In the decade before Michigan and its largest city became the latest hot spot for the deadly coronavirus, officials were steadily, and at times dramatically, cutting back on their first line of defence against pandemics and other public health emergencies.
Approaching bankruptcy, Detroit disbanded most of its public health department and handed its responsibilities to a private non-profit. When the department reopened in 2014 in the back of the municipal parking office, its per capita budget was a fraction of other big cities’, to serve a needier population.
In Ingham County, home to the capital city of Lansing, then-Public Health Director Renee Branch Canady sat down at budget time every year for seven straight years to figure out what more to cut.
“It was just chop, chop, chop,” Canady said. By the time she left in 2014, all the health educators, who teach people how to prevent disease, were gone.
What happened in Michigan also played out across the country and at the federal level after the 2008 recession, which caused serious budget problems for governments. But as the economy recovered, public health funding did not, a review of budget figures and interviews with health experts and officials shows.
A shortfall persisted despite several alarming outbreaks, from H1N1 to Ebola, and has left the U.S. more vulnerable now to COVID-19, experts say. In normal times, public health workers are in the community, immunizing children, checking on newborns and performing other tasks. In a health emergency, they’re tracing outbreaks, conducting testing and serving as “first responders” when people fall sick — efforts that are lagging in many states as the coronavirus spreads.
“Our funding decisions tied their hands,” said Brian Castrucci, who worked with health departments in Philadelphia, Texas and Georgia and is now president of the de Beaumont Foundation, a health advocacy organization.
The cuts came under both Democratic and Republican administrations. While there is no single number that reflects all federal, state and local spending, the budget for the federal Centers for Disease Control, the core agency for public health, fell by 10 per cent between fiscal year 2010 and 2019 after adjusting for inflation, according to an analysis by the Trust for America’s Health, a public health research and advocacy organization. The group found that federal funding to help state and local officials prepare for emergencies such as outbreak has also fallenshrunk — from about $1 billion after 9-11 to under $650 million last year.
Between 2008 and 2017, state and local health departments lost more than 55,000 jobs — one-fifth of their workforce, a major factor as cities struggle to respond to COVID-19.
“It definitely has made a difference,” said John Auerbach, Trust for America’s Health CEO and a former public health director in Massachusetts.
New York has seen the most COVID-19 cases in the U.S., but numbers are surging in places such as Detroit, where those testing positive nearly tripled in the week between March 28 and Saturday, when officials said the city was approaching 4,000 cases, with 129 deaths. A more robust health system could have done more earlier to track down and isolate people who were exposed, said the city’s former health director, Abdul El-Sayed.
State spending on public health in Michigan dropped 16% from an inflation-adjusted high point of $300 million in 2004, according to a 2018 study.
Some of the funding problems, Canady and other public health advocates believe, stem from a fundamental belief in smaller government among Republican governors, including former Michigan Gov. Rick Snyder, who called for “shared sacrifice” after the state’s auto-dependent economy was battered by the recession.
In Kansas, then-Gov. Sam Brownback ran what he called a “red-state experiment” to cut taxes. State spending on its Public Health Division, outside of federal funds, dropped 28% between 2008 and 2016.
The cuts meant a “shifting of responsibility for services from the state level to the county level,” Democratic Gov. Laura Kelly said in an interview. “And we saw that in public health.”
In Maine, then-Gov. Paul Le Page’s administration stopped replacing public health nurses who were dealing with families in the opioid crisis. The number of nurses fell from around 60 to the low 20s before the Legislature tried to reverse the action.
Although agencies often receive emergency funding when a crisis strikes, the infusion is temporary.
“Decisions are made politically to support something when it becomes an epidemic,” said Derrick Neal, a public health official in Abilene when Ebola surfaced in Texas. “And then as time passes, the funding shrinks.”
In Oklahoma, state funding for the Department of Health still hasn’t returned to its levels of 2014, when a combination of slumping oil prices, tax cuts and corporate breaks punched a giant hole in the state’s budget. When state revenues later improved, the money went to other priorities.
“It’s much easier to cut funding for public health than it is to start taking away benefits from people or access to care for people,” said former state Rep. Doug Cox, an emergency room doctor.
Castrucci said the problem with providing more money only at times of emergency is it doesn’t allow time to recruit and train new workers.
“We waited until the house was on fire before we started interviewing firefighters,” he said.
For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, and death.
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Associated Press reporters David Eggert in Lansing, Michigan, Paul Weber in Austin, Texas, John Hanna in Topeka, Kansas, and Sean Murphy in Oklahoma City contributed to this report.
TORONTO – Canada’s main stock index was up more than 100 points in late-morning trading, helped by strength in the base metal sector, while U.S. stock markets were also higher.
The S&P/TSX composite index was 143.00 points at 24,048.88.
In New York, the Dow Jones industrial average was up 174.22 points at 42,088.97. The S&P 500 index was up 10.23 points at 5,732.49, while the Nasdaq composite was up 30.02 points at 18,112.23.
The Canadian dollar traded for 74.23 cents US compared with 74.28 cents US on Wednesday.
