The COVID-19 pandemic has pointed out shortfalls in Missouri's public health, a recent report says.
A study Missouri Foundation for Health commissioned determined local public health agencies' capacity to respond to a public health emergency varied greatly, in part because of "tremendous variation in training, skills and capacity across (local public health agencies), with many lacking the fundamental infrastructure and expertise to mount an effective response."
The report - Missouri's Public Health Response to COVID-19: Key Findings and Recommendations for State Action and Investment - is available online. The foundation released the report earlier this month.
Challenges the report identified included:
- The ability to collect and analyze data associated with an infectious disease outbreak was "severely lacking."
- The state did not fully leverage lessons from the past.
- The pandemic accentuated that Missouri's commitment to financing public health is among the lowest nationwide.
- Local agencies did not receive consistent guidance regarding COVID-19 mitigation measures from state or local leaders.
The foundation contracted with George Washington University (in Washington, D.C.) to assess Missouri's public health preparedness and ability to respond to the pandemic and future public health crises. Results may not exactly reflect the public health response here in Central Missouri - the university conducted 138 stakeholder interviews in Northeast, Southwest and St. Louis regions.
Missouri has historically depended disproportionately on federal dollars to operate public health programs, the report says. But, those funds are often limited because of ties to specific programs or services and can't be used elsewhere. Additionally, federal money for pandemic response (CARES Act for example) went to county officials rather than directly to local public heath agencies. In many cases, those funds never reached the agencies.
"The state now has a singular opportunity to build stronger public health agencies at the state and local levels with unprecedented amounts of funding from the federal government," the report determined.
Missouri has received $921 million in federal COVID-19 response funding from the Centers for Disease Control and Prevention.
"Some of that funding was used to surge critical resources in response to the pandemic, but significant portions can also be leveraged for modernization activities. Additional federal fiscal relief funding from the U.S. Department of Treasury can also be used for public health modernization," the report states.
The report included a focus on equity. It came up with eight key recommendations.
The first is to provide financial support and technical assistance for public health accreditation. It recommends Missouri set up a fund to provide technical assistance to local public health agencies, allowing them to assess readiness for accreditation via the Public health Accreditation Board. The national board strengthens public health through accreditation and innovation - continually improving agencies, according to phaboard.org. The fund may be used to cover fees associated with the accreditation application process.
Second, the state must prioritize equity.
"Expand funding, staff and other supports to help (local agencies) integrate equity principles into data collection and reporting and community engagement (i.e., trust-building, links to social services)," the report said. "Increase workforce and funding of the Office of Minority Health."
Third, build a modern surveillance system. The system should by consistent with federal standards and provide agencies or regional bodies with hardware and software to manage the system.
Fourth, create regional coordinating bodies. Missouri should incentivize sharing of staffing and services among smaller agencies. In those instances, have a lead public agency designated to convene and coordinate. The goal is to develop and strengthen all foundational public health capabilities.
Fifth, bolster the public health workforce. Recruit and hire equitably through promotion practices, new training programs and enhanced salaries for leaders with advanced training.
"Deploy skilled staff within regions," the report recommends.
Sixth, ensure equitable public health funding across Missouri. Health agencies should receive a minimum level of funding linked to the delivery of services and an equity analysis that incorporates social vulnerability. Assure that public health money goes directly to agencies.
Seventh, clarify agency governance and authorities.
Eighth, harmonize policy development.
"Ensure consistent policies across jurisdictions for public health prevention and mitigation measures," the report says. "(Missouri Department of Health and Senior Services) should establish and adhere to protocols for consultation with agencies on new policies during emergencies."