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.

LAS CRUCES, N.M. -- A new study showed people who do not have a close friend or family member who has experienced a run-in with COVID-19 are more likely to express vaccine hesitancy than those who know someone who has been sick.

Jagdish Khubchandani, public health sciences professor at New Mexico State University, one of the researchers to probe vaccine hesitancy and reasons for it, said study participants were asked if someone in their social circle had been infected, hospitalized or died due to COVID-19.

"And those who said yes are more likely to accept a vaccine," Khubchandani reported. "So those who do not know anyone who has died in family or friends or hospitalized are two times more likely to deny a vaccine."

The study was published last week in the International Journal of Environmental Research and Public Health. It included 1,600 participants, with about 80% reporting they received at least one dose of a COVID-19 vaccine. Of the remaining participants, 10% said they planned to get it, while 11% said they would not.

Khubchandani said vaccine refusal in the study group was higher among non-Hispanic Black people, political conservatives, independent-leaning voters, suburban dwellers, people with less than a college education and non-married individuals.

He believes hesitancy has been caused in part due to inconsistent messaging from the federal government about vaccines and about wearing masks.

"Vaccine hesitancy is a very complicated topic," Khubchandani acknowledged. "I've always said global health crises are also information and communication crises. We have no strategy to deal with the issue."

The Biden administration has avoided vaccine mandates until last week, when it announced vaccinations or proof of weekly testing will be required for federal government employees, including those in the health-care sector.

SEATTLE - Washington state's largest union of public workers has reached an agreement with the state on Gov. Jay Inslee's vaccine mandate.

The deal ensures access to and education about the shot on work time as well as an additional day of leave so workers can get vaccinated. The Washington Federation of State Employees filed a lawsuit in August to compel the state to negotiate in good faith on the details of the mandate.

Union president Mike Yestramski said the agreement is a win for public health and due process.

"This entire bargaining process and that lawsuit that we had filed," said Yestramski, "all of that was about impact bargaining and the fundamental right of unions to bargain workplace conditions."

The Washington Federation of State Employees is withdrawing that lawsuit.

The agreement also includes options for people near retirement and a consistent and equitable process across workplaces for employees seeking a medical or religious exemption.

More than 80% of members voted in favor of the agreement.

Yestramski said the union has continued to push for safety measures in the face of this virus.

"We've been pretty vocal," said Yestramski, "pretty open from the beginning of this pandemic that vaccination, masking, social distancing, all of those things are incredibly important pieces to end this pandemic and to keep our communities safe."

The Washington Federation of State Employees' includes 47,000 public service workers in state agencies, higher education and behavioral health.

INDIANAPOLIS -- Indiana officials are conducting a survey to better understand the unmet needs of caregivers across the state, which they say will also help more Hoosiers age at home.

Darcy Tower, director of consumer success, strategy and operations for the Indiana Family and Social Services Administration Division of Aging, said the COVID-19 pandemic has spotlighted long-standing gaps in the care system, such as national shortages of care workers and high turnover.

She pointed out caregivers have faced unique challenges and stressors, from fear of exposing loved ones to the virus to dealing with the effects of social isolation.

"Most Hoosiers, they want to age at home," Tower reported. "And Indiana is working to give more people over age 60 on Medicaid this choice by really making long-term services and supports more effective and better coordinated."

Tower added long-term services and supports include in-home personal care, adult day centers, support for caregivers, assisted living and nursing-home care. She noted they promote the health and well-being of people who need assistance with day-to-day activities because of their long-term condition, disability or cognitive impairment.

Tower emphasized the Division of Aging has waiver services that allow Medicaid to pay caregivers, but she contended they need to expand the program to support needs that may not be financial, including education and training, or respite services.

"So many of these folks live under the assumption that caregiving is just really something that you do for the people who are important to us," Tower observed. "Of course, that is incredibly commendable. These are also people who need support."

Tower hopes the survey will help Indiana better meet those needs. She stressed if you are a family member, friend, neighbor or community volunteer providing care, companionship, transportation or financial or medical help to somebody 55 or older without the expectation of pay, her agency wants to hear from you, either at 800-258-7691 or at survey.indiana.edu/caregiver/volunteer.