nonpartisan Congressional Budget Office estimates 16 million Americans, including 140,000 in Colorado, would lose Medicaid health insurance.

Josh Bivens, chief economist at nonpartisan think tank the Economic Policy Institute, said if the bill passes as-is, health providers would see a steep increase in what is known as uncompensated care, when people without coverage get sick but cannot afford to pay their medical bill.

"It means hospitals and doctors no longer receive that income stream from Medicaid payments," Bivens pointed out. "Lots of them are going to be forced out of business and there's going to be closures of hospitals, especially in rural counties."

Republicans have cast doubt on the Congressional Budget Office projections and claimed cutting $715 billion from Medicaid by eliminating fraud and adding work requirements for adults would not reduce coverage. The GOP bill aims to fund Trump administration priorities, including more immigration raids and border wall construction, and extending tax cuts passed in 2017.

Bivens stressed if the bill becomes law, it would result in what he describes as the direct transfer of income from vulnerable families to the richest Americans. He noted the average cuts to Medicaid, which would kick in after the 2026 midterm elections, would be more than $70 billion a year.

"Then if you look at the tax cuts that will be received by just people making over $1 million per year, those are $70 billion as well," Bivens explained. "We're going to take $70 billion away from poor families on Medicaid, and we're going to give it to families who are making more than $1 million per year."

Six Nobel laureate economists have signed an open letter opposing cuts to safety net programs in the budget reconciliation bill, warning the measure would add $5 trillion to the national debt.

While headlines about the latest Trump-Musk feud may catch more people's attention, Bivens added the bill will have the biggest effects on Coloradans.

"I think the fact that six Nobel Prize winners said, 'This is important enough for me to try to draw attention to the implications of this bill,' should make people realize the stakes are really large," Bivens emphasized.


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A New Mexico coalition is stressing an urgent need for the state to adopt the strongest possible heat risk standards for indoor and outdoor workers.

New Mexico is the sixth-fastest-warming state in the nation, according to the Union of Concerned Scientists, fueled by climate change which makes heat waves more common.

Carlos Matutes, community advocate for the environmental group GreenLatinos, said 80% of those working in agriculture are Latino, as are 64% of those working in the building trades. He added Latino workers are overrepresented in oil and gas production and need to be protected.

"Depriving them of paid rest periods, of shade, of water during the summer months is unconscionable," Matutes asserted. "We're trying to make sure New Mexico Environment Department establishes these rules as quickly as possible."

Two states, Texas and Florida, have passed laws limiting local governments' ability to require employers to provide water breaks to outdoor workers. In contrast, California adopted protections in 2006. Matutes noted the Environmental Department has already announced the process to consider a heat-protection rule has been delayed and will not take effect before workers endure this summer's heat.

It is not just workers who suffer from extreme heat but also kids in school classrooms.

Whitney Holland, president of the American Federation of Teachers-New Mexico, said the days of putting a box fan in a classroom window on hot days are long past and the number of sweltering days increases each year.

"Thinking through a student's day, from the time they get on the bus, with buses that don't have air conditioning, in the cafeteria, in the library, all of those places," Holland outlined. "If they don't have proper ventilation and good air quality, research shows students feel fatigued, they are unable to focus, all of those things."

As might be expected, Holland added late afternoon, following the lunch break, is when students are most miserable, which disrupts the learning environment. This summer's forecast calls for hotter-than-normal temperatures from coast to coast, according to NOAA's Climate Prediction Center.


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