Sixteen CALPHO directors and executive committee members attended last Friday’s Funding and Financing Symposium, hosted by the Center for Public Health Practice. Below are some thoughts from Rio Grande Director Emily Brown and Tri-County Executive Director John Douglas:
- “The Public Health Funding/Financing Summit was a valuable opportunity to talk about this topic with a broad range of public health partners. There was time to reflect on how far our public health system has come since the 2008 act, as well as learn more about the history and timing behind the act. We were reminded of articulating the importance of public health's value and finding ways to communicate this in a language, and with a direct "ask", that resonates with our legislators, commissioners, and the public. For me, this discussion also further highlighted the continuing disparities between large and small health departments. The answer is not as easy as just increasing funding. I look forward to the next phase of this discussion so we can be prepared, when the timing is right, to take the next step towards improving our public health infrastructure. (Also - the CU South Denver campus was a beautiful location. I appreciated the opportunity to see a new facility in our state!)” -Emily Brown, MPH, CPH
- “The symposium did a great job of diving into the unsexy but critically important topic of how to do a better job of funding core public health services. I learned a lot of important history about this topic in Colorado, and, more importantly, gained a renewed understanding of the essential importance of better ‘telling the public health story.’” -John Douglas, MD
While funding and financing public health was the symposium’s topic, the conversation was dominated by how we communicate the value of public health. This challenge is an old one. We have long recognized the difficulty behind demonstrating the value of public health when success is often defined by nothing happening. It is important to continue the branding-messaging-value-proposition conversation, but it might be more productive to consider communication tactics as a supporting element of a larger funding reform strategy. The specific funding and financing reform effort we choose to pursue will directly inform how we communicate our value. Each potential strategy has different audiences, timing considerations, channels, stakeholders, and opponents. For instance:
- Convincing county commissioners to contribute more than the minimum per capita contribution to their LPHA. The direct audience for this effort would be the commissioners, but we would also consider the voters who put them there and organizations they listen to as potential campaign targets. This could be a multi-pronged strategy: LPHAs and their partners making direct appeals, presentations at CCI, development of messaging frameworks for local policymaker and community engagement, and op-eds in local papers. Recruiting the National Association of Counties (NACO) to support our message might also be part of the effort.
- Reforming the Public Health Act. Communication tactics for this strategy would primarily target state legislators with direct education and testimony. We could also develop messaging guidelines for advocacy and activist partners, leveraging their communications clout to amplify our own. Such partners could also engage in direct advocacy with legislators’ constituents and such an effort would probably require campaign-style communications tactics, including traditional and social media.
- Initiating a Wellness Trust. This strategy, like Massachusetts’ Prevention and Wellness Trust, is a method of financing prevention with funds from the health care sector. So far, wellness trusts funds have been applied categorically to chronic disease prevention programs both in and outside of governmental public health, but one can imagine a version that bolsters long-term, operational public health funding streams. Their justification is based in language of health care cost reduction, the triple aim, and “population health.” Whether we would choose a ballot or legislative avenue for this, communications tactics would probably focus on the likely opposition: hospitals and other large providers. Hopefully this would not be a contentious effort, but would instead attempt to strengthen current public health-health care partnerships to build consensus around the concept of a wellness trust. We might use the “population health” language they recognize, stressing that a trust would support their payment and delivery reforms already under way. Something like a wellness trust might only happen with the health care partners as an ally, with their better-resourced communications leading the advocacy effort. Learn more about wellness trusts here.
During the symposium, Senator Irene Aguilar, one of the legislative panelists, and Boulder County Public Health Director Jeff Zayach pointed to the 800-pound gorilla riding the elephant in the room: TABOR. Overcoming this obstacle would obviously be bigger than public health. This effort would be about the philosophy of government funding in general, and messages about public health’s value would be just a small part of a large, coordinated campaign. Such an effort would also remind us that we are not alone, that our country’s dwindling social investments has hurt many other sectors like education, human services, and transportation.
From this perspective, there is collective approach to communicating our value, using the concept of infrastructure. Lee Thielen, former Executive Director of CALPHO and part of the symposium’s opening plenary, hinted at this concept by quoting a recent blog in Health Affairs: “At the end of the day, we must acknowledge that public health is part of the vital infrastructure of a modern, secure, economically competitive, and just nation.” Perhaps this simple message can guide us until we have a specific funding-financing reform strategy to support.