SPECIAL REPORT: NC’s destructive disinvestment in public health

Falling public health investments show health is not a priority in N.C.
State leaders can take steps to comprehensively fund the social, economic, and environmental factors that impact health and create equitable systems

By Sydney Idzikowski, BTC Research Assistant; Luis Toledo, BTC Public Policy Analyst; with Suzy Khachaturyan, BTC intern

A 10-year review of public health spending shows that public health funding in North Carolina has not kept pace with the growing population. A new report from the North Carolina Budget & Tax Center (“Falling public health investments show health is not a priority in N.C.”) gives a breakdown of how state investments in the North Carolina Department of Health and Human Services have changed since 2008. It then takes a deeper look at how the state has failed to adequately invest in public health and continues to limit the ability of our local health departments to keep communities healthy, as well as identifies the need to focus on equitable health outcomes to create a culture of health where every North Carolinian can reach their full potential.

Some major takeaways from the report:

• Despite the promise public health shows in improving health broadly and advancing health equity, state investments to the North Carolina Department of Health and Human Services have fallen by 5 percent since 2008. Funding for the Division of Public Health has been cut by nearly a third. Meanwhile, North Carolina’s population has grown by 12 percent. The result is that the state has $92 less per person today than in 2008 even as the threat of new diseases, the opportunity of new treatments, and the growing need to address the social, economic, and environmental factors that influence health become more prominent.
• Counties and local governments are forced to fill funding gaps as state investments in local health departments fail to keep up. Local health departments are hit particularly hard by the lack of public health investments in North Carolina. Between fiscal years 2008-19 and 2015-16 state and federal investments for local health departments have increased by a mere 0.3 percent ($373,000), while county appropriations for local health departments have grown by 19.4 percent ($43.4 million).
• Communities of color and communities with residents living with low incomes still face barriers to good health. The continued lack of investments in public health over the last decade have coincided with insufficient progress on several key indicators for health. Significant health disparities persist in the areas of low birth weight, deaths from heart disease, and childhood poverty. North Carolina can better reduce these gaps by targeting funding to communities that can benefit the most.

The Budget & Tax Center has also released a series of six new infographics documenting funding trends around the specific health areas of older adult health, diabetes, dental health, safe drinking water, infant and maternal health, and substance use.

This is from the report’s introduction:

A healthy population is vital to achieving economic prosperity. Good health is the cornerstone of North Carolina’s success; healthy populations have higher capacities for learning, greater work productivity, and stronger communities. Adequate public investments play an important role in promoting and sustaining health and well-being. To date, “health spending” is often narrowly considered spending on health coverage or access alone. However, the health of North Carolinians actually begins outside of medical settings, where we live, learn, work, and play. Health transcends structural boundaries and intersects with nearly every aspect of our lives.

Making sure that every North Carolinian has a chance at prosperity and success means creating a culture of health that allows all individuals and families to thrive. State leaders can take steps to comprehensively fund the social, economic, and environmental factors that impact health and create equitable systems that ensure all North Carolinians can achieve their highest level of health and wellbeing. One specific public investment that can support these broader goals of improving the health of all communities is a state commitment to public health agencies. These agencies work at the state and local level to ensure that a wide range of protections, information, and services are available to every North Carolinian. It is through these comprehensive services that public health agencies across the state are gaining ground in advancing equitable outcomes in health. Such efforts hold promise, if adequately funded, to address the longtime barriers to success that are disproportionately felt by communities of color and by communities with residents who have low incomes.

Despite the promise that public health shows in improving health broadly and advancing health equity, state funding in this area has decreased. This report gives a breakdown of how state investments in the North Carolina Department of Health and Human Services have changed since 2008. It then takes a deeper look at how the state has failed to adequately invest in public health and continues to limit the ability of our local health departments to keep communities healthy. The report concludes by identifying the need to focus on equitable health outcomes to create a culture of health where every North Carolinian can reach their full potential.

Click here and scroll to page 2 to read the rest of this important report.