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.

Nebraska's long-term care facilities face staffing shortages and other factors that could lead to more closures if state funding isn't increased.

An estimated 400,000 people nationwide have left this facet of the health-care industry since the pandemic began.

In Nebraska, the long-term care crisis has already led to closure of 44 nursing homes and 35 assisted-living facilities since 2015, the majority in rural communities.

Jalene Carpenter, president and CEO of the Nebraska Health Care Association, said others remain at risk of closing their doors.

"We have people needing services, wanting services," said Carpenter, "but the facility is struggling with staffing and is not able to accept additional residents, because they're having to care for the ones that they already have living with them."

Carpenter explained that when facilities can't serve new residents, they struggle to remain financially sound.

She citeed the low unemployment rate, the high inflation affecting food and supply costs, and the state's inadequate reimbursement rate for Medicaid residents as other contributors to this crisis.

Gov. Jim Pillen's proposed budget includes no increase in Medicaid rates, which Carpenter called "incredibly concerning."

Carpenter said the reimbursement rate is critical, since 60% of Nebraska nursing home residents rely on Medicaid to pay for their care.

She described them as "hard-working Nebraskans" who paid their taxes - but now, need expensive care and have run out of resources. She added that when a facility closes, it affects not only the residents and their families - but the local economy as well.

"Healthy education, healthy businesses, and healthy access to all levels of health care, and long-term care is a really important part of that," said Carpenter. "Yes, it is an incredibly expensive form of care, but it's also so critical to our society that we have access for seniors, to that care."

Two bills to increase the Medicaid reimbursement rate have been introduced this legislative session - LB 129 for nursing homes and LB 131 for assisted living facilities. Carpenter said she believes the future of some of these facilities depends on the fate of those bills.

February is National Heart Month, and doctors want Virginians to understand heart health a bit better - specifically, heart attacks and cardiac arrest.

According to the Centers for Disease Control and Prevention, more than 800,000 people have heart attacks every year, and the majority are first-time heart attacks. Cardiac arrest can involve numerous factors, and heart attack is the most common.

Dr. Benjamin Galper, assistant chief of cardiology at Mid-Atlantic Permanente Medical Group in northern Virginia, said this is partly why the two get mixed up. He said typically, signs of a heart attack can be chest pressure, nausea or sweating - but the signs of cardiac arrest are more dire.

"Cardiac arrest, itself is not subtle," he said. "If you've gotten to the point of cardiac arrest, it means the person is unconscious, that they don't have a pulse when you take their pulse and they're not breathing. So, when someone's had cardiac arrest, it's usually obvious and usually quite concerning."

National Heart Month is a good time to commit to reducing those risks, with a heart-healthy diet and regular exercise. Galper also encouraged people to get CPR training, to be able to aid someone having a heart attack until first responders arrive - and possibly save a life.

Underlying diseases such as diabetes or prediabetes can make a person more susceptible to heart problems. Dr. Ravi Johar, chief medical officer at UnitedHealthcare, said genetics can be another risk factor.

"Things like Marfan Syndrome increases the risk of aneurysms and abnormal blood flow to the heart, and things of that sort, so there can be some genetic consequences," he said. "There can also be genetic history; if your parents had problems with their hearts, there's a higher likelihood that you may."

He added that heart disease can affect people at any age. CDC research has found it can start as early as 35, and the risks increase with age. Anyone experiencing new chest pains or shortness of breath is encouraged to talk with their doctor about their heart-health options.

With Black History Month underway, Wisconsin researchers and support groups are highlighting the disparities in cases of Alzheimer's disease.

The Centers for Disease Control and Prevention said older Black Americans are about two times more likely than whites to have Alzheimer's and other dementias.

As drugs designed to treat conditions accelerate toward the market, the University of Wisconsin School of Medicine and Public Health noted Black adults are less likely to be included in the research. The school has made it a priority to focus on the Black population in an ongoing study.

Diane Beckley Milner, director of diversity, equity and inclusion for the Alzheimer's Association Wisconsin Chapter, said participation is important.

"Without us being involved in those clinical trials as Black Americans, then the research, it's not going to lend itself to giving accurate information," Milner pointed out.

The university acknowledged Black individuals can be reluctant to participate in studies, citing historical trauma from events such as the Tuskegee experiment. Officials say when it comes to the UW study, Black volunteers account for 27% of the people enrolled, which is much higher than the state's Black population, suggesting it provides hope in boosting research inclusivity.

Milner emphasized partnerships her group has with organizations such as the African Methodist Episcopal Church can help ease fears and create more awareness within the Black community.

"Having that partnership has proved to be very, very important and critical to making sure that people get information that they can trust," Milner explained.

She added a common challenge her group has found in outreach is many Black Americans view cognitive decline as simply a sign of aging, and not a disease. The association also works with nursing organizations in hopes of educating more people within the Black population.