Death by a Thousand Budget Cuts

Public funding for local health departments (LHDs) is flat or declining, and few indicators suggest this trend is improving. Almost one-fourth of LHDs (23%) reported a lower budget in 2014 than the prior fiscal year, and more LHDs (27%) expect budget cuts to continue into the next fiscal year.1 These financial conditions force local health boards and health officials into the unenviable position of reducing their workforces and critical services. Since 2008, LHDs have eliminated 51 700 jobs because of layoffs/attrition due to hiring freezes or budget cuts; LHDs reported 3400 jobs lost in 2014 alone.1 Each budget cut erodes the ability of LHDs to serve their communities.

Measuring the value of population health interventions is challenging, with limited funds for research and evaluation. Many LHDs have difficulty clearly articulating returns on investments for taxpayer-funded public health programs. Underresourced public health advocacy efforts ensure that lawmakers remain uninformed of, or worse, unimpressed with, the value and necessity of public health services. Public health programs and safeguards, which are often unseen until there is a crisis or publicized threat, have become easy prey for deficit hawks.

The journey of death by a thousand budget cuts has already claimed tens of thousands of jobs and hundreds of critical community programs. The governmental public health workforce is not just deciding how to make do with less; it is struggling to sustain essential infrastructure. Senior practitioners realize they may pass on a public health system that is in worse shape than when they inherited it.

What if there were another way? What if, instead of being casualties of budget cuts and bystanders to the swings of the political pendulum, public health started carving its own path? What if private support could replenish dwindling resources? What if advocates who believe strongly in the value of the public's health invested their resources to advance the human condition?

Foundation for the Public's Health

The National Association of County & City Health Officials created the Foundation for the Public's Health to attract private support to the LHDs serving more than 220 million Americans. The Foundation's mission is to link the humanitarian aspirations of donors with critical needs in their communities. With the support of public health practitioners, corporate America, forward-thinking foundations, and individual donors, sourced locally and regionally and distributed locally and regionally, the Foundation will create a new, sustainable model of support while building a public health culture of philanthropy.

Launched in July, the Foundation focuses its work in 3 main areas: (1) community initiatives; (2) philanthropy and partnerships; and (3) strategy and sustainability. Under the community initiatives program, the Foundation works with LHDs to identify their communities' most pressing concerns, build local coalitions to design and implement locally integrated public health projects, and raise awareness and money to support project implementation. The Foundation's work in philanthropy and partnerships entails educating donors and other foundations about how their money can support the critical work of LHDs. The strategy and sustainability function of the Foundation provides counsel to help build LHDs' fund-raising capacities. These fee-based services help LHD leaders evaluate fund-raising opportunities, strengthen their communication methods, and learn effective techniques for writing grant proposals.

Making a Case for Support

Some people believe philanthropists do not support health departments because governments fund health department programs; however, fire and police departments, public schools, and public hospitals have been raising philanthropic dollars for decades. Besides the Robert Wood Johnson Foundation and the de Beaumont Foundation, only a handful of individuals, private foundations, and corporations support public health. There is not more private support for public health in part because the field is not asking for it.

Governmental public health has a compelling case for support because it sustains the health of thousands of communities across the nation. Philanthropists will not support public health for their own sake; they will support public health programming for the millions of people who will benefit from it. To attract the interest of private donors, health departments must improve their ability to show the value of their work through the individuals they help.

Stories form the basis for a culture of philanthropy. Stories connect staff, beneficiaries, and donors in a way that facts and figures never will. When communicating about their work, many public health practitioners focus on systems, inputs, and outcomes but less on people. The adage in fund-raising is that "people give to people." Perhaps, a bit simplistic, but individuals will only support an organization's work if they feel the people who will benefit from it.

So, how do LHDs effectively tell their stories? Ask questions of community members and the program staff who provide direct services. Ask a variety of questions among different segments of the community to find compelling stories that describe how people benefit from the work of health departments. Once health department leaders discover the stories, they should share them with their staff to build a common vision.

In addition to amplifying their message through stories, LHD leaders and staff should develop the following characteristics throughout their organizations to begin building a culture of philanthropy:

* A willingness to fully engage with staff, communities, and donors.

* A willingness to learn and educate colleagues about the benefits of giving.

* An understanding that everyone who works in public health is an ambassador to the philanthropic world.

* An appreciation that philanthropists are stakeholders in public health.

* An understanding that people give because of the needs an organization fills, not the needs it has.

* An understanding that donor capacity does not equal donor interest.

* An understanding that authentic stories will help build a shared vision.

* An understanding that philanthropy is strategic and personal.

A Better Way of Doing Business

Building a public health culture of philanthropy means public health practitioners are willing to partner with individuals and organizations to find better ways of doing business. It means LHDs are willing to admit that they lack all of the resources they need. Governmental public health needs a new model of support to meet the immense tasks of preventing, protecting, and promoting the public's health.

Philanthropy is not a substitute for government funding. Public health is and should remain a government function. Philanthropy can provide supplemental funding for critical programs that are unable to meet the full demands of the communities they serve. Health departments can quickly deploy philanthropic dollars to address budget gaps, initiate pilot projects, and fund innovation. They can use private donations to advocate for additional government funding of LHDs. They can also use philanthropic funding to help raise public awareness of the benefits of governmental public health in their communities.

Isn't it time for LHDs to be recognized for the vital role they play in the lives of all Americans? Isn't it time LHDs be able to rebuild the critical infrastructure, workforce, and programs they have lost over the last decade? Isn't it time to turn philanthropists into public health advocates?

Learn more about how the Foundation for the Public's Health is building on the promise of public health at https://tfph.org/.

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