Want to Improve Health and Equity? Take a Look at Your Budget

When you think about budgets, the first images that come to mind might be spreadsheets, calculators, and maybe a pie chart or two. Not exactly the instruments of modern medicine. But budgets are actually one of policymakers’ most important tools for improving health and advancing health equity.

Of course budget decision around Medicaid and public health programs are crucial for health, but other areas of the budget also shape health—and which communities have opportunities to be healthy—in profound ways. In fact, researchers have identified connections between higher state and local investments and improved health across many areas including education; transit and transportation; fire and police; water, sewer, and waste management; parks, recreation, and libraries; housing; and even unemployment insurance. States with a higher ratio of spending on things like education, income support, and housing relative to their spending on health care report better health outcomes (like lower infant mortality rates and lower rates of death from heart attack, lung cancer, and type 2 diabetes).

So, what does this have to do with the City Health Dashboard? The Dashboard data illuminate health outcomes for the 500 largest U.S. cities, as well as how those outcomes differ across parts of the city and among racial/ethnic and age groups. Understanding these variations can be a helpful starting point for community leaders and policymakers who want to identify and prioritize policy changes needed to improve health and health equity.

Zooming in on Lansing, MI

Let’s take a look at the Dashboard data for Lansing, Michigan, my hometown. Lansing is a mid-sized state capital, with just over 115,000 residents. It’s home to a minor league baseball team, the Lansing Lugnuts; Potter Park Zoo (a favorite spot of mine since as early as I can remember); two General Motors manufacturing plants; and it was the birthplace of the Oldsmobile.

While the city has a lot to offer, it can improve in areas that are critical determinants of health, like education, povertym and health insurance. The Dashboard data show that:

• Third-grade reading proficiency is just 26.4%, far lower than the 46.2% average across Dashboard cities.

• The child poverty rate is 41%, nearly twice the average of 22.6% across Dashboard cities. The variance in rates within the city ranges from below 10% in some parts to 75.9% in others. The child poverty rate also varies by race/ethnicity, with far higher rates among children identified as Black or of a race other than Asian, White, or Hispanic.

• The non-elderly uninsured rate is better than the average among Dashboard cities, but still ranges from single digits in some parts of the city to more than 20% in other parts.

                                                       Lansing, MI: Children in Poverty

Discrete initiatives and interventions like disease prevention and health promotion programs—especially when they are led by members of the affected communities—are valuable and should always be part of the solution. Cities also need to consider the role of structural forces, like their budget and their state’s budget, in shaping health outcomes.

So what could state and local policymakers consider to help Lansing improve on some of the measures mentioned above?

• Deeper investments in quality early childhood education may improve reading proficiency, high school graduation rates, and other health and economic outcomes later in life.

• Increasing the state’s earned income tax credit (currently refundable and set at 6% of the federal credit) and making it available to more workers is a proven way to increase economic stability and is linked with improved maternal and child health outcomes. Policymakers could also consider increasing economic security for low-income families by increasing the minimum wage, promoting scheduling stability, and enacting paid family leave and paid sick leave policies, all of which could reduce child poverty.

• Investing in community-based outreach and partnerships as well as enrollment assistance could help more residents eligible for affordable health coverage to enroll. The state could also consider creating a reinsurance program to reduce premiums for private insurance sold through the individual market.

By increasing opportunities for all residents to have a high-quality education, economic stability, and access to health coverage, the city would also be taking steps to disrupt systems that have historically held back communities of color and low-income people. Those are steps that would really make this Michigander #LoveLansing.

Jennifer Sullivan, MHS is a Senior Policy Analyst at the Center on Budget and Policy Priorities, where she where she directs efforts to improve population health and advance equity through better state budget and tax policies.