Cutting public health centers is a bad idea

Commentary By Jennifer Meyer

For The Cordova Times

In Governor Walker’s third state of the state address the following.

“By the end of this year, we will have closed seven trooper posts; six public health centers; three maintenance stations; one correctional facility; two youth detention facilities; multiple job centers; and a fire training facility,” Governor Walker said. “We can’t keep cutting the budget and expect to improve our situation. Alaskans demand – and deserve – better.”  Along with center closures, the public health nursing workforce who actually live and work in the communities they serve was reduced by thirty positions and the budget cut by 25 percent. Constituents have complained to their representatives about the closures and cuts in services, but it appears to have fallen on deaf ears.

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I agree with the Governor we can’t keep cutting our way out of the fiscal disaster.

Cutting public health centers is a particularly bad idea and here is why. Let’s review a short story.

“People are being swept downstream by a river’s raging water.

The crowd on shore works to pluck them out of the rushing water, but many are missed and swept away.

Some of the rescue group decided to pull out those that could not swim first. As the rescue group continues it’s never ending battle, a few hike upstream to see what is causing people to fall into the river in the first place. 

They identify the root cause of the problem (people crossing a dangerous river without a bridge), come up with a solution (build a bridge), and put the solution into action.

As a result: people stop falling into the river. They are no longer at risk and there is no need to focus all the resources on pulling people out of the river one at a time.”

This parable is standard in the health sciences to help illustrate the difference between public health and health care. If you haven’t already guessed the individuals looking UPSTREAM are your public health professionals and those working DOWNSTREAM are your traditional health care providers and rescue professionals. We need BOTH. You can’t have a healthy population without BOTH public health and health care systems working in collaboration.

Think of public health centers as your population health disease detectives. Not only do they offer health education they also work to prevent and control communicable diseases like measles, whooping cough, STD’s, TB, and respond to outbreaks, they also work on challenging social issues like drug and alcohol abuse, teen pregnancy, domestic violence.

Now, take an issue like opioid addiction. Restrictions on opioid prescriptions have led to more people seeking heroin and unfortunately this drug is often cut with highly potent fentanyl leading to more overdoses. Walker just declared a state of emergency and Narcan kits are being distributed (via public health centers to community partners) which reverse the opioid action during an overdose event. This is an excellent example of a downstream intervention.

But, where does that individual go when resuscitated? Who pays the hospital costs? Are there enough rehab beds? After discharge where do they go? The public health professional is trained to work with community partners to ask what are the causes and conditions of addiction, how can we prevent addiction, how can we identify early signs or risks of addiction and how can we coordinate groups already working on these issues? What are the root causes of the current crisis and how can we mobilize most effectively and not duplicate efforts? Now, eliminating the upstream action, as the Alaska Legislature wants, will clearly result in endless downstream demand, negative consequences, and ever increasing costs for all Alaskans.

Join me is defending public health in Alaska. It is simply the fiscally responsible thing to do.

Jennifer Meyer is an assistant professor and co-chair of the Allied Health Department with the University of Alaska Fairbanks College of Rural and Community Development.