New Seattle-King County Public Health Chief Predicts Drastic Budget Troubles Ahead

by Sally James

The new director of Public Health — Seattle and King County is Faisal Khan, M.D., who began his role in September 2022. Khan has a direct style of communication, and one of his messages to the public is that the cutoff of federal funds for COVID-19 relief efforts will mean belt-tightening on every kind of work that the public health department does, from homelessness to HIV prevention.

Federal money sent as emergency funds for COVID-19 work ended on Dec. 31. Without giving any specifics or dollar amounts, Khan said the end of those payments means widespread pain for his organization.

"We have been sustained and supported by federal emergency funding. Now all of that has gone away and it will come to a grinding halt as of Dec. 31 [2022] … All the structures and processes and community relationships that we've put into place will have to be dismantled or massively scaled down," Khan said during a phone interview with the Emerald.

Khan identifies as Pakistani American and immigrated to the United States after medical school. The 48-year-old was most recently acting director of the St. Louis County Department of Public Health. In that role, he clashed with politicians in a public scuffle because they did not want a mask mandate; he also denounced what he called "racist" behavior, after individuals in a county council hearing threatened and ridiculed him.

Khan says until he moved to the United States, he didn't feel the need to label himself.

"It is interesting when you land on these shores, you are almost forced to check one box amongst five or six," he explained. "I always thought of myself as a physician from Pakistan before I landed in the U.S. Here, you sort of check the Asian box, and then the South Asian and non-Hispanic box, etc."

He resigned his job in St. Louis and came to Seattle because — in his own words — "I looked for a place that truly values health care and public health."

Here in Seattle, Khan heads an organization with about 1,400 employees, 40 sites, and a biennial budget of $686 million, according to the agency's website. It is one of the largest metro health departments in the nation.

The pandemic of COVID-19, which has been an overwhelming challenge since it began, remains a challenge. He is disappointed by the low percentage of King County residents who have had their most recent bivalent booster vaccine for COVID-19. Overall, the county's data show about 28% of the county's residents are "up to date" on their COVID-19 vaccines and boosters. Khan warns us to stay vigilant.

"This is a challenging phase of the pandemic that we are in," he said. "People have more or less put the pandemic in their rearview mirror without realizing they are still vulnerable."

In November, some hospitals reported a surge of patients including people with three different viruses. These include COVID-19, flu, and respiratory syncytial virus (or RSV). The three-virus surge was called a tripledemic. That appears to be waning in King County. The county reported about 14 hospitalizations per day for COVID-19 recently, but the dashboard warned that weather and holidays are delaying data. In general, both flu and RSV infections have been declining nationwide.

"These decreasing case rates are good news, but this doesn't mean we're in the clear. We have yet to see the impact holiday travel and gatherings may have on these rates," he warned in an email on Tuesday, Jan. 3. "We're also closely watching for changes in COVID-19 variants and influenza viral types that could lead to another surge in cases. Finally, while the number of hospital visits for these respiratory illnesses has decreased recently, hospitals remain stressed due to capacity challenges."

Khan hopes that his agency might be able to focus more on chronic disease rather than episodes of infections. One of those is what he calls diabesity, a combination of obesity and diabetes. Nationwide, obesity and Type 2 diabetes, which develops later in life, are a joint epidemic. Lifestyle and lack of access to healthy food play a role. Communities with fewer safe spaces for outdoor play, for example, have higher rates of obesity, and high-poverty communities have fewer options for health care that could help prevent the complications of diabetes.

With the budget crunch that Khan sees looming for his agency, there will be difficult conversations about where to spend the limited budget.

"There are days when I wonder if the only thing we learned from the pandemic as a country is that we refuse to learn from our mistakes and improve," he said. "We are back to the same old, same old feast or famine cycle of public health funding, and it is back to the famine phase. That is very disappointing."

Featured Image: Faisal Khan, M.D., has been the director of Public Health — Seattle & King County since September 2022. (Photo courtesy of Public Health — Seattle & King County.)