Texas has been criticized lately for the amount the state spends on public health, which includes things like vaccination programs, programs aimed at reducing obesity, tobacco use and diseases like asthma, HIV and diabetes.
Public health also includes tracking and containing disease outbreaks, which is getting more attention since Texas had the first Ebola case in the U.S.
These days, we’re measuring how well a local entity is spending on infectious disease by what we can see. You know, the goggles, the brightly colored gloves and suits and the puffy shoe covers health care workers wear while treating Ebola patients? But maybe the best way to measure public health spending is by what you don’t see.
"Public health is one of the areas where when we do our job, no one knows it’s working," says Dr. Phil Huang, the medical director for the Austin/Travis County Health and Human Services Department. After all, unless your local disease detective wears a trench coat and fedora, you don’t know he or she is investigating something like a foodborne outbreak.
"You look at the growth in the number of restaurants in our community, the number of food trailers and things like that," Huang says. "Or the population shifts and more people coming into our community and you have more STDs and other infectious diseases."
So in Austin, the more people move here, the challenges aren’t limited to housing and traffic. Austin/Travis County has five epidemiologists.
"Epidemiologists have a great skill set and they tend to have higher salaries," says Catherine Troisi, an infectious disease expert and professor at the University of Texas School of Public Health. "Many health departments can’t afford to hire an epidemiologist."
"If you look at per capita spending of state dollars, Texas is 33rd at $19.31 per capita," says Richard Hamburg, deputy director of the Trust for America's Health, a non-partisan, non-profit organization that focuses on disease prevention. "The per capita rates run from as low as $5.86 in Missouri to as high as $144.99 per capita in Hawaii."
Texas spends less than the national average on public health. State spending on public health has actually gone down since the 2010-2011 fiscal year.
Catherine Troisi from the UT School of Public Health says Texas could be doing even more to improve its public health capabilities -- by expanding Medicaid eligibility, an option under the Affordable Care Act.
"If more people had insurance, then money wouldn’t be taken from public health funding sources for routine matters," Troisi says. "It would also prevent outbreaks because people would be more likely to get treatment early on."
Those recommendations are the kinds of things discussed by a state committee formed in 2011. Stephen Williams chairs this committee. He also directs the Houston Health and Human Services Department.
"I’m not a proponent of just throwing money at an issue. I think it needs to be a thoughtful and logical process," Williams says, who adds that Texas needs to spend on storing data and dealing with housing, for instance, like when someone needs to be isolated. He says the state also needs more epidemiologists – those disease detectives.
"The same concepts and skills used against tuberculosis, HIV, hepatitis, syphilis, measles, pertussis and many common diseases are the same that are needed to respond to exotic diseases like Ebola," Williams says.
Whatever lawmakers decide to do, however, he urges lawmakers to think carefully before they act.
"There needs to be some science that determines whether or not that’s the appropriate thing to do," he says. "It can’t be reactionary like some of the things we see going on around Ebola."
Gov. Rick Perry’s Task Force on Infectious Disease will issue its first report with recommendations following the Ebola outbreak in Dallas on Dec. 1. That may give us a better idea of what the next Legislature will be looking at when it comes to spending on public health in the future.