By MEGAN HART

Kansas spends only about $12 per person on public health, making it one of the states putting the least money into preventing chronic and infectious diseases.

According to a recent report from the Trust for America’s Health, Kansas spent about $36 million in fiscal year 2015 on public health programs for its 2.9 million people, or about $12.40 per person. That ranked the state 47th in per capita spending compared to the other 49 states and the District of Columbia.

Missouri ranked even lower, spending $5.90 per person. Only Nevada spent less.

Public health departments in Kansas provide immunizations, prepare for disease outbreaks and track illnesses considered a public health risk, such as Lyme disease, sexually transmitted infections and measles. Most also offer health education and some health care services, such as prenatal care for low-income mothers.

Michelle Ponce, executive director of the Kansas Association of Local Health Departments, said state funding to local health departments in Kansas has been unchanged since 1995. At the same time, costs have gone up and departments have faced new threats like Zika virus, she said.

“While (funding) hasn’t been cut, it also hasn’t increased in 20 years,” she said.

Kansas has a decentralized system, so public health departments are controlled locally and vary in what they can afford to offer, Ponce said. While many receive federal public health funding, she said, those dollars typically can only be used for a narrow purpose.

“We’ve seen quite a few counties make substantial reductions in what they can provide,” she said. “It’s certainly a challenge.”

Comparisons not exact

Nationwide, the report said states spent a median amount of $33.50 per person, meaning half spent more and half spent less. West Virginia spent most, at $220.80 per person.

Albert Lang, spokesman for the Trust for America’s Health, said the state-to-state comparisons may not be exact because states report their spending differently, but the researchers have attempted to include a broad range of public health spending while remaining consistent in what is counted in each state. Medicaid and federally funded health programs aren’t part of the equation, he said.

“We try to include any funding that can be specifically tied to public health in a given state,” he said.

Bert Malone, vice president of the Missouri Public Health Association, said the state’s 115 public health agencies have increased their reliance on local tax dollars or other sources of fundraising. As Missouri reduced state funding, he said, some agencies have cut hours or health education.

“They lack any reliable source of state funds,” he said. “If one county doesn’t pass a mill tax increase, you don’t get those services that another county is able to offer.”

Kansas also ranked in the bottom half when it came to public health grants from federal agencies. The state received $57.8 million from the Centers for Disease Control and Prevention in fiscal year 2015, or about $19.86 per person, and $69.5 million, or $23.88 per person, from the Health Resources and Services Administration, for a combined total of $43.74.

Missouri received slightly more, with $17.33 per person from the CDC and $27.52 per person from the HRSA, for a combined $44.85 per person.

With federal and local spending added, public health spending nationwide averaged $255 per person in 2014 — down from $281 in 2008. That accounted for about 2.4 percent of all health care spending in the United States.

Spending and outcomes

There wasn’t a clear link between public health spending and health outcomes in the states.

West Virginia spent more per person than any other state but fared poorly on the preterm birth rate, percentage of adults who smoked or were obese, on-time vaccinations for children and adults with diabetes. On the other hand, Hawaii came in second in public health spending and its residents have relatively good outcomes.

Public health efforts affect some conditions more than others. A 2011 study in Health Affairs found that when spending by local health departments increased 10 percent, infant mortality fell by 6.9 percent and heart disease deaths dropped by 3.2 percent. There was less impact on deaths from diabetes and cancer, however, and deaths from influenza and Alzheimer’s disease showed almost no change.

The Trust for America’s Health report estimated every $1 spent on programs that succeed in improving nutrition, increasing physical activity or preventing tobacco use would yield about $5.60 in savings on future health care.

But Malone said Missouri policymakers haven’t recognized the value of investing in public health.

“Legislators simply don’t like people telling them how to live their lives, so chronic disease prevention has been a low priority,” he said.

Officials with the Kansas Department of Health and Environment and Missouri Department of Health and Senior Services did not respond to requests for comment on the public health spending report.

Megan Hart is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC

JOHN HANNA, AP Political Writer

TOPEKA, Kan. (AP) — Top Republicans in the Kansas Legislature hope to finish work on a plan for balancing a state budget that would require GOP Gov. Sam Brownback to do most of the work.

