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August 16, 2021
Kara Odom Walker
Christopher F. Koller
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Almost 18 months after COVID-19 first appeared, states are reflecting on their priorities and considering opportunities to rebuild. Thanks to American Rescue Plan Act (ARPA), unprecedented funds are flowing to support state and local needs, including housing, education, food insecurity, health workforce, and public health and preparedness. (See table.) For already harried state governments, this federal largesse poses administrative and political challenges to quickly plan and spend these dollars in ways that placate stakeholders, meet federal timelines, and minimize ongoing state obligations.
The COVID-19 pandemic should serve as a sober reminder, however, that using these funds for a variety of one-time investments will not get us closer to a more equitable and healthier future. To improve population health, we need to envision a future where health services are whole person–oriented and all communities are engaged. ARPA funds give us a chance to put this vision to work.
According to the US Department of the Treasury, interim final rule on ARPA, one of the goals of the Coronavirus State and Local Fiscal Recovery Funds is to “address systemic public health and economic challenges that may have contributed to more severe impacts of the pandemic among low-income communities and people of color.” The Department of Treasury’s guidance gives states the flexibility and the opportunity to reduce their most persistent health inequities.
When taking this on, states should consider using ARPA funds within a population health framework. Evidence clearly points to the positive impacts that increased access to community health, behavioral health, and social services have on population health. In addition, investments in education and early childhood care may pay off in in long-term health and socioeconomic status.
Expanding community health teams. To mitigate the impact of COVID-19, these funds can be used to ensure that vaccination programs include COVID-19 vaccinations, that community health resources are data-informed and guided by gaps in need, and that capital investments are established. Additionally, state leaders can use this moment to train new contact tracers to address COVID-19 and serve as a “ready-to-hire” workforce for community health teams. With ARPA funds, these teams can be connected to a data infrastructure and become a population health resource.
Enhancing behavioral health services. The ARPA funds are also dedicated to improving behavioral health services, as the demand for them has increased with pandemic-related stress. Bolstering the behavioral health workforce and investing in access to mental health treatment not only allows us to address the crisis in front of us but will also alleviate the long-term impacts of adverse childhood events, substance abuse, and trauma. States may also invest the funds in improving access to integrated health and social services. If every state-deployed funds for navigating the social drivers of health, this upfront investment would position state health systems well for moving toward paying for health (rather than sickness) and supporting the social needs that can drive poor health outcomes and lead to “deaths of despair” from suicide and substance abuse.
Reducing child poverty. Relatedly, ARPA is estimated to cut poverty by one-third and, thanks to its expanded child tax credit, reduce child poverty by half; this reduction is four times greater than ever achieved in a single year. The first half of the year’s credit is being delivered in monthly payments to families via direct deposit, with the remainder coming as a tax refund next year. This investment may help boost educational outcomes, social supports, and access to early care and education. It may also affect life expectancy: the higher a person’s educational attainment, the longer their life expectancy.
Administrative and political challenges remain. States need a way of tracking and coordinating all the funds available across federal and states agencies. Procurement systems — built to ensure integrity — can stifle nimbleness, waste time, and doom valuable new relationships with partners from marginalized and disempowered communities. Legislatures concerned about having their policymaking authority usurped need to build trusting relationships with their executive branch counterparts.
Prioritizing spending in these areas will create a new generation of healthy Americans. Although this legislation alone isn’t sufficient to overcome generations of inequities and underinvestment in public health, it is a strong start. Ongoing work will be needed, but let’s start with the end in mind: to improve health and take on the social, economic, and racial inequities that underlie our challenges to create a healthier America.
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