RENO, Nev. – “Fragile and at-risk” is how Nevada’s public health infrastructure could be described based on the findings of a recent assessment conducted by University of Nevada, Reno Extension, in partnership with the Nevada Association of Counties. The assessment, which maps the public health infrastructure in 15 of 17 counties in Nevada (excluding the two most urban counties, Clark and Washoe), provides baseline data for decision-makers and stakeholders as they consider the needs of their communities.

Over the past year, Extension’s Nevada Economic Assessment Project team worked with the Nevada Association of Counties to conduct an assessment of the state’s public health infrastructure to provide local governments, policymakers and local organizations with data to help them prioritize the highest needs in their communities and propose solutions.

“This is a base data collection that allows us to see what’s really going on in Nevada, see what we have, see what we’re missing, and then from there, perhaps we can improve,” Joe Lednicky, Extension economist who headed up the 125-page assessment posted online, Foundational Public Health Services in Suburban, Rural and Frontier Nevada, said.

Public health infrastructure focuses on the health of a population, not individual health care. While the term infrastructure may elicit thoughts of buildings, public health infrastructure also includes people and programs available in the community, as well as capacity and expertise. Food inspection, water and air quality monitoring, mosquito abatement, and emergency response are all also examples of public health efforts that individuals may not think about when considering the subject.

“When public health is done well, you often don’t know it’s being done,” Amy Hyne-Sutherland, Nevada Association of Counties public health coordinator, said. “The gaps shown in this comprehensive assessment are real opportunities to serve our communities. Solid public health infrastructure can have lasting positive impacts on Nevadans that reach beyond the measure of public health. It sets the pathway for solid economic development and a pathway to meet the needs of all of our residents.”

Hyne-Sutherland noted that while many studies are done on community health needs, an assessment on Nevada’s public health infrastructure had not been done outside Clark and Washoe counties.

“Community health needs assessments are done frequently,” Hyne-Sutherland said. “But this was not a health needs assessment; it was about infrastructure – what is in place to meet the needs of constituents.”

Large counties, limited resources: Assessing Nevada’s fragile public health system

For this assessment, the focus was on 13 key components consisting of foundational areas and foundational capabilities, which are all part of a national tool called the Foundational Public Health Services Assessment. The foundational areas included communicable disease control; chronic disease and injury prevention; environmental public health; maternal, child and family health; access to and linkage with clinical care. The foundational capabilities included assessment and surveillance; community partnership development; equity; organizational competencies; policy development and support; accountability and performance management; emergency preparedness and response; and communications. This national tool used was adapted to accommodate Nevada’s unique landscape, with its large counties consisting of rural communities geographically spread out throughout much of the state.

“Nevada’s geography, Nevada’s infrastructure for public health is so unique,” Hyne-Sutherland said.  “I don’t think that most Nevadans realize how different our state is than other states in terms of size of counties. We have 17 counties. The average number of counties in states in the U.S. is 63. And in most U.S. states, there is a health department, a local health department, in every single county no matter how small. We don’t have a full-time local department in each of our 17 counties, even though many of them are giant counties.”

The assessment included online surveys followed by in-person meetings with stakeholders in each county consisting of county leadership, emergency managers, CEOs from critical access hospitals, school district administrators and others. It focused on rating the health authority on these criteria. Hyne-Sutherland said a lot of counties rely on their human services teams, local nonprofits and similar organizations that help with some of these public health infrastructure services

“Local coordination around health-related services is often very good, but we were focusing specifically on public health services delivered by the actual public health authority,” Hyne-Sutherland said. “For many counties, that is the Department of Public and Behavioral Health, but it also includes the Central Nevada Health District, which serves four counties (Mineral, Pershing, Eureka and Churchill) and the City of Fallon. These authorities have expert, passionate staff who are working with very limited resources. When the health authority has such a massive area to serve, and there is a lack of funding, it can be very difficult. The more local you get, the easier it becomes to coordinate and efficiently build infrastructure. The Central Nevada Health District, for example, is a new district. It required local investment to stand up, but it’s worth it, as they are already making strides in improving local delivery of service.”

The Nevada Association of Counties and other key stakeholders have been educating lawmakers and policy leaders on the need for sustainable funding of Nevada’s public health infrastructure. This assessment enables communities to focus those dollars where it is needed most and use them wisely in partnership with the local health authority and the residents the counties serve.

“I don’t mean to be alarmist,” Hyne-Sutherland said. “A lot of strides were made with COVID-relief funding, ARPA dollars, even SB 118, but that was one-time funding. We’re in this perpetual state of being at risk and fragile with our public health system because we are largely grant funded. We don’t have noncategorical, sustainable funding. And so, the result is that we get what we pay for, which is hardly anything. Nevada ranks 47th in the nation for state investment in public health.”

