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 dipped lower Friday despite strength in energy stocks, while U.S. markets were mixed as the Dow eked out another record but tech stocks dragged.
The mood Friday was mixed after a strong week for equities in both Canada and the U.S., said Andrew Buntain, vice-president and portfolio manager at Fiduciary Trust Canada.
The S&P/TSX composite index closed down 77.01 points at 23,956.82, one day after it . It closed over 24,000 for the first time on Thursday.
The strength this past week wasn’t just in North American markets, noted Buntain, as Chinese stocks enjoyed a rally after the country’s central banks announced a suite of measures intended to boost the economy.
Meanwhile, an undercurrent of broadening strength continued this week as investors spread out their interest beyond a narrow set of tech giants, said Buntain.
“Some of the sectors that have been ignored for several years have been some of the better performers this year,” he said.
“We’re very encouraged by that.”
In New York on Friday, the Dow Jones industrial average was up 137.89 points at 42,313. The S&P 500 index was down 7.20 points at 5,738.17 after setting an all-time high on Thursday, while the Nasdaq composite was down 70.70 points at 18,119.59.
A report Friday on one of the U.S. central bank’s preferred measures of inflation — the personal consumption expenditures price index — showed continued cooling.
The Federal Reserve started lowering its key interest rate last week, and is expected to keep going this fall and into 2025.
However, the Fed’s next interest rate decision isn’t until November, noted Buntain, so there’s plenty of data for the central bank to take in yet — including next week’s labour report.
The job market has been an increasingly key focus for the central bank after recent reports showed cooling in that area of the economy. Friday’s report also showed consumer spending in August didn’t meet economists’ expectations.
In Canada, where the Bank of Canada is set for its next rate decision later in October, Friday brought a GDP report that was a little stronger than expected, said Buntain.
“The Bank of Canada has already delivered three cuts and signalled maybe some further reductions,” he said.
If inflation continues to move lower, Buntain added, the Bank of Canada could even announce an outsized half-percentage-point cut, echoing the Fed’s move last week.
The Canadian dollar traded for 74.08 cents US compared with 74.22 cents US on Thursday.
The November crude oil contract was up 51 cents at US$68.18 per barrel and the November natural gas contract was up 15 cents at US$2.90 per mmBTU.
The December gold contract was down US$26.80 at US$2,668.10 an ounce and the December copper contract was down four cents at US$4.60 a pound.
— With files from The Associated Press
This report by The Canadian Press was first published Sept. 27, 2024.
TORONTO – Canada’s main stock index closed above 24,000 for the first time Thursday as strength in base metals and other sectors outweighed losses in energy, while U.S. markets also rose and the S&P 500 notched another record as well.
“Another day, another record,” said Angelo Kourkafas, senior investment strategist at Edward Jones.
“The path of least resistance continues to be higher.”
The S&P/TSX composite index closed up 127.95 points at 24,033.83.
In New York, the Dow Jones industrial average was up 260.36 points at 42,175.11. The S&P 500 index was up 23.11 points at 5,745.37, while the Nasdaq composite was up 108.09 points at 18,190.29.
Markets continue to be optimistic about an economic soft landing, said Kourkafas, after the U.S. Federal Reserve last week announced an outsized cut to its key interest rate following months of speculation about when it would start easing policy.
Economic data Thursday added to the story that the U.S. economy remains resilient despite higher rates, said Kourkafas.
The U.S. economy grew at a three-per-cent annual rate in the second quarter, one report said, picking up from the first quarter of the year. Another report showed fewer U.S. workers applied for unemployment benefits last week.
The data shows “the economy remains on strong footing while the Fed is pivoting now in a decisive way towards an easier policy,” said Kourkafas.
The Fed’s decisive move gave investors more reason to believe that a soft landing is still the “base case scenario,” he said, “and likely reduces the downside risks for a recession by having the Fed moving too late or falling behind the curve.”
North of the border, the TSX usually gets a boost from Wall St. strength, said Kourkafas, but on Thursday the index also reflected some optimism of its own as the Bank of Canada has already cut rates three times to address weakening in the economy.
“The Bank of Canada likely now will be emboldened by the Fed,” he said.
“They didn’t want to move too far ahead of the Fed, and now that the Fed moved in a bigger-than-expected way, that provides more room for the Bank of Canada to cut as aggressively as needed to support the economy, given that inflation is within the target range.”
The TSX has also been benefiting from strength in materials after China’s central bank announced several measures meant to support the company’s economy, said Kourkafas.
However, energy stocks dragged on the Canadian index as oil prices fell Thursday following a report that Saudi Arabia was preparing to abandon its unofficial US$100-per-barrel price target for crude as it prepares to increase its output.
The Canadian dollar traded for 74.22 cents US compared with 74.28 cents US on Wednesday.
The November crude oil contract was down US$2.02 at US$67.67 per barrel and the November natural gas contract was down seven cents at US$2.75 per mmBTU.
The December gold contract was up US$10.20 at US$2,694.90 an ounce and the December copper contract was up 15 cents at US$4.64 a pound.
— With files from The Associated Press
This report by The Canadian Press was first published Sept. 26, 2024.
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.
