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THE SURPRISING LINK BETWEEN BUDGETING AND GOOD HEALTH
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Carl Smith
March 22, 2024
Governing
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_ Health outcomes and life expectancy improve in counties where
residents have greater opportunity to engage in civic life. _
Residents of Belle Mina, Ala., wait for a public hearing about
permitting for a rock quarry they believe will cause respiratory
illness in their town. Engagement in civic life is associated with
longer life spans, according to a new report., Scott Turner/TNS
The health department in Tacoma-Pierce County, Wash., is always
looking for ways to improve public health outcomes. To find out what
might work best, the department tried something that might sound
obvious, but isn’t always done. Namely, asking members of the public
for their input about what's most important.
Too often, health officials are prescriptive, coming into communities
they may know little about and applying a standard intervention that
might not match local needs, says Benjii Bittle, director of the
Public Health Centers for Excellence, a partnership between the health
department and the Spokane Regional Health District. “We may have
subject matter expertise, but their lived experience isn’t given its
due in a lot of traditional community engagement practices,” says
Bittle, who has written about participatory budgeting
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journal.
The idea of participatory budgeting — having citizens engage
directly in decisions about how governments spend money — is not
new, but there’s increasing interest in its use in public health. In
addition to informing decisions about specific issues, it fosters
better relationships between health departments and those they serve.
Average life expectancy is three years shorter in communities where
there are barriers to participation in civic life, whether access to
libraries and broadband Internet, deliberations over policy, or
voting, according to a new report on well-being in the nation’s
counties
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from the University of Wisconsin Population Health Institute.
Participatory budgeting stands out among strategies to increase
engagement, says Sheri Johnson, the report’s principal investigator.
One of the early sites for the Tacoma-Pierce County Health
Department's exercises in participatory budgeting was a high school in
East Tacoma with a student population at risk of being shunted into a
“school to prison” pipeline. Male students of color said that the
lack of mirrors in their bathrooms made them feel "invisible and like
they were already in prison.”
More than 1,000 students voted on seven projects drawn from hundreds
of ideas their peers put forward about how to spend $60,000 to improve
health at the school. Voting was hosted by Pierce County Elections and
included printed ballots of the kind used in county elections.
Along the way, students learned about the election administration
process and conducted their own vote count using county equipment.
They decided to go with bathroom improvements. Participation in a
public health decision became a lesson about democracy and voting as a
tool to effect change.
_Students at Lincoln High School in East Tacoma, Wash., had a chance
to vote on how $60,000 would be spent to improve health on their
campus. (Pierce County Television)_
[Life expectancy.jpg]
Shorter lifespans are more prevalent in counties in states
(highlighted) with the greatest structural barriers to civic health.
(CHR&R)
Information Deserts
Participation in civic processes is driven by information. The
Wisconsin institute’s new report shows relationships between health
and the “information environments” in counties, which include
local news outlets as well as libraries. Overall, those living in the
West and Northeast have more access to information, and longer life
expectancy, than those in the South.
The report calls out “digital redlining” by broadband providers
that excludes low-income neighborhoods. Places where the information
environment is less robust also tend to have structural barriers to
civic engagement, such as obstacles to voting or other forms of
discrimination, says Michael Stevenson, a policy analyst at the
institute.
That’s one reason participatory budgeting has promise. It gives
power to groups of people who have historically been marginalized,
giving them the chance to make decisions that affect their lives and
helping to build relationships between them and their governments.
The Tacoma-Pierce County Health Department has been running
participatory budget sessions since 2017, recently involving
million-dollar projects in each of Tacoma’s five city council
districts. To ensure wider participation, materials were translated
into nine languages other than English. The turnout rate was higher
than for the county's general election, with thousands of residents of
Vietnamese heritage voting for the first time.
Bittle would like to see participatory budgeting used in public health
on the national stage. As excited as he is about its potential, he
acknowledges some downsides. Such efforts can move slowly — at the
“speed of trust,” as Bittle puts it. They are also time- and
staff-intensive.
Elected officials tend to offer bipartisan support for putting
decisions about public funds in the hands of community members, but
administrators can be less enthusiastic about diverging from
traditional ways of doing things. “There’s a lot of removing
obstacles and talking to people to create the critical path,” Bittle
says. “All of that work takes a lot of nuance.”
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* Participatory Budgeting and Health Outcomes; Tacoma-Pierce County
Health Department;
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