Top Issues of 2023 Session: Public Health Modernization and Funding

Elected officials embark on the 2023 legislative session to consider local health department funding that is consistent with a 15-year old, pre-opioid, pre-pandemic budget.

Public health funding and resources have long been a legislative priority of MACo. But now, in the wake of the pandemic, it seems the attention might finally be in place to move the legislative needle. In the 2022 Issues Paper published by the Department of Legislative Services (DLS), there are citations of multiple reports calling for the modernization of and investment in public health resources.

As a precursor, public health was defined in the report as “what we as a society do collectively to assure the conditions in which people can be healthy.” This is comprised of five foundational areas that are managed by local health departments:

  • communicable disease control
  • chronic disease and injury prevention
  • environmental public health
  • maternal, child, and family care
  • access and linkage to clinical care

Multiple studies have found that public health factors – including healthy behaviors, social and economic conditions, and the physical environment – contribute far more to health and well-being than clinical care. This is a profound reality and juxtaposition to consider alongside the numerous complications that were both exacerbated and illuminated by the pandemic. Studies have shown Maryland with an increase in reported anxiety and depression, a continually poor national ranking in drug use overdose despite some improvements, and community disparities related to physical and mental health, such as access to healthy food, safe and affordable housing, and affordable medical care.

Major weaknesses appeared at the national, state, and local levels around collecting and sharing data, insufficiency maintaining a qualified workforce, and lack of effective collaboration across governmental tiers as well as private and public resources. Even in areas where mental health services were both enhanced and expanded, the resources did not keep pace with demand. In response to similar findings some states have begun an audit and modernization process such as Indiana, Massachusetts, Michigan and Missouri to name a few.

County Impacts

Both the Bipartisan Policy Center’s Report on Public Health Modernization and the Commonwealth Fund Commission on a National Public Health System outlined strategies in the DLS report. The major takeaway was a call to provide flexible and stable funding to state and local health departments to establish and maintain foundational capabilities to protect citizens. Similar to podcast discussions and previous coverage on the Conduit Street Blog, the DLS paper acknowledged the shared funding concerns expressed by MACo. Not only did the pandemic expose challenges in the State related to data collection, workforce, emergency laboratory capacity, and other core functions, but the erosion of funding for local health departments was categorically outlined to draw even greater attention to a long-standing problem that depleted the public health infrastructure leading into the pandemic.

For background, Core Funding for local health departments is established through a statutory formula. In 1997 a minimum funding level was set with subsequent increases based on inflation and population growth. Between fiscal 2008 and 2010, significant cuts were made to the public health formula bringing the core funding number below even the established minimum from 1997, now 25 years ago. This seismic shift sent Maryland’s public health infrastructure into the 2020 pandemic with funding that was potentially sufficient more than two decades before the crisis hit.

While the State budget for fiscal year 2023 made some discretionary enhancements, it only proved to match the funding of fiscal year 2008, now some 15 years prior to the reality of public health today. The state is now saddled with a public health budget that preceded the COVID-19 crisis, the opioid epidemic, the mental health crisis, record inflation, and significant workforce changes. These numbers represent a significant opportunity for legislators to redo the math in the interest of, “assuring the conditions in which people can be healthy.”