NC gets high grade in public health readiness despite low funding

Last year brought one public health crisis after another nationally – Zika virus in Florida, contaminated water in Michigan, and massive flooding in eastern North Carolina caused by Hurricane Matthew.

The silver lining for our state’s residents: whatever challenge comes next, North Carolina is well prepared to deal with it, according to a new report created by the nonprofit Trust for America’s Health and funded by the Robert Wood Johnson Foundation.

The study, “Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism,” rates Massachusetts, North Carolina and Washington state as the nation’s leaders in public health preparedness. Released in December, the report examines 10 critical indicators, ranging from funding and accreditation to climate change readiness, flu vaccination rates, food safety, and public health laboratories. It raises concerns, too, about public health funding here.

Massachusetts was the only state to receive passing grades in all 10 categories. North Carolina and Washington were the only two to pass in nine of the categories.

In some respects, the results are not surprising because North Carolina has long been a leader in public health care.

In the 1990s, we established a state-level system for accrediting local health departments that became a national model. For decades, we have leveraged innovative public-private partnerships, and our focus on preparedness, instead of simply reacting to crises belatedly, is well-respected in the industry.

The report shows that North Carolina’s FY2015-16 per capita funding allocation of $14.08 is one of the lowest in the country, with only seven states spending less.

Lynette Tolson, executive director of the N.C. Association of Local Health Directors, says our state’s rankings are even more impressive, considering that the one category in the report where we are not up to standard is arguably the most important – funding.

More funding on agenda

The Trust for America’s Health report notes that, at the state level, North Carolina cut funding for public health by 2.3 percent from fiscal year 2014-15 to fiscal year 2015-16 to $139.1 million, marking the third straight year of budget decreases. The report shows that North Carolina’s FY2015-16 per capita funding allocation of $14.08 is one of the lowest in the country, with only seven states spending less.

The funding situation is actually worse than it appears, Tolson says. Because North Carolina’s public health infrastructure is more decentralized than that of most other states, funding at the county level is also crucial. And local funding in the state’s 100 counties has also been falling, creating a double whammy. Over time, the cumulative spending cuts will also erode the overall infrastructure.

That North Carolina continues to score well in national reports on public health despite serious funding gaps, Tolson says, is a testament to the ingenuity of our public health officials – health directors, nurses, epidemiologists, lab technicians and others who are charged with managing a dizzying array of health issues that include everything from primary health care, AIDS and obesity to clean water, safe food and natural disasters.

That’s why one of the N.C. Association of Local Health Directors’ top priorities for the coming year is fighting for more dollars to track and tackle communicable disease outbreaks, such as the flu, Zika and hepatitis C. Currently, Tolson says, there is little funding earmarked for those efforts, which means that existing resources need to be re-deployed from other critical projects when outbreaks occur. Then there are non-communicable problems that also require urgent attention – highlighted by the national opioid addiction epidemic. Current funding in that arena is severely limited as well.

Private funding, consequently, is becoming more important than ever, and an ambitious project spearheaded by the Winston-Salem-based Kate B. Reynolds Charitable Trust is breaking new ground. The foundation’s Healthy Places NC initiative is investing $100 million over a 10-year period to improve the health of residents in 10 to 12 rural counties across the state, from Beaufort and Halifax counties to the east and McDowell and Burke counties to the west. The initiative is identifying key health issues, arranging partnerships to address them, and heavily emphasizing measurable outcomes.

But even a project as sweeping as this is bounded by time and reach. And it reinforces the fact that continuing North Carolina’s leadership in public health will require serious reconsideration of the public dollars we’re investing in it.

Christopher Gergen is CEO of Forward Impact, a fellow in Innovation and Entrepreneurship at Duke University, and author of Life Entrepreneurs: Ordinary People Creating Extraordinary Lives. Stephen Martin is deputy chief of staff at the nonprofit Center for Creative Leadership in Greensboro. They can be reached at and followed on Twitter through @cgergen.