LINCOLN, Neb. (AP) — Nebraska Attorney General Doug Peterson and his counterpart in Oklahoma are joining a lawsuit aimed at halting legal marijuana in Colorado.

The Lincoln Journal Star reports that the two states asked to be added as plaintiffs this month in a case being considered by an appeals court in Denver.

The appeal combines two separate cases: one on behalf of a Colorado couple who own land near a recreational marijuana growing facility and another brought one by a group of sheriffs from Colorado, Kansas and Nebraska.

Oklahoma and Nebraska argue they have “unique sovereign interests” in stopping marijuana from crossing their state borders, and that they shouldn’t be left out as the court weighs the issue.

The U.S. Supreme Court denied considering a similar lawsuit by states in March.

NEW YORK (AP) — Nearly 4 million Nissan cars are being recalled due to major safety problems where passenger air bags or seat belts could fail in a crash.

Nissan North America, Inc. says the first problem is with a sensor that detects if the front passenger seat is occupied. The issue, with 3.2 million cars, can have the computer incorrectly think that an adult is a child or classify the seat as empty, turning off the air bag.

A number of models are affected including the Maxima, Altima, LEAF, Sentra, Pathfinder and some Infiniti models.

A second problem affects 620,000 Sentras and their front seat child restraint system, which might cause air bags to inflate when they shouldn’t.

Nissan says it will notify owners and fix the issues free of charge.

MINNEAPOLIS, Kan. (AP) — A north-central Kansas man faces more than 16 years in prison for a vehicle crash that killed a teenager and her father.

Jason Jeardoe of Bennington was convicted earlier of involuntary manslaughter while driving under the influence of alcohol in the 2014 deaths of Jason Pisocki and his daughter, Emma Jo Pisocki.

The Topeka Capital-Journal reports Jeardoe was sentenced Friday to 16 years and three months in jail.

The Kansas Highway Patrol says the collision occurred April 11, 2014, about three miles west of Bennington. A parked vehicle was partially in the westbound lane, and Jeardoe, who was driving west, moved his pickup truck into the eastbound lane to avoid it, colliding head-on with the Pisockis’ vehicle.

They died at the scene.

LAWRENCE, Kan. (AP) — A Kansas man has been sentenced to life in prison for a 2014 home invasion that left another man dead.

The Kansas City Star reports 31-year-old Dustin Walker of Lawrence must serve 20 years before he is eligible for parole after being sentenced Friday.

The life sentence was ordered to run consecutively with a sentence of 10 years and 10 months for aggravated burglary.

Walker was found guilty last month of first-degree murder for the March 2014 killing of Patrick Roberts.

Roberts was fatally shot inside a Lawrence apartment after two men broke in and demanded, “Where is it?”

Roberts’ brother wrestled the gun from one of the intruders, who fled. A co-defendant previously was sentenced to life in prison with no chance of parole for 20 years.

MATTHEW PERRONE, AP Health Writer

WASHINGTON (AP) — The Food and Drug Administration is reconsidering whether doctors who prescribe painkillers like OxyContin should be required to take safety training courses, according to federal documents.

A panel of FDA advisers meets next week to review risk-management plans put in place nearly four years ago to reduce misuse and abuse of long-acting painkillers, powerful opioids frequently abused for their euphoric effects.

Under the current risk programs, drugmakers fund voluntary training for physicians in safely prescribing their medications. However, many experts — including a previous panel of FDA advisers — said the measures didn’t go far enough and that physician training should be mandatory.

The FDA will ask outside safety experts on Tuesday what changes should be made to improve the risk plans, according to briefing documents posted Friday.

WICHITA, Kan. (AP) — A woman has been found guilty in the death of another woman who was hit by an SUV in Wichita following an argument at a party.

The Wichita Eagle reports that 31-year-old Tiplance Walker was convicted of second-degree intentional murder and two counts of child endangerment Friday. Prosecutors say Walker rammed her SUV into a backyard chain-link fence at 31-year-old Lydia Treto’s home on May 17, 2015, striking Treto.

Authorities say Walker’s 10-year-old and 4-month-old sons were in the vehicle at the time of the collision.

Walker is scheduled to be sentenced June 22.