If there’s a silver lininglocal health officials hope it’s a newfound interest in increased funding for the
Members of the City Council agree. Many said the department should get more money and expand its programs — after all,whether that’s managing a pandemic or the impacts of poverty — but who foots the bill is a source of disagreement.
In years past, the health department watched as its funding dwindled, forcing layoffs, reassignments and a holistic restructuring in 2015. This wasn’t because the city cut the funding; the health department doesn’t get any money from the city’s coffers.
Instead, like most health departments, it’s largely financed by grants. A few years ago, when the grants ran out, the department found itself overextended with more employees and programs than it could afford, losing $2 to $3 million a year, City Manager Steve Mermell said.
Since the 2015 restructuring, the Pasadena Public Health Department’s budget stabilized around $12 million a year — though the next three years may be closer to $16 million, thanks to a coronavirus-related grant from the Centers for Disease Control, according to Manuel Carmona, the department’s deputy director and its former finance manager.
Carmona explained that half the department’s funding comes from grants. Another quarter is from state sales tax and DMV fees.
Meanwhile, the department generates an eighth of its budget from restaurant and home inspections, as well as others, but that’s all provided at-cost to residents. It doesn’t make any profit from those services.
The last eighth is scattered around miscellaneous sources, Carmona said. Just 1% is from county grants.
Even though the state requires each health department to fulfill specific duties, the amount of funding it sends to the local health department “falls far short” of what’s needed to get the work done, Dr. Ying-Ying Goh, Pasadena’s public health director and medical officer, said in an interview.
By sending just a quarter of the department’s total budget, it effectively forces the department to chase down grants to make ends meet. And even with the grant funding, Goh said they health department doesn’t have enough money to pursue more ambitious solutions to problems like poverty and the health impacts that flow from it.
“That’s a flawed model,” Goh said. “Fundamentally, we should be doing something different.”
Mayor Victor Gordo agrees.
“Paying a quarter of ‘not enough’ is not acceptable to me or the residents of Pasadena,” Gordo said.
He argued that the state and county have financial obligations to the city’s health department because, if Pasadena decided to disband its health department, the county would be responsible for the city’s residents and the county would have to pick up the check.
“In my opinion, that means we are entitled to assistance from the county and state to properly fund and meet the responsibility that we have taken on their behalf,” Gordo said.
Each member of the City Council interviewed for this story agreed with Gordo; they thought the county and state should be paying more for the city’s health department.
Even Councilman Tyron Hampton, an outspoken critic of the health department’s pandemic performance, voiced an interest in lobbying the state or county for additional funds.
But should the city itself be chipping in more funding?
Grants versus city coffers
Mermell oversaw the 2015 restructuring and spent nine months working within the health department during that period. He said they did “miraculous work with grants,” but thought it may not be enough.
“I do foresee a time when we’ll need to put general fund dollars into the health department,” he said. “I’m hopeful, through the pandemic, that people start to realize that we can’t take public health matters for granted.”
When it comes to the county, Mermell said Pasadena was occasionally frustrated trying to prop up city programs that are supported by county grants.
Pasadena tries to get a pro-rated share of these grants, such as one that’s earmarked for Black infant health, and “sometimes we get it, sometimes we don’t,” Mermell said.
“Sometimes we have to beg the county for it, and that’s frustrating.”
Ultimately, Mermell hoped the state would provide more funding. If it were to come from the local level, that would require a City Council decision.
Councilwoman Felicia Williams isn’t thrilled with that idea and believes the grant funded model can work — if the city were more aggressive in pursuing them.
In her day job, Williams pursues infrastructure-related grants for other cities. She believes Pasadena isn’t applying for every grant it qualifies for, and it isn’t as successful in winning some grants as it could be.
Williams believes the city is leaving money on the table and called for it to hire a dedicated in-house grant writer to pursue more opportunities. Right now, the city uses a consultant.
But Assistant City Manager Nicholas Rodriguez believes this model works better for the health department, and Goh agrees with him.
Over the years, the city had considered bringing someone on full-time, but each grant requires subject matter expertise. It’s easier and more cost-effective to find that in a consulting firm with specialists, as opposed to an in-house generalist.
“With respect to whether the city is actually leaving good money on the table, it is important to remember that not every grant application is successful,” Rodriguez said in a statement, noting that it’s a highly competitive process.
“There is just no way of insuring a successful application given that funding priorities of the granting source, as well as the number of applicants, dictate the success or failure of any particular application — and even whether it is fruitful to apply.”
Councilman Andy Wilson noted that the under the grant funded model, the health department effectively “pays for itself,” he said in an interview.
He argued that the city has a limited budget based on the tax revenue it collects and thought it was a “no brainer” to lobby the state and county to pay more.
But if the city itself was going to pay, it would have to come out of other programs, he said. In addition to lobbying, he thought the city should look at health-related programs run by other departments and analyze whether that money would be more effective if it were under the health department’s purview.
Unlike his colleagues, Hampton was supportive of the city using general fund dollars in the health department, but he criticized its officials for not flagging the issue earlier.
“If they knew this had the potential to happen, then they’re the professionals who should’ve said we’re underfunded,” Hampton said.
Regardless, for Goh, Carmona and other public health officials, it doesn’t matter where the money comes from — as long as it’s there, and it’s stable, and it lets them do their jobs.
“I don’t want us to come out of this pandemic and be in the situation we were before with progressively — from year to year — a decreased amount of resources going toward the public health system,” Goh said. “That would just be shameful for us to continue that mistake, that error.”