The November crude oil contract was down US$1.68 at US$68.01 per barrel and the November natural gas contract was down six cents at US$2.75 per mmBTU.
The December gold contract was up US$4.40 at US$2,689.10 an ounce and the December copper contract was up 13 cents at US$4.62 a pound.
This report by The Canadian Press was first published Sept. 26, 2024.
Switching to an online-only bank more than a decade ago was just another way Jessica Morgan was trying to save money at the time as a new grad.
“Saving money was the main motivator,” Morgan, now a financial educator and founder of Canadianbudget.ca, recalled.
“After graduating, you no longer qualify for student rates where you might get free banking and I didn’t want to go back to paying fees for giving the bank my money to hold.”
Digital lenders have grown in popularity in recent years, with more players popping up in the sector and traditional banks beefing up their online offerings. But some Canadians may still be hesitant to bank with a financial firm that doesn’t have physical branches where you can talk to an employee face-to-face.
Natasha Macmillan, director of everyday banking at Ratehub.ca, says some of that hesitancy to switch to an online lender is loyalty.
“There’s a large portion of Canadians who have had the same bank account for many years … they’re just hesitant to switch because it’s what they know.”
Tedious paperwork to switch banks can also discourage many Canadians from making the move despite the ease of opening online-only bank accounts, Macmillan added.
“There’s that aspect of you still need to sit down, do your research and then pick that online-only bank,” she said.
Data security concerns have also sowed seeds of doubt among many who are contemplating the switch, and prefer to continue to work with traditional banks with long-established reputations, Macmillan said.
Morgan said she often hears concerns from her clients — “What if I need help? Is this bank safe to use?” or more logistical questions, such as having access to an ATM or getting certified cheques.
One of the only major snags she personally recalls running into with her online lender was when she was purchasing a home.
“I needed to get a certified cheque, like, right away if I was going to put in an offer,” Morgan said. “You can get a certified cheque but it takes three days or so. They courier it to you.” She ended up going to her husband’s traditional bank to get day-of service.
Most online-only banks tend to offer banking products, such as savings accounts, with higher interest rates compared with traditional banks. Many also offer access to cash through any bank ATM without charge.
“Digital banks have generally a lower cost structure than a traditional bank and those savings will be passed on to the customer,” said Mahima Poddar, group head of personal banking at EQ Bank. For example, EQ offers a high-interest chequing account with no fees on everyday banking and unlimited transactions.
But customers should be aware they can’t deposit cash into their account and they can only withdraw bills, not coins.
“We don’t offer depositing of cash, but all of our research has shown that the use of cash is really diminishing,” Poddar said. “There are very few reasons why you need to urgently deposit.”
Customers also have to get used to doing all their banking by phone or through the company’s website or app.
Poddar added she thinks Canadians are more open to change, especially after the COVID-19 pandemic, which accelerated the need for better online banking services.
While trust in traditional institutions plays a strong role in choosing a bank, Poddar said EQ has the same level of protection and is governed by the same regulators as the big six banks in the country.
Lisa Brandt, 61, switched to online-only Manulife Bank more than five years ago. She says she has benefited from the move and has saved a lot of money over time on various banking fees.
“It puts me in the driver’s seat,” she said.
However, she did run into an issue once with depositing a cheque after she sold her home.
“If you’re going to deposit a couple hundred thousand dollars from a house sale, you’ll have to courier (the cheque) to them,” she said.
“It’s not quite as simple as walking into a branch and saying, ‘Give me my money.'”
While many online-only banks have been growing their consumer banking product offerings, traditional banks tend to have more financial product options, not only for individuals but also for small businesses.
“What we have heard from some Canadians is while they might be moving their chequing, savings and GIC accounts to those (online-only) spaces, they’re still maintaining a mortgage with the big players,” Macmillan said.
It’s not about moving all assets to one bank but weighing options on an individual basis, such as picking a bank with the lowest fee on a chequing account but moving investments to another bank for a better return, she explained.
“We’re starting to see that flexibility where people are shopping around for the best opportunity that can give them the most bang for their buck,” Macmillan said.
She added it is important for people to identify why they’re thinking of switching and find an online-only bank that aligns with their goals.
“It’s finding that happy medium where you do feel trust and security, that lower cost and fees and also the convenience and accessibility,” Macmillan said.
This report by The Canadian Press was first published Sept. 26, 2024.
TORONTO – Strength in the energy and base metal stocks lifted Canada’s main stock index higher in late-morning trading, while U.S. stock markets also climbed higher.
The S&P/TSX composite index was up 78.80 points at 23,973.51.
In New York, the Dow Jones industrial average was up 89.81 points at 42,214.46. The S&P 500 index was up 2.55 points at 5,721.12, while the Nasdaq composite was up 21.24 points at 17,995.51.
The Canadian dollar traded for 74.24 cents US compared with 74.02 cents US on Monday.
The November crude oil contract was up US$1.06 at US$71.43 per barrel and the November natural gas contract was down two cents at US$2.83 per mmBTU.
The December gold contract was up US$18.10 at US$2,670.60 an ounce and the December copper contract was up 15 cents at US$4.49 a pound.
This report by The Canadian Press was first published Sept. 24, 2024.
