By Mukti Kulkarni, MD, NACCHO Prevention Health Policy Resident

With so many fiscal challenges, how can local health departments secure sources of perpetual funding for their vital work in advancing population health? On October 19, the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Population Health Improvement convened a workshop on Building Sustainable Financing Structures to help answer that question. During the meeting, leaders from public health and other sectors explored and presented examples of innovative financing arrangements to enhance participants’ fiscal knowledge.

Throughout the meeting, participants continually highlighted the need to collaborate with other fields to build sustainable financing mechanisms, and the challenges and opportunities this need presents. While several participants recognized that disjointed systems of knowledge and governance in the U.S. make collaboration more difficult, there was consensus around the need for multi-sectoral cooperation to combine resources to address social determinants of health and health inequity – a message consistent with the Department of Health and Human Service’s Public Health 3.0 recommendations. The following suggestions emerged for public health practitioners seeking to work collaboratively:

• Think and speak broadly about health. Communicate the concept of health as a resource for everyday life to demonstrate the relevancy of public health initiatives to other sectors, politicians, and the public.
• Consider how public health research and policy can include other disciplines, in addition to advocating for “health in all policies.” Become familiar with the language, goals, and outcome measures of other sectors (e.g., education, housing, clean energy) to identify co-benefits and opportunities for collective problem-solving. Adapt public health efforts for mutual benefit in order to pool resources and holistically promote community well-being.

Roundtable members who are already engaged in efforts that reflect the above suggestions shared real-world examples of how these types of innovations can work:

• Raphael Bostic and Anthony Orlando of the University of Southern California opened the workshop with a historical review of four initiatives that used different institutional and financial structures to address social determinants of health.
• Elizabeth Lyon of the Council on State Governments Justice Center presented the Justice Reinvestment Initiative (JRI), a contemporary criminal justice program that uses data and public-private partnerships to reduce spending while promoting public safety.
• Judge Steven Teske illustrated how JRI is working in Clayton County, Georgia to restructure their juvenile justice system, incorporate evidence-based interventions that address underlying causes of juvenile offenses, and reinvest savings to support youth and families. Judge Teske highlighted strategies that have enabled the success of JRI in Clayton County, and can be applied to population health initiatives:
  1. Identify a champion, either a person or a group, who can convene stakeholders.
  2. Adapt evidence-based best practices into algorithms that address the issue of concern, and formulate interventions using compromise and consensus, instead of majority rule or other processes.
  3. Plan an incremental implementation approach that includes oversight and quality control.
  4. Formulate a sustainability plan involving key stakeholders.
  5. Use public relations to generate political will.

The third session featured panelists with experience in clean energy financing. Michael Bodaken of the National Housing Trust described how they financed solar panels in affordable housing units across their portfolio, using an innovative combination of funding sources. Investing in renewable energy has reduced operating expenses and allowed the organization to sustainably offer affordable rental housing. Holmes Hummel of Clean Energy Works presented an inclusive financing model called Pay as You Save® that allows all customers to access efficient energy upgrades using a system that benefits customers and utility companies. Joel Rogers, law professor at the University of Wisconsin-Madison, spoke of the parallels between population health and clean energy financing, including the inequitable distribution of costs, and opportunities for both sectors to benefit from one another.

Finally, ReThink Health Director Bobby Milstein drew upon lessons from the energy sector to point out that anything of value can be financed, and that waste represents an opportunity to improve efficiency and generate value. He urged population health strategists to identify such opportunities while aligning appropriate institutional and financing arrangements. To assist with the process, he presented a “menu of financing structures” organized by dependability. This broad array of funding mechanisms ranged from the less-sustainable grants and donations to the more-sustainable taxes, trusts, community wealth building, and commercial markets.

While there’s much more work to be done to identify and create sustainable funding for improving population health, this roundtable meeting demonstrates that this issue is on the radar of leaders from public health and other sectors. To learn more about building sustainable financing structures to improve population health:

• View the attendee packet and watch session recordings from the National Academies meeting
• Visit the National Academy of Sciences, Engineering, and Medicine’s website.
• Visit the Public Health Financing page of the NACCHO website.