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COVID Exposes Missouri’s Need for Public Health Overhaul

With some of the lowest vaccination rates in the nation, state officials are hopeful that a new lead to the Department of Health and Senior Services will update the whole system and make it better, post-COVID.

(TNS) — As Missouri continues to slog through the COVID-19 pandemic, health advocates hope Gov. Mike Parson’s appointment of an Illinois official to lead the Department of Health and Senior Services could be a new era for the state’s embattled public health system.

“I think you’ll see that whole department, that whole agency be rebuilt,” Parson said in April as he embarked on the search for a new director after asking Dr. Randall Williams to resign.

On Wednesday, he announced the appointment of Donald Kauerauf, a former Illinois public health official, who told reporters he wants Missouri to rank No. 1 in health outcomes. He said he wants to focus on getting Missourians back to preventative care, and addressing their social determinants of health — the environmental or socioeconomic factors that play a role in one’s risk of disease.

He’ll have his work cut out for him when he starts in September.

Missouri often ranks in the lowest 15 states for several poor health outcomes, including cardiovascular deaths, cancer incidence, maternal mortality and premature death.

It also has one of the lowest rates of child vaccinations.

Health advocates point to a fragmented public health system for which Missouri frequently sits at the bottom of the nation in funding.

Health department staffing fell by 8 percent in the past decade, according to an Associated Press and Kaiser Health News investigation last year. And Missouri’s state dollars toward public health amounted to just $7 per person last year, according to the State Health Access Data Assistance Center affiliated with the University of Minnesota School of Public Health.

For years, medical organizations and health advocates have been putting together proposals to revamp the state’s public health system into one with minimum standards in areas such as chronic disease prevention and maternal and child health.

The state appears to be getting on board. Missouri officials are in the beginning stages of a “plan to make transformative investments” in the public health system, according to the health department. In an April meeting convened by Parson’s office, top state officials discussed using multiple federal grants to implement a “statewide long-term public health system concept.”

Clay Goddard, director of public health transformation of the Missouri Foundation for Health, said it’s too soon to say exactly what changes will be made. But he said the state will be using the advocates’ standards.

“That means that no matter where you live, you’re guaranteed some coverage from that invisible blanket of public health protection,” he said. “And I don’t think we can universally say that right now, with the way that the system has really been gutted in the last decade.”

Nothing revealed the consequences of the shortcomings in that system more than the COVID-19 pandemic.

“The general population was not aware of the need to improve our public health system for the most part,” said Lynelle Phillips, vice president of the Missouri Public Health Association. “Now they are. COVID really exposed the lack of public health infrastructure and the work we have to do moving forward.”

Local health officials, already strained before the crisis, often struggled to get direct resources during the pandemic. Many found it difficult to keep up with contact tracing and other measures to mitigate the virus’ spread, and shifted their entire departments toward COVID-19 response. Some let other services, like women’s health screenings and children’s immunizations, falter.

“All of the other programs that we have been doing have suffered because COVID has consumed us,” Janice Morrow, administrator of the Ripley County Health Center, said in June.

In Springfield, the epicenter of a yet-unending COVID-19 outbreak among the unvaccinated being driven by the aggressive delta variant, officials said they were “caught on our heels” shifting back to normal operations when the delta began its rapid spread in southwest Missouri.

“We’re torn currently with regard to capacity to serve our community because we’re still trying to keep up with this crisis, yet we recognize the fact that we have to do some of the services that Public Health provides otherwise and we haven’t been able to offer as well throughout the past year and a half,” Springfield-Greene County Health Department director Katie Towns said earlier this month.

Towns said she wished her department had the resources to conduct deep, community-level research on issues like vaccine hesitancy — data that she said would help the response “tremendously.”

Phillips said the pandemic did provide one opportunity, a better relationship between public health departments and private health care providers such as hospitals, that she hopes the state will use to coordinate other efforts, such as reducing smoking or promoting healthier eating.

The health system overhaul could encompass anything from administrative improvements to disaster preparedness.

A slide show provided by DHSS lists numerous goals, including developing local health agencies into expert resources for health policy decisions, creating a “chief health strategist” to improve consistency statewide, training and assessment for local departments and establishing a team to focus on grant funding.

There are also proposals to improve infectious disease detection and surveillance through methods used during the COVID pandemic such as contact tracing and wastewater testing, maintain a state supply of protective equipment, improve access to health care for rural and minority communities and even promote public health as a career field.

The health department said it could not make Kauerauf, who is finishing his role advising emergency management in Illinois, available for an interview until he starts in Missouri in September.

“Mr. Kauerauf has extensive experience in public health and has previously led transformations,” DHSS spokeswoman Lisa Cox said in an email. “These plans are adaptable, and we look forward to his leadership and direction on our focus areas and efforts.”

Both Goddard and Phillips have been involved in the discussions with the state and said they’re in the early stages. But both had suggestions of areas they’d like to see change with the transformation plan.

Goddard said DHSS needs to become “a better advocate” in lobbying the federal government for funding to pass down to the local departments. And he wanted to see the department push local departments to get accredited. Only 18 percent of the state’s 114 local health departments are accredited now.

Phillips said the state can also improve its health technology, to better track infectious disease reports or immunizations.

Securing federal funding appears to be a critical part of the proposal.

An April document obtained by The Star, which was sent to then-health director Williams after a meeting of top state officials, shows the plan of a “massive investment” is being spearheaded directly by Parson’s office and involves several other state agencies including the departments of education and economic development.

“The scale, scope, and complexity of this effort is beyond any single department,” according to the meeting notes, which were sent by Parson’s policy director Kayla Hahn. “The federal grant opportunity cannot fail. The unprecedented scale of the investment means not only that its impact should be lasting, but also it will be scrutinized today, tomorrow, and years to come.”

©2021 The Kansas City Star. Distributed by Tribune Content Agency, LLC.
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