Central San Joaquin Valley counties get less government funding to keep people healthy, despite having some of the highest poverty and chronic disease rates in California, according to a report released this week.
The lower funding has made it difficult for Valley counties to fight illnesses such as diabetes and heart disease, the report's authors said.
And smaller budgets could be in store in the coming year. The main source of state revenue for public health departments will be reduced under changes brought by the Affordable Care Act.
The report reinforces "that this region doesn't get the funding that is required to provide really good public health," said David Luchini, assistant director of the Fresno County Department of Public Health.
Local health departments meet their obligations to provide basic services such as flu shots and tuberculosis screenings, but "what we're not doing is prevention -- chronic disease prevention -- on any scale that our needs require," said John Capitman, report co-author and executive director of the Central Valley Health Policy Institute at California State University, Fresno.
The report, which compared eight Valley counties with counties of similar population, shows Valley counties receive less per person in local, state and federal revenue.
Fresno County got $60 per person for public health in 2010, according to the report, "Operational and Statutory Capacity of Local Health Departments in the San Joaquin Valley." By comparison, counties of similar size on average got $182 per person. The funds do not include Medi-Cal and Medicare.
Madera County received $62 per person and Kings County got $79. Counties of similar population received on average $110.
That's partly because the counties contribute smaller shares of health-care dollars. According to the report, Fresno County contributed only 3% of the public health budget. On average, counties of similar population pitched in 28%.
The low investment in public health by Valley counties "reflects both historical and current concerns with minimizing the role of government," Capitman said. Public health has not done a good job of informing county leaders of the value of investing in healthy communities, he said.
But a larger issue is looming: a reduction in state "realignment" funding for public health, Capitman said.
The state will cut realignment funds to counties next year when it takes over responsibility for the health care of the medically indigent who can be enrolled in Medi-Cal under the Affordable Care Act, also called Obamacare.
Just how much counties will lose has yet to be determined.
Valley health departments historically have received a smaller proportion of the realignment funds, which come from sales taxes and vehicle license fees collected by the state. In 1991, California began distributing the funds based on a formula that had its beginnings in the passage of Proposition 13 in 1978. The law cut property taxes, which counties had used to fund health and other services. To compensate for the loss, the state looked at how much counties had lost in property tax revenues. Bigger counties that lost the most got a larger share of realignment funds.
The health institute report, however, recommends that counties with high poverty and high disease rates get a greater proportion of realignment funds.
Luchini said he hopes the report will trigger conversations at the state Capitol "about what's going on in our San Joaquin Valley." The region has health needs that have to be addressed, he said.
Capitman, however, sees little appetite for changing the realignment funding formula. The focus now is on the upcoming reductions in realignment funds next year.
Despite tight budgets, Valley health department officials said they do the best they can to provide programs in obesity prevention, tobacco cessation, diabetes and asthma education, among others.
"That sort of speaks to the fact these counties are at least making the best use of the funds that they can and are still providing services," said Keith Winkler, the Kings County public health director.
But more money would allow counties to expand programs. Dr. Karen Haught, public health officer for Tulare County, would like a program to reduce injuries, particularly traffic accidents. "They've always been sort of a high concern here," she said.
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