Summary

The Preventive Health and Health Services (PHHS) Block Grant (Block Grant) continues to offer public health leadership a major lever to promote health and ensure the delivery of essential public health services. This column describes reasons why public health leaders must maintain strong participation in defining and communicating the collective and localized benefits of this flexible funding program for prevention.

Background

For the past 35 years, the PHHS Block Grant has been a bedrock federal program at the Centers for Disease Control and Prevention (CDC) that enables all 50 states, the District of Columbia, 2 American Indian tribes, 5 US territories, and 3 freely associated states in the Pacific to address unique public health needs using innovative state and community-driven strategies. The Block Grant is intentionally structured to provide grantees with funding they can use to address state and local emerging health issues or to "fill funding gaps in programs that deal with leading causes of death and disability."1 For public health leadership, this type of funding is critical to fulfilling CDC's 10 Essential Public Health Services, chief among which are to "monitor health status to identify and solve community health problems; diagnose and investigate health problems and health hazards in the community; inform, educate, and empower people about health issues; and mobilize community partnerships and action to identify and solve health problems."2

Evaluating the Collective Benefits of the Block Grant

The PHHS Block Grant has been vulnerable to criticism for a lack of accountability and limited ability to demonstrate collective impact. By design, the grant provides customizable funding to address grantee-defined priority health needs. While this flexibility is deemed valuable by grantees, it poses unique challenges to evaluation and reporting on the collective benefits of the grant. The Association of State and Territorial Health Officials is among several national public health organizations that are actively working with the CDC to identify feasible and meaningful approaches to increasing the evaluability and accountability of the grant. Informed by evaluability assessment methodology, the CDC has initiated a plan to improve the programmatic focus, evaluation, and reporting of PHHS Block Grant services, projects, and activities. Accomplishments to date include engagement with national partners and the field, conducting rapid exploratory assessments, and standardizing reporting of grantee funding allocations and individual accomplishments in key program areas. This important work is already increasing the transparency of the program and our understanding of how Block Grant funds are invested.

Communicating the Local Benefit

Public health leaders must also continue to describe the ways state-directed funding benefits their specific populations. Many communication tools are available for public health leaders to promote the value of the Block Grant. The CDC and organizations such as the National Association for Chronic Disease Directors have been compiling success stories by jurisdictions that describe the wide variety of ways the Block Grant has made a difference. The Office of Oral Health of the Massachusetts Department of Public Health created a partnership with the Better Oral Health for Massachusetts Coalition and the Massachusetts League of Community Health centers with the goal of increasing fluoridation across the state. The partnership has so far upgraded 7 community water systems and monitored an additional 140 for fluoridation levels. High-level champions in Oklahoma have made preventing prescription drug misuse and overdose a priority because more overdose deaths involve prescription painkillers than methadone, heroin, and cocaine combined. A cross-sector workgroup led the development of a comprehensive state plan to combat prescription drug overdose, and several other legal and administrative protections have been put into place that make it harder to accidentally overdose on opioid painkillers in Oklahoma. The Block Grant provided critical support to Massachusetts and Oklahoma as they made these health outcome and policy improvements.

In fact, health departments may be uniquely positioned to take a historical perspective on their Block Grant investments and report on how their initial Block Grant investments have flourished. For example, in 2003, Vermont's Department of Health directed a portion of its Block Grant to seed an evidence-based model for chronic disease self-management that eventually became a central feature of Vermont's health systems' transformation process. Arguably, this seed funding built a foundation for Vermont's Centers for Medicare & Medicaid Services demonstration project, enabled a statewide expansion of Vermont's Blueprint for Health, and led to cost savings from decreased hospital admissions and emergency department visits.3 Stories such as these demonstrate the importance and long-lasting influence of the Block Grant on the health of our nation's communities.

Conclusion

So much public health funding continues to be directed at specific programs or services; the Block Grant is the type of customizable funding that is indispensable for states and communities, allowing them to direct the funding where there is the greatest need or can do the most good. Despite constrained federal budgets, Congress has continued to support and expand this important funding mechanism in the annual appropriations process. There is a great need and responsibility for public health leaders at all levels-federal, state, and local-to demonstrate how states and communities use the Block Grant to improve the health and wellness of the constituents they serve. Developing and using success stories is one powerful tool.4,5 Block Grant coordinators can help articulate the strategic value when Block Grant funding is used to build the capacity across many different areas of public health. States, communities, and public health organizations have been able to develop some of these important messages, but the need for them is extensive and ongoing. Another important messaging tool, and one that does not exist currently, is for leaders at the federal level and at public health organizations to formulate metrics that demonstrate the collective benefit of state and local initiatives at the national level. The Block Grant has been put to a wide variety of wonderful and productive uses. It is vital for the public health community that we articulate how the funding has been used and what far-reaching outcomes have resulted.

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