Public health care gaps: Geographic inequity undermines Nevada’s health infrastructure

Accountability and performance management fared the worst across the state. Geographic equity was also rated low. According to the assessment, “For most of the counties surveyed, direct services (either delivered by the health authority or by a community agency that has been contracted to provide services) are frequently limited to a single population center within a county.”

“The results of the assessment showed that geographical location really impacted service level.” Hyne-Sutherland said.  “We think it’s important for policymakers to see this data, and we will work to address this across our county membership.”

The geographic inequity was linked to low scores for chronic disease and injury prevention, and access to clinical care.

“Those kinds of things go hand in hand with a lack of health care across rural and frontier parts of the state,” Hyne-Sutherland said. “Because if you’re in Goldfield, it’s a two-hour-plus drive to the closest hospital, should something happen. While that is partially health care and partially public health, that distance also affects things like kids needing physicals for school sports or immunizations to start the school year or things of that nature. Where some of those heath care offerings aren’t necessarily available, it impacts chronic disease and injury prevention.”

While many results rated the infrastructure at the low end, as a whole, counties across the state had high ratings for emergency preparedness and response. The assessment reflects that this capability area was bolstered by regular Local Emergency Planning Committee meetings, support and regular communication from multiple state agencies, and a dedicated Public Health Preparedness Program supported at the state and local level.

Interstate collaboration: Unlocking public health potential across Nevada

Additionally, there were areas that offered room for optimism. The biggest opportunity was related to communication, which was identified as a key strength. This is because of the ability for improvements to be made simply by increasing collaboration.

“There are state programs and health district programs that maybe do have some grant funding, but they’re not implemented everywhere because there isn’t a local team,” Hyne-Sutherland said. “There isn’t always capacity to do that, but there might be availability if there was more communication.”

She also said that through the process of the assessment, participants also learned about resources they could access, but just didn’t know about.

“People in the meeting would say ‘Oh, I work in the school district, and this isn’t happening here yet,’” Hyne-Sutherland said. “Or they’d respond with, ‘Oh, I’m not even aware of that program.’”

Extension Specialist Marlene Rebori, who helped plan and facilitate the in-person meetings following the survey, also noted that individuals in the communities themselves were an asset, especially as they participated in the process, as they helped to paint an honest picture of the needs in their community.

“They love their communities and they’re very proud of their communities,” Rebori said.

She further noted how important the community engagement component of the project was.

“You bring the people in who are affected, and who are impacted by the decision and have them provide their input about what’s really happening, what’s going on,” Rebori said.

With the assessment completed, Hyne-Sutherland says it can be used in a variety of ways and that it is delivered in a way that makes it easy to use.

“There are 13 areas that we looked at, the 13 foundational public health services,” Hyne-Sutherland said. “For each of those areas, it has opportunities that are very tangible and very specific. Without having done the study, these findings would not have come to light. In addition to counties, I hope that health authorities, not-for-profits and other community agencies use it. The application is broad. It can be used as an advocacy tool. It can be used for strategic planning. Counties can use this as a guide to make targeted, strategic investment in their region or in their county.”

The Foundational Public Health Services in Suburban, Rural and Frontier Nevada assessment was funded through a Centers for Disease Control grant subawarded from the Nevada State Division of Public and Behavioral Health. For questions about the assessment, contact Lednicky at lednicky@unr.edu or 702-948-5971.

By Amy Alonzo — As states across the nation grapple with a highly contagious strain of bird flu infecting livestock and commercial poultry facilities, Nevada has thus far remained largely safe from infection, according to state officials.

Bird flu is a highly contagious virus that can lead to illness in livestock and death in poultry.  

There are two strains of the virus — one affecting wild birds and another affecting livestock and domestic birds.

Earlier this month, the Nevada Department of Agriculture (NDA) confirmed the state’s first case of bird flu at a dairy operating in remote Nye County.

In 2022, the NDA confirmed the state’s first case of the virus in a backyard flock of chickens in Carson City. There are no commercial egg producers in the state. 

The strain affecting wild bird populations has been found in geese and ducks in Reno and birds of prey and waterfowl in western Nevada.

The virus can spread multiple ways, including through contact between birds, contact between humans and birds, contact between livestock and through contaminated feed, manure and bird droppings. Occasionally it spreads to humans, leading to mild respiratory symptoms and pink eye, although the risk to people is low, according to the Centers for Disease Control and Prevention. It most often sickens those who work with poultry and livestock.

The rampant spread of the virus has led to increasing commercial egg prices, a declaration of emergency in a neighboring state and extra safety precautions in Nevada.

