Why did a rural Nevada county turn down funds to create a public health department?

ELKO, Nevada — When Elko County commissioners rejected a $500,000 grant from the Centers for Disease Control and Prevention that could have helped the county create a health department or health district, Kayla Hopkins pleaded with them to reconsider.

Hopkins, who has lived for nearly nine years in the sprawling, rural county that forms the northeast corner of Nevada, told the council how she struggled with postpartum depression and needed mental health resources.

“I couldn’t get the help I needed,” Hopkins said in a town hall meeting in late 2021, adding that she had fallen into what could be considered a nervous breakdown. She said she was sent by air ambulance more than 300 miles to Carson City, where she received treatment at a mental institution for 10 days.

“I was away from my family,” Hopkins said. “I was far from my support system here, and I still have mental health issues, and I still can’t get the help I need because we just don’t have it here. “

Appeals from Hopkins and others were not enough to sway the commissioners-elect. Nor were there 11 letters from local health officials urging the council to accept the injection of public health funding. Four of the county’s five commissioners, citing concerns about government overreach and their lack of faith in federal agencies, voted against continuing the grant. Nearly a year later, as the pandemic nears a third year and with the arrival of monkeypox, the county still has no public health department to respond.

And the same distrust of the agencies that administer public health grants persists elsewhere.

Elko County, home to about 54,000 people, hasn’t been alone in rejecting federal aid aimed at bolstering public health over the past year. Experts say they are surprised and concerned to see the rare local or state leader, influenced by political partisanship, reject funding opportunities for historically constrained public health systems.

While many conservative leaders and their constituents have opposed measures intended to combat Covid – things like masking policies and the promotion of vaccines – the pandemic has exposed longstanding cracks in the country’s public health infrastructure. , especially in rural and underserved communities.

“Partisan politics has poisoned the well to such an extent that we are willing to sacrifice the health of our citizens,” said Brian Castrucci, president and CEO of the Beaumont Foundation, a national nonprofit organization that defends public health policy. “Is political grandstanding worth it?”

Over the past two years, officials in Idaho, Iowa and New Hampshire have rejected Covid relief money, their decisions often accompanied by political statements about the federal government’s overreach. And officials representing local governments across the country, including Arizona’s Cochise and Pinal counties, echoed those moves. A survey of local governments in 15 states by the National League of Cities found that more than 200 small governments have turned down pandemic relief funds, a small percentage of the money available to small governments.

Elko commissioners declined a CDC-funded workforce grant, money intended to “establish, develop, and maintain a public health workforce, including school nurses.” The funding would have flowed through the state to the county, allowing it to hire two employees dedicated to public health services for two years.

County employees tasked with researching the grant and presenting it to the council said the idea was to conduct a study over those two years that would help them determine how much it would cost to set up a local health department or a health district, involving neighboring counties. .

Elko County has not had a public health department since budget challenges prompted officials to disband it more than 15 years ago.

Adriane Casalotti, head of government and public affairs for the National Association of County and City Health Officials, said communities across the country have generally called for increased funding during the pandemic, which has put a strain on strains already underfunded and understaffed public health infrastructure.

“That being said,” Casalotti said, “over the past few months, I would say, we’ve heard of a handful of health services that wouldn’t ask for or couldn’t accept … specific grants,” involving Covid vaccines.

At an Elko County Commission meeting in late 2021, then-Transit Management Coordinator Abigail Wheeler presented the grant to the board and a packed room. of residents eager to air their grievances about the CDC and perceive allegations of federal government overspending, overspending, and corruption regarding the pandemic response.

Wheeler started by asking county commissioners to keep an open mind.

Abigail Wheeler presented a Centers for Disease Control and Prevention grant to the Elko County, Nevada commission last year, telling her the funding could help the city create a health department or district and give Elko more local control over public health. The commission disagreed.Elko County via Kaiser Health News

“I’m very aware that this is basically the worst time for this grant to be given because there’s a lot of public health disgust because of what’s happened with Covid and our whole community, our whole country. and the world,” she said. “We’ve been beaten to death, the fallout from the Covid pandemic.”

Wheeler, now the county’s grants and contracts manager, began by reminding commissioners that creating a local health department or district was a goal that predated the pandemic and the polarization it sparked. .

A 2019 meeting with the state Department of Health and Human Services highlighted the need for more local public health infrastructure.

“They’re thinking about things like TB and measles and restaurant inspections,” Wheeler said. “They don’t think about Covid. And they’re like, “We can’t reach you if you have TB. We are 370 miles from Elko County.

Elko is like a landlocked island, Wheeler said during an interview with KHN. Although smaller in population than Clark or Washoe counties in Nevada, Elko spans over 17,000 square miles, making it the fourth largest county in the contiguous United States and the second largest in Nevada.

“We have to be our own cavalry,” Wheeler said.

Commissioners and community members who opposed the grant said Elko did not need more resources from public health or from any district or health department. They said they were concerned about the abandonment of local autonomy and growing bureaucracy. They also expressed distrust of the CDC.

“You are 100% factual that the timing couldn’t be worse,” Jon Karr, then chairman of the commission, said at the meeting. While he said he doesn’t buy into all of the CDC conspiracy theories that others are touting, he added that he doesn’t believe CDC officials should be trusted.

Commissioner Rex Steninger said he voted against the grant because he feared the commission would be “subordinate” to the new entity. “Grants always come with strings attached,” he wrote in an email response to questions from KHN. “We don’t want CDC tenacles [sic] reach Elko County.

Wheeler pointed to the fractured local public health system at the meeting, saying creating a health district or department could help reduce bureaucracy and give the county more control over decisions in the hands of the county. state officials. She said it was clear the county needed more resources, citing the public health response duties she took on in her position as transit manager.

“We are not public health experts, we are just people who are ready to step in and take responsibility for this,” Wheeler said, referring to other county employees who have helped with the public health response to Covid.

Wheeler was disappointed the county council turned down the grant opportunity, she told KHN in October. She said she would still like to see public health become a county function one day.

Since speaking at the meeting nearly a year ago, Hopkins said she has found the mental health services she needs locally. But not everyone is as lucky as her to find the help they need close to home, she said. The county’s decision to reject the CDC grant makes her sad, she said, but she accepts it was the commission’s decision.

Other local leaders have seen the need to increase public health resources amid the pandemic. The Elko City Council wrote a letter of support for the CDC grant the day before the commission rejected it. “We know for sure that this is not something the city wants to tackle on our own,” said City Manager Curtis Calder. “But if our regional partners want to do it in partnership, we are ready to help where we can.”

Other rural Nevada counties collaborated with the University of Nevada-Reno School of Medicine to create the Central Nevada Health District, serving four counties and a small town near Reno. “If we don’t step in and help ourselves and our constituents, we can’t complain when the state doesn’t provide what we need or what we expect,” Dr. JJ Goicoechea wrote. , Commissioner of neighboring Eureka County and the Interim State. veterinarian, in an email response to KHN.

Casalotti said there are benefits to having local health services staffed and run by people who live in the community, as opposed to a state government hundreds of miles away.

“One of the things we hope people can learn from the pandemic is that you don’t want to have to build the plane while flying it,” she said. “At some point, you have to take the leap because the next crisis is fast approaching.”

But polarization remains a barrier, Castrucci said.

“It has become a holy war, it has become a war of good and evil,” he said. “I don’t know how to get through this to get to a place where we put the health of our nation first.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.

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