The first patient to be diagnosed with Ebola in the United States, Thomas Eric Duncan, tragically died on Wednesday after battling the disease in Dallas. The case has brought Texas’ public health system into the national spotlight, and caused many to ask the question: Is Texas prepared to handle a public health crisis?
That’s the question the Texas Senate Health and Human Services Committee tackled at a hearing on Tuesday. They questioned public health and hospital officials about several issues that came to light with the Ebola case. The biggest question on everyone’s minds was why Duncan was initially turned away from Texas Health Presbyterian Hospital in Dallas with antibiotics when he first arrived exhibiting symptoms of Ebola. Another major question was how waste from Ebola patients and those exposed to Ebola was being handled, a big concern given that Ebola is transmitted through direct contact with bodily fluids, especially human waste. As the Texas Tribune reported, “Delays in getting state permits to transport and dispose of the waste resulted in Duncan’s girlfriend and three family members being quarantined in [Duncan’s] apartment alongside the soiled materials,” increasing their risk of exposure to the disease.
In light of the Ebola case, Governor Rick Perry announced the formation of a task force to examine Texas’ infectious disease preparedness, to be headed by Dr. Brett Giroir, chief executive officer of Texas A&M University’s Health Science Center. Giroir told the Senate committee that waste disposal and “hospital preparedness and improved diagnostics” are two issues that the task force will examine.
The case has also exposed holes in the state’s broader public health structure. Dr. Eduardo Sanchez, current chairman of the Texas Public Health Coalition and former commissioner of the Texas Department of State Health Services (DSHS), explained to the Texas Tribune, “We don’t really have a unifying construct for public health in Texas that’s comprehensive. The system is not as connected as it could be.”
The main issue is that public health systems primarily operate on the local level, without much coordination on a state or federal level. They are mostly funded by local taxes, and “may be supplemented by state and federal grants.” Local public health departments are mostly autonomous–there’s no unifying statewide set of standards to bring them together, so each has a different budget and set of services it provides. What’s more, since they are primarily locally funded, public health departments are vulnerable to local budget cuts as cities across the state face economic pressure. In Texas, “Thirty- six percent of local health departments in Texas laid off staff as a result of budget cuts between 2008 and 2013.”
It’s not just a Texas problem. A study by the Trust for America’s Health and Robert Wood Johnson Foundation released last year found that “federal funding for public health has remained at a relatively flat and insufficient level for years.” Trying to close billions of dollars of budget shortfalls, 29 states have cut their public health funding in the past two years, and “state and local health departments have cut more than 45,700 jobs across the country since 2008.”
Funding for public health departments is often one of the first to go in cases of a budget shortfall, especially when people are perceived to generally be in good health. Without the spectre of an infectious disease like Ebola looming, public health departments are seen as disposable. (Never mind that the United States is on the verge of a public health crisis in terms of obesity and its related ailments–diabetes, heart disease, high blood pressure, and the like. Culturally, those are discussed more as individual “lifestyle” issues than public health ones. When the government does try to intervene to promote healthy eating, it’s decried as being the food police, violating the fundamentally American right to eat as much junk food as we please.) It’s only when someone comes down with a scary infectious disease that people realize that public health departments do provide some vital services after all.
That awareness has certainly started to spread in Texas, as we faced the first Ebola case diagnosed in the United States. Much of the focus has been on a report by the Sunset Advisory Commission, which found that “the roles and responsibilities of DSHS and local health departments remain undefined.” For example, there are an estimated 129 local health departments in Texas, “but that number is unclear because the state does not track health departments that it does not fund. Only 65 local health departments received DSHS funding in fiscal year 2013.” Local health officials have complained that DSHS lacks “statutory clarity” to coordinate statewide public health services, and others have called the relationship between local and state departments of public health “haphazard.”
The lack of coordination between health departments is something that the Legislature is looking at. State Sen. Charles Schwertner, R-Georgetown, the chairman of the Senate Health and Human Services committee saidlast week that, “We need to constantly focus to make sure that our coordination between the federal level, the state level and the local level … are working in concert to make sure that we are protecting the health, safety and welfare of our citizens.”
To be clear, you’re still not going to get Ebola. The state’s public health system has been able to handle the Ebola case appropriately to prevent an epidemic. Last week, when Ebola was suspected, “DSHS requested help from the federal Centers for Disease Control and Prevention, which dispatched a team of investigators to Texas. DSHS also operates the state public health lab in Austin, where the current Ebola case was confirmed.” Ebola doesn’t spread that easily, and those who were exposed are quarantined. But this case has brought Texas’ public health infrastructure into the public eye, and revealed many major issues. The state is taking steps to address the problems–let’s hope the threat of Ebola is enough to get them into gear now and fix the public health system before a real crisis hits.