Near-record high egg prices

The virus has led to near record-high egg prices as commercial producers struggle to meet demand for eggs with decreasing flocks.

The virus can have very high mortality rates in birds — as high as 95 percent in domestic chickens. More than 6 million birds were slaughtered in November because of the bird flu, The Associated Press reported.

At the end of 2022, there were 308 million commercial laying hens, down 4.5 percent from the year prior. Conversely, egg consumption in the nation has increased nearly 5 percent since 2000 and, as commercial producers battle deaths from bird flu, they are also adapting to changing consumer demands and law changes that unintentionally can increase infections. 

In 2021, Nevada became the ninth state to ban the sale of eggs that come from hens in cages, as well as the keeping of egg-laying hens in cages in the state.

The bill, introduced by Assemblyman Howard Watts (D-Las Vegas), requires all eggs sold in the state come from cage-free facilities. Nevada sources its eggs from other states, many of which also have cage-free laws, including California, Oregon, Washington and Colorado.The nation’s top 10 egg-producing states, producing two-thirds of the nation’s eggs, are all east of the Rockies.

Hens raised in cage-free facilities can interact in ways they wouldn’t if they were isolated in cages, potentially allowing the virus to spread more easily, the AP reported. And, with more Western states requiring cage-free eggs, demand is limiting supply and raising costs.

According to the Bureau of Labor Statistics, the average price of a dozen grade A large eggs in November was $3.65, up from $2.14 a year ago.  Prices have fluctuated throughout the years, reaching record highs of around $5 a dozen in late 2022 and early 2023 as avian flu decimated commercial poultry populations. According to the United States Department of Agriculture (USDA), more than 43 million egg-laying hens died from avian flu during that time, and egg inventories were down nearly a third.

Some states have suspended their cage-free requirements during the outbreak of the virus; Nevada cannot, said J.J. Goicoechea, director of the NDA, because the cage-free requirement is written into state law.

“We are looking at a legislative fix” to see if a variance can be granted to suspend the law during extreme egg shortages, he told The Nevada Independent.

California’s response and Nevada’s precautions

Just days ago, California Gov. Gavin Newsom declared a state of emergency as the state battles the spread of the virus.  

Since March there have been 61 confirmed cases of bird flu infections in humans across seven states; more than half of those (34) were in California, primarily among poultry and dairy workers in Tulare County, the nation’s largest milk producer. The virus has also shown up in at least 17 of the state’s wastewater systems.

Nevada isn’t likely to see the same effects as California because of its more remote nature, Goicoechea said. The outbreak at the dairy in Nye County was at an isolated facility, he said, and has been contained thus far. 

“We’re very comfortable with our response [that] we will be able to keep it there,” he told The Nevada Independent. The contaminated herd is under quarantine until it tests negative for three weeks.

Pasteurized milk will not transmit the virus to humans, according to the USDA, and selling raw milk is illegal in Nevada. Dairy and meat products remain safe for consumption.  

If the virus does reach Northern Nevada, it could spread more quickly because of the proximity of production facilities, Goicoechea said.

“My goal is to snuff this out and prevent it from getting to Northern Nevada,” he said.

— This story is used with permission of The Nevada Independent. Go here for updates to this and other Nevada Independent stories.

Related

Despite the fact that he was running against Vice President Kamala Harris, a Democratic candidate with a South Asian background, exit polls show Trump nearly doubled his share of votes from AAPI voters relative to his 2020 performance, subsequently flipping the Silver State red for the first time in two decades. 

Nevada has the highest percentage of AAPI voters among the seven battleground states, and the population has grown to almost 3.2 million, up from 2.7 million in 2010. The demographic shift toward Trump was the outcome of successful targeting by his campaign, voters hearing the right things, and general apathy toward the cultural issues Democrats were highlighting to excite voters.

The economy and border

Unsurprisingly, Trump’s focus on the economy and immigration was a key factor in shifting Nevada’s AAPI demographic toward the GOP. In an exit poll conducted after the interview, 64% of AAPI respondents said they voted for Trump, compared to the 61% in 2020 who said they voted for Biden

Post-election exit polls showed that his message on the twin issues pulled the race in his favor, as data showed concerns about the economy and immigration resonated with Nevadan voters across racial divides. Of the Nevada residents who voted for Trump, overwhelming majorities cited economy as their top concern, followed by immigration.

Many American Filipinos, who form the largest Asian ethnic group in Nevada, felt resentment that people could “stay here illegally” when they “went through the mill” to become permanent residents, said Jose Manuel Romualdez, the Philippines ambassador to the U.S., during post-election musings on ABS-CBN News.

James Zarsadiaz, an Associate Professor of History and Director of the Yuchengco Philippine Studies Program at the University of San Francisco, agreed.

