The Snohomish County Health District is asking cities for a $2 per capita contribution for the second year in a row.

District administrator Jefferson Ketchel made a formal request to the Monroe City Council at the end of November. Washington municipalities have less than a month to finalize their 2018 budgets. Ketchel largely focused on the concept of prevention.

“I don’t want to just be end-of-pipe, cleaning up syringes in parks,” he said. “I want to be preventing people from becoming addicted in the first place.”

Lack of resources is a major hurdle, Ketchel said. With finances consistently up in the air, the agency tries to remain as predictable as possible in providing services, he said.

“I have worked in local public health for 23 years — our funding sources are extremely unreliable,” he said.

In March, the council agreed to fund a $1 per capita payment — roughly $18,120 — to the financially strained health district, which first sought help from local municipalities in 2016. A $2 per capita allowance had originally been included in this year’s budget.

The process is not unique. The health district formed in 1959, and local governments have given short-term contributions periodically since 1967. The agency does not have taxing authority; state law says public health district can’t raise money through taxes, so the often responsibility falls on county governments and local jurisdictions.

“State funding for local public health has decreased 65.7 percent from a peak of $27.29 per capita in 2000 to $9.36 per capita in 2014,” according to the this year’s interlocal agreement to contribute. “The Health District has experienced a 22 percent decrease from its 2005 funding level while the county population has increased by 14 percent in the same 10-year period...The Health District ranks 34 out of 35 local health jurisdictions in the state for public health expenditures per resident.”

After debating for several months earlier this year, the council agreed to halve the contribution. Councilmembers Jim Kamp and Jason Gamble voted against the disbursement altogether. Gamble said it was a one-time shot in the arm and wasn’t a sustainable way to fund public health.

“We are basically doing this to feel good, I just want to make sure we all understand that. We are not getting any additional services for customers. It’s all great, the stuff that they are providing — it’s fantastic,” he had said. “They will be providing us the same services tomorrow if we approve the $0 and stay status quo, and they’ll be providing Mill Creek the same services, which probably has more demand on the system. Some of these larger cities have more demand on the system, and on their (the health district) resources than we do, so just remember that.”

Ketchel said he wants to show how critical public health services are to every facet of a functional community for Monroe. He also talked about the partnerships with cities that are crucial to the survival of programs, and how he has been digging into the public health system to ensure the agency is using its money wisely.

Not unique to, but affecting the community is the opioid crisis, nuisance property cleanups, a rising number of STDs and a statewide spike in mumps cases; the health district has had a hand in each one of those efforts, including in Monroe, Ketchel said.

This year the agency conducted the first Point-In-Time survey of overdoses throughout the course of a week in July; law enforcement, emergency services agencies, hospitals and clinics throughout Snohomish County contributed data. It was found through review that the majority of overdoses were the result of heroin use.

The health district coordinated with the Monroe School District when multiple confirmed and probable cases of the mumps were reported at Frank Wagner Elementary and Park Place Middle schools. The agency put together 1,000 needle cleanup kits, which are free to community members who want to safely dispose of syringes, especially those found in public spaces.

This year Snohomish County, Lake Stevens and Arlington have already agreed to set aside some money in their budgets, he said. About half a dozen of the cities approached last year chose not to participate.

Brier, Mill Creek, Index, Gold Bar and Sultan did not allocate any funds. He said he has had positive conversations this year with officials in a few of those cities.