Joint investigation details hollowed-out US public health departments

By Michelle R. Smith, Meghan Hoyer, Mike Householder, Lauren Weber, Laura Ungar, Hannah Recht and Anna Maria Barry-Jester

AP’s Michelle Smith paired with KHN’s Lauren Weber, Laura Ungar, Hannah Recht and Anna Maria Barry-Jester to take a definitive look at state and local public health. While many people understood public health in general had suffered budget cuts over the years, the collaborative team used data to show exactly how expansive those cuts have been. They used deep reporting to show the impact those cuts have had over time. They painted a picture of a system starved of money and staff for years, facing more cuts amid a pandemic. With no single source of data, Recht pulled from more than a dozen sources, and worked with AP data editor Meghan Hoyer and KHN’s Liz Lucas. Weber, Ungar, Smith and Barry-Jester interviewed more than 150 people who told them of the burnout, low pay, threats and frustrations among public health workers.

Their reporting,and graphics by Francois Duckett and Recht,showed:

— At least 38,000 state and local public health jobs have disappeared since 2008.
— Most states had seen steep drops in spending.
— Priorities such as police get more money.
— Billions in cuts have been a bipartisan endeavor.

Public health is low on the nation’s list of spending priorities: 83% of Americans live in counties that spend more on policing than on nonhospital health. https://t.co/qcQoEYcoVY pic.twitter.com/xSqeyOW5RK

— Michelle R. Smith (@MRSmithAP) July 1, 2020

AP statehouse reporters helped determine 14 states had cut public health during the pandemic or were considering cuts. Jeannie Ohm shepherded video, shot by Mike Householder and Federica Narancio. Narancio and Paul Sancya contributed photos.

The package was a top story on Apple News,Politico’s Playbook highlighted it,and it made several front pages. KARE-11 in Minneapolis used it to do its own investigation. A New York Times editorial cited it. One political science professor wrote to say he plans to teach the story in the fall. The Public Health Foundation’s president wrote a note of thanks, calling the story “exceptionally well researched and presented.”

Ap 20177592390634 Ss — Jennifer Gottschalk, environmental health supervisor for the Toledo-Lucas County Health Department, is tested for COVID-19 in a Toledo, Ohio, hospital, March 24, 2020. Gottschalk says she fielded calls about COVID-19 cases from a hospital bed while fighting the disease herself. She then worked throughout her home isolation, stopping only when her coughing was too severe to talk. – Jennifer Gottschalk via AP

Ap 20177592519342 Ss — A stack of paperwork detailing positive COVID-19 test results sits in a box at the Toledo-Lucas County Health Department offices in Toledo, Ohio, June 24, 2020. – AP Photo / Paul Sancya

Ap 20177592488524 Ss — Jennifer Gottschalk, environmental health supervisor of the Toledo-Lucas County Health Department, reads paperwork about positive COVID-19 test results in Toledo, Ohio, June 24, 2020. – AP Photo / Paul Sancya

Ap 20177592416551 Ss — Jennifer Gottschalk, environmental health supervisor of the Toledo-Lucas County Health Department, walks down a hallway of the department’s offices in Toledo, Ohio, June 24, 2020. When the coronavirus pandemic struck earlier in the year, the department was so short-staffed that her duties included overseeing campground and pool inspections, rodent control and sewage programs, while also supervising outbreak preparedness for a community of more than 425,000 people. – AP Photo / Paul Sancya

Ap 20177592617163 Ss — Roland Mack holds a poster with pictures and messages made by family members in memory of his sister, Chantee Mack, in District Heights, Md., June 19, 2020. Chantee Mack, a Prince George’s County, Md., public health worker, died of COVID-19. Her family and co-workers believe she and several colleagues contracted the disease in their office. – AP Photo / Federica Narancio

Ap 20177592688860 Ss — Volunteers take registration information for COVID-19 testing, May 23, 2020, in Annandale, Va., where testing was available from Fairfax County at no cost and without a doctor’s order. Since 2010, spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%, according to an analysis of government spending on public health by KHN and The Associated Press. – AP Photo / Jacquelyn Martin

Kansas’ governor and three U.S. senators shared it,as did high-profile experts including Michigan’s top health official. Former HHS Secretary Kathleen Sebelius emailed her “highest compliments.” “Hopefully it will inspire some good ideas for Joe Biden,” Sebelius wrote.

The COVID-19 pandemic has brought to light what happens when we don't support and invest in public health. We must do better,as a state and as a nation. The health of Kansas residents,and our economy, depend on it. https://t.co/e4n8Sxfkdh

— Governor Laura Kelly (@GovLauraKelly) July 1, 2020

For an ambitious story that laid bare the state of America’s public health system,Smith,Hoyer,Householder,Ungar,Weber, Recht and Barry-Jester share this week’s Best of the States.

For AP’s complete coverage of the coronavirus:

– AP’s hub for comprehensive all-formats coverage of the virus outbreak.

– Understanding the Outbreak: stories explaining the new coronavirus.

– One Good Thing: daily stories of hope and humanity amid the crisis.

– Ground Game: Inside the Outbreak: AP’s podcast series.

– Lives Lost: stories behind the victims of COVID-19.