“Some Asian immigrants and refugees in particular feel they settled in the U.S. the ‘correct’ way. Conservative messaging helps convince them that undocumented individuals sully the dignity of the legal pathways to citizenship that they took,” he wrote in an op-ed following the election. 

While immigration concerns loomed large, many professionals, including Zarsadiaz and Ana Wood, the director of the Las Vegas Asian Chamber of Commerce, said the economy was the single most important issue Nevada voters considered as they cast their votes.

“All those [rising costs] affect the Asian businesses,” Wood told the Nevada Independent in late October. “They’re finding that they have financial challenges. And I’m not talking just about restaurants — I’m talking about even the spas, nail salons, dry cleaners.”

Karthick Ramakrishnan, a political scientist and founder of the polling organization AAPI Data, told NBC News following the election that Asian Americans viewed Trump more favorably in 2024 because of economic concerns.

“If you’re unemployed or employed, if you’re retired or working, everyone feels the pain of inflation,” Ramakrishnan said. “That was a significant headwind for the Democratic Party, including Harris.”

It was the Harris campaign’s failure to adequately address concerns about the voters’ two top issues that helped drive the vice president’s historic decline in support from the AAPI community, according to Shakeel Syed, the executive director of the nonprofit South Asian Network.

“Look at Trump’s agenda: He ran on inflation and immigration primarily,” Syed told NBC. “And I think she did not address those things.”

The culture war factor

While the twin pillars of economy and immigration propelled Trump to the White House, it was the Democratic Party’s stance on controversial “culture war” issues that helped drive voters away from Harris, according to experts.

Renu Mukherjee, a fellow at the Manhattan Institute, reported following the election that Asian Americans pivoted to Trump because of an “indifference” to progressive issues, including “soft on crime” measures, diversity, equity, and inclusion policies in the classroom, and abortion. 

Romualdez, the Filipino ambassador, agreed that the Harris campaign made a strategic mistake in “hammering” AAPI voters on abortion instead of kitchen table issues.

“I think the messaging was, was lost in the translation, in the sense that what’s important, really, for most people here was the economy and the illegal [immigrants.] You know, Trump was able to connect that the illegal immigration is what is causing the economy to be burdened … he was able to connect that … and that he was going to get rid of it, he was going to change and going to and bring down inflation prices,” the ambassador said.

Overall, Mukherjee wrote that “Asian Americans’ dissatisfaction with Democratic positions on the economy, crime, and education reflect their broader dissatisfaction with progressive assaults on merit, fairness, and the American dream — ideas that many Asian American groups hold dear.”

Multiple national surveys in recent years have indicated Asian Americans increasingly view relaxed crime policies backed by progressives with disfavor. ​The majority of Asian Americans in California, which borders Nevada, supported the passage of a ballot measure this year that sought to roll back some of the Golden State’s more lenient penalties for certain offenses. 

The Democratic Party’s view on racial equity in the education system and movement away from merit-based standards has also turned AAPI voters away, according to Asra Nomani, a former journalism professor at Georgetown University.

“The injustice of being labeled as ‘privileged,’ ‘selfish,’ ‘cheaters,’ ‘overrepresented,’ ‘white adjacent,’ and ‘resource hoarders’ hurt very deeply,” Nomani said during an interview with RealClearPolitics. It led to “political mobilization and a reconsideration of long-standing political loyalties.”

Some members of the AAPI community rejected Harris because her campaign’s liberal stance on gender identity conflicted with their religious beliefs. Others, particularly Filipino voters with backgrounds in communist countries, gravitated toward Republicans due to their “conservative” tendencies, according to Pauline Lee, the president of the Nevada Republican Club and a Chinese American.

With Filipino Americans currently being the largest and fastest-growing segment of the AAPI population in the U.S., Lee told the Nevada Independent that the “older Filipinos who came to this country are all conservative,” in comments that were backed up by Filipino Ambassador Romualdez.

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Trump made his pitch directly

Trumpworld made reaching the voting bloc a large focus of efforts in Nevada, with Turning Point USA holding an AAPI-themed rally in Las Vegas just weeks before Election Day. Trump himself appeared at the event alongside Hawaiian native Tulsi Gabbard, a top campaign surrogate, hailing her as “an incredible leader from the Asian American Pacific Community,” as he delivered remarks that focused largely on the economy and the border.

TPUSA president Charlie Kirk concluded the pitch to Asian Americans, saying, “Just as we’re seeing huge shifts with Hispanics and the black community, this is a group that is poised to resonate powerfully with President Trump’s message of economic empowerment, law-and-order, safe streets, and a return to orderly, sane immigration policies.