Local Public Health Funding Must Be a Part of Our “New Normal”

A version of this column originally appeared in the Alpena News

As final negotiations ramp up on the state budget, one of the League’s priorities is calling on policymakers to increase essential local public health funding, which supports local health departments’ (or LHDs’) delivery of core public health-related services and programming. Greater public health investment in Michigan is sorely needed: even when combined with federal funding, limited state investment results in $83 in per-capita public health spending, below the national average of $116, which ranks Michigan 40th in the nation out of all states and Washington, D.C. 

But here’s the big picture: public health protects us all and inadequate funding impacts LHDs’ ability to keep us healthy.  

Public health is broad and impactful to our everyday lives; it encompasses infectious disease control, environmental safety, health behavior change, quality food and water in addition to social determinants of health—or non-medical factors influenced by the conditions in which people are born, work, age and live. In addition, because public health prevents disease from occurring in the first place, it tends to work invisibly, and success is often measured when disease doesn’t occur at all. 

In fact, if Michigan lawmakers want to keep their constituents safe and healthy, a proactive and preventative approach to local public health funding must be a part of our “new normal” as we look beyond the COVID pandemic.

To be clear, “safe and healthy” is much broader than not being hospitalized or dying from COVID. All 45 LHDs (covering all 83 counties) are required to provide Essential Local Public Health Services (ELPHS), which is core public health programming across seven different areas. In addition, LHDs connect families to affordable healthcare, collect and analyze local health data and provide many services focused on children’s health by both conducting the majority of Women, Infants, and Children (WIC) programs across Michigan and participating in the Children’s Special Health Care Services (CSHCS) program. 

But over the past two years, all LHDs have had to shift resources away from this regularly scheduled programming to prioritize managing the COVID pandemic and saving lives in their communities.

LHDs have operated with limited funding for longer, since Michigan has not invested in local public health systems over the last decade, as outlined in the League’s recent budget brief, Local Public Health Funding in Michigan: An Evergreen Need, Even in Our “New Normal.” Public health appropriations in Michigan have increased overall since 2010; yet, state ELPHS funding has remained relatively stagnant, even despite recent boosts, including flat funding from 2015 to 2018, resulting in just a 6% inflation-adjusted increase. Often, public health funding is targeted to address specific diseases or initiatives, as opposed to supporting basic public health functions that LHDs provide. At the same time, research has shown that LHD spending is some of the most effective public health spending, linked to the delivery of essential services, stronger public health system performance and reduced deaths overall. Without additional ELPHS investment, basic public health functions, services and systems suffer as LHDs have to do more with less. Ultimately, this can mean worse health outcomes across Michigan’s communities. 

What’s more, LHDs are already entitled to more funding under statute: per the Michigan Public Health Code, the money that LHDs spend on ELPHS should be reimbursed by the state at a 50% match, yet a 2019 internal review found that the state would need to contribute $36 million to meet this cost-sharing requirement. Even after a new funding formula was implemented in 2020, LHDs have continued to go without tens of millions of additional state dollars, which would support LHDs in their delivery of essential services across Michigan. 

Ultimately, this lack of public health investment has a detrimental impact on Michiganders’ health. Based on America’s Health Rankings, despite ranking highly on measures of clinical care (13th in the nation), like access to care and quality of care, Michigan falls dramatically on measures of health outcomes related to overall health and mortality (40th in the nation). The Legislature’s ability to invest in local public health systems through ELPHS provides an opportunity to shift this trajectory. 

Michigan may be doing well on clinical care factors, but such factors only influence about 20% of health outcomes. It is clear that our state is neglecting other changeable health factors, like social determinants of health, by not investing in policies, programs and capacity—particularly at the local level—that support health factors outside of clinical care.

In addition, systemic barriers like geographic and economic segregation as well as institutional racism push social and economic resources that improve health outcomes farther from reach for Michigan’s communities of color, which contributes to racial health disparities. Critically, these disparities are not inevitabilities and strategic policymaking and funding can shift health outcomes. In fact, the League’s brief includes a case study of the Michigan Coronavirus Racial Disparities Task Force, which highlights how targeted actions dramatically reduced racial health disparities in the span of one year.

Unfortunately, all proposed Fiscal Year 2023 budgets have actually reduced state spending on ELPHS by nearly $2 million. There is still time to advocate for this priority and urge your lawmakers to ensure that final negotiations include a much-needed boost for local public health. Proactive investment in local public health systems through ELPHS must happen now if we hope to see better health outcomes in our state’s future.