The November election is important to the health of the community, according to documents distributed by the Colorado Springs public health initiative committee. If voters say no to the removal of revenue restrictions that prohibit the El Paso County Department of Health and Environment from accepting non-tax dollars, food and water safety and air quality could be in jeopardy, said Liz Feder, co-chairwoman of the public health initiative committee.
Ballot issue 1 B is asking voters to change spending limits imposed by the Tabor Amendment. Tabor sets caps that are determined by the department’s revenue the previous year. The health department has lost revenue because the state withdrew $725,000 in per capita funding in 2002. That same year, the county commissioners approved a $1.2 million reduction over three years in the amount they allocate to the health department. County tax dollars account for one-third of the health department’s budget.
As the revenues decrease, the health department’s baseline budget shrinks – a process which is referred to as the Tabor ratchet-down effect. Even if the state restores the lost funding to the health department, under the Tabor ruling the department could not accept the money because once revenue is reduced it is permanently lowered, Feder said.
“An economic recovery won’t solve the health department’s problems,” she said. “The initiative is not a tax increase nor is it a de-Taborizing effort, and it won’t affect fees or licenses because our revenues come in by way of grants and contracts.”
The initiative asks voters to eliminate the cap on revenue, so the department can receive its total share of the grants awarded from agencies such as the Centers for Disease Control and Prevention.
Not everyone agrees, however, that the initiative is necessary.
According to the county’s “Notice of Election” pamphlet, naysayers of the initiative believe the Tabor formula – automatic inflation plus growth equals the increase – is sufficient. They also say 1 B lasts forever, and voters should be asked annually whether to approve exceeding revenue limits. Those who disagree with the initiative say there should be a dollar amount listed on the ballot, and that health department projects should be outlined in the initiative.
Feder said the department is behind the eight ball and an across-the-board ousting of the cap is vital to the county’s economic well being. “For example, we rely heavily on tourism in this community,” she said. “What happens if the health department cannot get on top of an infectious disease quickly? It can reach epidemic proportions, scaring visitors and requiring quarantines. It could shut the city down.
“Last year, the health department did a fantastic job taking care of the West Nile virus, but they had to pull inspectors off restaurants to do so. If the restaurants and mineral springs, etc., aren’t safe, it could spell out an economic catastrophe. The health department is a frontline defender of this community in the same way as the fire and police departments.”
The state board of health has been managing and fending off diseases since its establishment in 1877, when the leading causes of death in Colorado were tuberculosis, typhoid, scarlet fever and diphtheria. In 1939, El Paso and Denver counties instituted health departments, at a time when the country was a few years away from introducing polio vaccines and anti-tuberculosis drugs and decades away from smallpox eradication and vaccines for measles and mumps. Fast forward 75 years, and community health issues are different but no less daunting.
El Paso County has a high infant mortality rate compared to the rest of the country, said Rosemary-Bakes Martin, public health administrator for the health department. Low birth weights, teen suicide, teen motor vehicle accidents and methamphetamine labs are 21st century threats to the health and welfare of county residents.
Martin said the county collaborates with 130 local and state agencies to ensure that health-related issues are addressed. Prevention is the health department’s No. 1 focus. “Our mission involves prevention, people and partnerships,” Martin said. “The department provides a safety value for the entire community.”
Protecting the community against diseases is not easy in today’s global market. “With so much world commerce, trade and travel, the next outbreak is just a plane ride away,” Martin said. “The health department must have the infrastructure to respond 24/7 to emergencies.”
Thus far in 2004, the department has responded to almost 2,000 cases of sexually transmitted diseases, more than 1,350 cases of vaccine preventable diseases and almost 200 cases of food-borne and enteric diseases, such as food poisonings, E.coli and salmonellosis.
Larry Schaad is the chief of health systems development and the acting director of the environmental health division of the health department. He oversees food inspections for restaurants, special events, grocery stores, fitness centers, schools and some institutions – most businesses that sell food. He also directs air quality and water-related inspections for manufacturers, auto garages, pools, tattoo parlors, spas, mineral springs, etc. The county works with the state on issues related to hazard waste and pollution.
Schaad said that even though the number of restaurants in the county has exploded to almost 2,000, the number of food inspectors has not mirrored the growth. The county has seven food inspectors, and the total number of county inspectors is below the norm, Schaad said. “The average number of inspectors for a population of 500,000 is 32.5, and we have a total of 20,” Bates said.
It’s not just the environmental division that has employee deficits. Bates said the national median of full time employees for health departments serving communities akin to the Springs is 437. The El Paso County health department has 194 full-time employees.
Regardless of its challenges, the department continues to provide a myriad of services that include the daily monitoring of the community’s air quality and inspections of septic tank installations and repairs and inspections of new construction sites over one acre.
National terrorism threats have created an infusion of dollars for the health department’s urgent response capabilities, such as protecting vital statistics, medical records and information systems, phone systems and facilities in the event of any kind of an emergency. Devising a small pox vaccination program in case of a bio-terrorist act also is within the scope of the health department.
Schaad said the department received a grant under the auspices of the bio-terrorism division for free-hand emergency-phone equipment. “The equipment, however, can be used for everyday use,” Schaad said. And it has come in handy during the flu vaccine crisis.
Susan Hilton Wheelan, public health information officer for the department, said the health department is intercepting more than 100 calls a day related to the flu vaccines, and health department professionals are taking turns answering those phones. It’s what happens in an emergency, Schaad said. “We have to pull people from their regular jobs in this type of situation.”
In light of employee shortfalls and budget constraints, the health department has transitioned many duplicated services and direct care services to other community agencies. Health promotion remains, and, at the helm of that division is Dan Martindale. He said, “The population is increasing and the revenues are decreasing,” which makes it difficult for the department to keep up with other growth-related changes, such as a burgeoning senior population, that spawn new challenges.
No matter the issues, community and business support is imperative to the department.
Although the county commissioners appoint the board of health directors, the health department is not a county agency.
The county’s distribution of tax dollars to the department is not set in stone. Feder said the quest to be more fiscally stable and le
ss vulnerable to those county tax dollars is one reason the department is seeking help from voters on Nov. 2.