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.

CONCORD, N.H. - New Hampshire advocates for affordable healthcare access want Congress to lower prescription costs by allowing Medicare to negotiate with drug companies.

Drug prices have risen faster than any other facet of medicine, and Laura Lynch - a 62-year-old New Hampshire resident who's covered by Medicare and Social Security Disability Insurance - said she spends $300 to $350 a month just on co-pays for medications for herself and her husband.

They're also receiving collection notices, because Lynch said they can't afford the ambulance bills from a heart attack her husband had in February.

"This is ridiculously hard," said Lynch. "Sometimes I just want to cry, because I don't know where it's going to come from, the next penny or dollar to pay these bills. I am so for 'Medicare for All.' But I'm also so for them fixing Medicare, so that situations like this don't come up and we lose everything."

President Joe Biden's budget plan includes improvements to Medicare, such as allowing negotiations with drug companies. Lynch adds for her and many others, it's urgent that Congress take action.

Today is the 56th anniversary of Medicare and Medicaid, which together provide health coverage to more than 120 million people.

Zandra Rice Hawkins, executive director of the group Granite State Progress, said drug companies have a monopoly to set their own prices. She noted other government programs already negotiate with drug companies, and sometimes pay half of what Medicare pays for medicines.

She said allowing Medicare to negotiate would make prescriptions much for affordable for all consumers.

"Lawmakers have not taken meaningful action over the last decade to rein in drug corporations power to price gouge," she said, "despite strong support for policies like Medicare negotiations among all voters of all political persuasions."

The White House plan also would close the Medicaid coverage gap - New Hampshire has expanded its Medicaid program, but in the dozen states that have not, more than two million people don't fit the eligibility requirements, but also can't afford employer-based or marketplace health insurance.

LANSING, Mich. -- Advocates for home- and community-based services in Michigan urged Congress to build off state efforts and invest in what's become known as the "care economy."

President Joe Biden's American Jobs Plan includes $400 billion to expand access to Medicaid home- and community-based services for seniors and people with disabilities, and to strengthen the care workforce.

Kelly Garrett, Michigan state director for Care in Action, said making investments will help keep people in their homes and communities for longer than they would be otherwise.

"We need to pay our essential workers, our domestic workers, our care workers a livable wage," Garrett asserted. "Also, people that need care should be able to get cared for in place in their homes, or wherever they choose to be cared for."

Michigan's paid medical-leave law went into effect in 2019, and applies to any employer with more than 50 workers, but domestic workers often do not fit the criteria.

Garrett joined a roundtable with people who rely on home-based and community services, caregiver advocates and lawmakers. She argued more progress is needed, and the White House plan would support well-paying caregiver jobs with benefits and collective bargaining rights.

Women, and especially Black, brown and Indigenous women, are more likely to leave the workforce to care for a family member, which became all the more evident during the pandemic.

Garrett added care infrastructure, such as home and community-based services as well as child care and paid family and medical leave, are so important because everyone needs care at some point in their lives.

"Everyone's gonna have this situation," Garrett explained. "Either you're going to be the caregiver, or you're going to need to be cared for. It just happens. And so passing this bill allows people to age with dignity, and to be taken care of with dignity."

Home- and community-based services can look different for different people, ranging from meal services and transportation to doctors' appointments, or having a personal aide come in to help get ready for the day and manage their medicines, or speech or occupational therapy at home or at a community facility.

Garrett urged Michiganders to contact their lawmakers and let them know how urgently needed the legislation is.

MINNEAPOLIS - As COVID cases trend upward again, public-health experts are setting the record straight on certain storylines about new infections.

Minnesota's seven-day average for new COVID cases had dipped below 100 earlier this summer. Now, it's nearing 300. Health officials blame the combination of the Delta variant spreading and a slower rate of vaccinations.

For some who elected to get the shots, there are instances of infections. But David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, said the vaccines still work; there are just some key things to remember.

"They give your immune system a jump-start on the virus, but every now and then, that jump-start is not quite enough to prevent an infection," he said. "Almost always, it's going to be enough to prevent you from getting really, really sick."

He said no vaccine is perfect. However, the federal Centers for Disease Control and Prevention has noted that fewer than 1% of COVID deaths and hospitalizations have been tied to fully vaccinated individuals. Despite the rarity of breakthrough cases, Dowdy said it's important to be cautious in public settings to prevent major spikes again, noting the risk for vulnerable populations, such as older adults, even if they've been vaccinated.

As for vaccination rates, groups such as AARP have raised concerns about benchmarks for staff members at places such as nursing homes.

Dowdy said there are many reasons some people are hesitant to get a shot, including in communities overlooked by public-health offices. However, he suggested that it's reasonable to take a closer look at places such as assisted-living facilities.

"That does change the calculus a little bit," he said. "You're not just thinking about yourself now; you're thinking about the people that you're having to come in contact with on a daily basis."

In its latest nursing home COVID-19 dashboard, AARP said just 17% of Minnesota nursing homes have met an industry target of having at least 75% of staff fully vaccinated. Overall, 88% of the state's nursing-home residents have completed the immunization cycle, compared with 62% of all staff.