ALBANY — New York’s county governments are pressing Gov. Kathy Hochul’s administration for a massive infusion of state funding to bolster local public health agencies.

The county health departments need an additional 1,000 full-time staffers to provide “an adequate infrastructure and a minimum package of public health services,” according to the New York State Association of County Health Officials (NYSACHO).

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$216.5M package

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That group, along with the New York State Association of County Governments and several advocacy organizations, are making a concerted push to get Hochul to embrace their proposal to channel $216.5 million in state funding into a package of initiatives that would strengthen the network of 58 local public health agencies.

Sarah Ravenhall, leader of NYSACHO, and Stephen Acquario, executive director of NYSAC, said the pandemic’s impact on New York illustrates the need for strengthening local health agencies.

“Every community, every resident of New York state, deserves a strong public health infrastructure,” Ravenhall said in an interview. “And now is the time to invest in that.”

The proposed funding would fortify the ability of counties to deal with six core functions: communicable disease control, chronic disease prevention, emergency preparedness, environmental health and threats posed by drinking water pollution, maternal and child health and community health assessment.

The NYSACHO survey found that 90% of the state’s local health departments are crimped by staffing shortages, hurting their ability to deliver those basic services.

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Fatigued, demoralized

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The county leaders also point to a recent survey by researchers at SUNY Oneonta and Bassett Healthcare Network Research Institute, concluding that staffers at local health departments are fatigued and demoralized as a result of staff shortages.

Said Acquario: “As the pandemic wears on and new public health challenges emerge, we cannot continue to expect our local health departments to battle 21st-century health threats with 20th-century resources.”

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Collaborative approach

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Hochul has taken a more collaborative approach in working with local governments than her predecessor, former Gov. Andrew Cuomo, who treated county leaders as spectators during the pandemic. County officials often learned of the state’s latest COVID-19 guidance only when Cuomo announced the shifts at press conferences.

Last March, the relationship between the county governments and Cuomo’s administration were further strained when a Cuomo ally, Larry Schwartz, the unofficial coordinator of the state’s vaccination effort, threatened to impose $100,000-per-day fines on 17 counties, including Niagara and Schoharie, if they did not immediately use all COVID-19 vaccine doses sent to them, according to a Schwartz memo acquired by CNHI.

County leaders complained about the ham-fisted threat, and Schwartz expressed regret for making it after CNHI inquired into the situation.

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In hindsight

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William Hammond, a health policy researcher at the Empire Center on Public Policy, said beefing up the ability of local governments to respond to health emergencies such as a pandemic would be a cost-effective way to prepare for such crises when they occur.

“The more you can do at the beginning of a crisis to contain it, the less the medical system needs to do in the long run,” Hammond said. “It’s clear in retrospect that a relatively small investment to prepare for the pandemic could have saved us billions of dollars.”

Any increase in the state’s investment in public health should be accompanied by an in-depth analysis of the state’s response to COVID-19 so that errors can be documented and studied, with an eye towards avoiding missteps in the future, Hammond said.

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Starting point

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The governor’s office is not showing its hand yet on the public health ingredients of the budget plan to be issued in the coming week. But last week Hochul, in her State of the State speech, said she will strive to increase New York’s health care workforce by 20% over the next five years.

Her spokesman, Avi Small, called the upcoming budget presentation “the starting point for negotiations with lawmakers on this critical matter.”

Hochul’s proposed budget is expected to top $200 billion when it is released next week. The annual fiscal blueprint is designed to fund all state services and programs for the fiscal year running from April 1 through March 31, 2023.