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Attaclunent 2: Joint BOH /BOCC 04/01/04 local level be maligned to argue for the move. A more salient move would be to provide more financial support to EH programs at the local level regardless of the state framework - this in and of itself would improve service availability and coverage (not delivery) at the local level. Financing Recommendations Recommendation 416a: Financing environmental health programs. Adding a local option to establish fees could potentially lead to confusion for restaurants, especially for national chain franchises. There is also a real and substantial infrastructure cost to establishing and collecting local fees that would also need to be included in a "fee structure." EHS operate as AGENTS OF THE STATE in this program. Fees should continue to be collected and dispersed by the state, although fees should be substantially increased to defray the REAL costs of this program. Recommendation #16b: Low wealth funding formula. Currently no counties are adequately funded by the state or local governments to provide core public health services. A base level of state funding that will enable core services to be provided in each county should be the first step in funding public health services. Other "supplemental" services could then be funded by an alternate funding formula. The Department of Public Instruction provides for a per pupil funding level for all school systems; there is no such baseline financing structure in place for local health departments. Recommendation #17: Medicaid relief for local governments. We should not assume that local governments would willingly or consistently redirect the local Medicaid match for public health infrastructure purposes. Again, it would be LOCAL money rather than STATE funds being used to finance LOCAL public health that is STATE mandated. Recommendation # 18: Eliminate funding gaps in critical public health services. Return to the comment on defusing "critical public health services" in Recommendation 4. The amount of money targeted to chronic disease prevention is very inadequate, even in this recommendation. This model assumes a regional "lead health department" model that has been popular in the state in the last five to seven years. The resources from this regional approach are not visible to local health departments other than those to the lead health department that was the initial grantee to "build capacity." Far more PREVENTION resources should be devoted to this area as "core" funding. Part II: Core Service Gaps: All local health departments should have well siting and construction rules that they administer. Protection of water supplies is basic to public health and the absence of such rules reflects poorly on NC's system. The issue of preemption needs immediate legislative attention as further delay will paralyze the ability of field practitioners to enforce public health laws and regulations as prescribed in Essential Service 6. -See also the comment on core services under Recommendation 4. Page 3 LAROSIESOM0404 Joint Boc -Boh mtgWttach 2 0304 BOH Public Health Task Force 2004 Recommendations.doc