Mistrust and polarization drive rural governments to reject federal public health funding

When Elko County commissioners rejected a $500,000 grant from the Centers for Disease Control and Prevention that could have helped the county create a health department or health district, Kayla Hopkins urged them to reconsider.

Hopkins, who has lived in the vastly rural county in Nevada’s northeast corner for nearly nine years, told the board how she struggles with postpartum depression and needs mental health resources.

“I wasn’t getting the help that I needed,” Hopkins said during a public meeting in late 2021. She said she was sent by air ambulance more than 300 miles to Carson City, where she received care at a psychiatric facility for 10 days.

“I was away from my family,” Hopkins said. “I was away from my support system here, and I still struggle with mental health, and I still can’t get the help I need because we don’t have it here.”

The arguments of Hopkins and others were not enough to sway the elected commissioners. Nor were 11 letters from local health leaders urging the board to take an infusion of public health funds. Four of the five county commissioners voted against pursuing Grant, citing concerns about government overreach and their lack of trust in federal agencies. Nearly a year later, as the epidemic heads into its third year and with the arrival of monkeypox, the county is still without a public health department to respond.

And the same mistrust of funding agencies for public health persists elsewhere.

Elko County, home to about 54,000 people, was not alone in rejecting federal aid intended to boost public health over the past year. Experts say they were shocked and concerned that the rare local or state leader, swayed by political partisanship, rejects funding opportunities for historically limited public health systems.

Many conservative politicians and their constituents have voiced opposition to measures to combat COVID-19 — things like masking policies and promoting vaccines — as the pandemic has long strained the country’s public health infrastructure, especially in rural and underserved communities. exposed the ongoing rift.

“Partisan politics has poisoned the well to the point that we are willing to sacrifice the health of our citizens,” said Brian Kastrucci, president and CEO of the De Beaumont Foundation, a national nonprofit that advocates for public health policy. ” “Is political grandeur worth it?”

Over the past two years, officials in Idaho, Iowa and New Hampshire rejected Covid relief funds, their decisions often accompanied by political pronouncements about the federal government’s overreach. And officials representing local governments across the country, including Cochise and Pinal counties in Arizona, echoed those moves. A survey of local governments in 15 states by the National League of Cities found that more than 200 small governments declined pandemic relief funds, a small percentage of funds available to small governments.

Alcoa commissioners turned down a workforce grant funded by the CDC aimed at “establishing, expanding and maintaining a public health workforce including school nurses.” Funding would have flowed to the county through the state, allowing it to dedicate two employees to public health services for two years.

County staff in charge of researching the grant and reporting it to the board said the idea was to conduct a study over those two years that would help them determine how much it would cost to create a local health department or a health district that would include Join neighboring counties. ,

Elko County does not have a public health department because a budget crisis forced officials to disband it more than 15 years ago.

Adrian Casalotti, chief of government and public affairs for the National Association of County and City Health Officers, said communities across the country have generally struggled with increased funding during the pandemic, which is already short and underfunded public health infrastructure. reduces the structure.

“That being said,” Casalotti said, “in recent months, I would say, we’ve heard about a handful of health departments that either won’t apply or can’t accept … specific grants,” of the COVID-19 pandemic. Vaccines are included.

At an Elko County Commission meeting in late 2021, then-transit management coordinator Abigail Wheeler briefed the board on grants and residents eager to air their complaints about the CDC and the federal government’s claims of redundancy, overspending and corruption. eager to implement. Epidemic response.

Wheeler began by asking county commissioners to keep an open mind.

“I am very aware that this is basically the worst time that this grant could come forward because there is so much distaste on public health because of Covid and what has happened to our entire community, our entire country and around the world,” she said . “We have been put to death, the result of the Covid pandemic.”

Wheeler, now the grants and contracts manager for the county, began by reminding commissioners that creating a local health department or district was a goal that preceded the pandemic and polarization.

A 2019 meeting with the state Department of Health and Human Services emphasized the need for more local public health infrastructure.

“They’re thinking about things like tuberculosis and measles and restaurant inspections,” Wheeler said. “They’re not thinking about COVID. And they’re telling themselves, ‘We can’t see you if you had a TB case. We’re 370 miles away from Elko County.'”

Elko is like a landlocked island, Wheeler said during an interview with KHN. Although smaller in population than Clark or Washoe counties in Nevada, Elko spans more than 17,000 square miles, making it the fourth largest county by area in the contiguous US and the second largest in Nevada.

Wheeler said, “We have to be our cavalry.”

Commissioners and community members who opposed the grant said Alcoa did not need more public health resources or the health district or department. He said he was concerned about the abandonment of local autonomy and growing bureaucracy. He also expressed distrust on the CDC.

“You are 100% factual that the timing couldn’t be worse,” said John Carr, then-chairman of the commission, during the meeting. Although he said he didn’t buy all the conspiracy theories about the CDC that others touted, he said he didn’t think CDC officials should be trusted.

Commissioner Rex Steininger said he voted against the grant because he feared the commission would be “subordinate” to the new entity. “Grants always have strings attached,” he wrote in an emailed response to questions from KHN. “We don’t want the tentacles of the CDC [sic] Arriving in Elko County.”

Wheeler pointed to the fragmented local public health system during the meeting, saying that creating a health district or department could help reduce bureaucracy and give counties more control over decisions in the hands of state officials. She said it was clear the county needed more resources, citing the public health response duties she took on in her position as transit manager.

“We’re not public health experts, we’re just guys who are ready to step up to the plate and take it,” Wheeler said, referring to other county employees.

Wheeler was disappointed that the county board turned down the grant opportunity, he told KHN in October. She said she would still like to see public health become a county job someday.

Since speaking at the meeting nearly a year ago, Hopkins said she found much-needed mental health services locally. But not everyone is as lucky as it is to get help as close to home as possible, she said. The county’s decision to decline the CDC grant saddens her, she said, but she accepts it was the commission’s decision.

Other local leaders saw a need for increased public health resources amid the pandemic. The Elko City Council wrote a letter of support for the CDC grant the day before it was rejected by the commission. City Manager Curtis Calder said, “We certainly know this is not something the city wants to deal with on its own.” “But if our regional partners want to do this as a partnership, we stand ready to assist wherever we can.”

Other rural Nevada counties cooperate with the University of Nevada–Reno School of Medicine to form the Central Nevada Health District, which serves four counties and a small city near Reno. Neighboring Eureka County and interim state commissioner Dr. J.J. Goicochia wrote, “If we will not step up and help ourselves and our constituents, we cannot complain when the state does not provide what we need or expect.” In response to an email to vet, KHN.

Caselotti said there are advantages to having local health departments staffed and run by people living in the community as opposed to state government hundreds of miles away.

“One of the things we’re hoping people can learn from the pandemic is you don’t want to be building the plane while you’re flying it,” she said. “At some point, you need to make the leap because the next crisis is just around the corner.”

But polarization remains an obstacle, Kastrucci said.

“It has become a holy war, it has become a war of right and wrong,” he said. “I don’t know how we’ll ever get to a place where we’re prioritizing the health of our country.”

This article from khn.org was written by Henry J. Reprinted with permission of the Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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