Arizona ranks nearly worst in the nation when it comes to per person spending on public health, according to data compiled by researchers at the University of Minnesota.
Arizona spent approximately $9 per person for state public health funding in 2017, according to a data analysis done by the State Health Access Data Assistance Center, or SHADAC for short.
SHADAC is associated with the University of Minnesota’s School of Public Health.
Nevada and Missouri are the only states that spend less, with Nevada spending $7 per person and Missouri spending $6.
The data compiled by SHADAC goes back to 2005 and shows how the Great Recession sharply cut health care spending.
In 2007, Arizona was spending $20 per person. Over the next four years that number would diminish every year until it reached its lowest point of $8 per person in 2011.
The number inched up by one dollar in 2015, where it has remained since.
“There are ways Arizona could increase its standing,” Will Humble, Executive Director for the Arizona Public Health Association and former Director of the Arizona Department of Health Services, told the Arizona Mirror.
The elephant in the room
Arizona is doing decently in one respect to healthcare funding, according to Humble.
Federal funds are a steady source of revenue for Arizona’s Department of Health Services, and when combined with dollars spent by the state, it raises the average dollar amount spent per person to be more in line with the national average, Humble said.
However, there is an “elephant in the room” that Humble said can harm those dollars.
Many state agencies are still coping with recession-era austerity measures, including hiring freezes and hiring caps. That means agencies, such as AZDHS, are limited on what federal grants they may be able to apply for, given the limited staff, Humble said.
Strategically applying for federal grants is about the best thing agencies could be doing to combat issues with state spending but if the agency lacks the appropriate staff or are having to prioritize them elsewhere it can tie their hands, Humble said.
In 2018, AZDHS received approximately $250 million in federal funding, a decrease of about $50 million from previous years. The $50 million decrease was in federal behavioral health funds, which the state took on when they transferred those services from the Arizona Department of Health Services to the Arizona Healthcare Cost Containment System.
“It’s not because we are sucky grant writers,” Bob England, interim director of the Pima County Health Department and former Maricopa County Health Department Director, told the Mirror.
England said Arizona public health entities are generally not as competitive due to the fact that they lack the programs that they are applying to get funding for.
“Most programs are not interested in funding from the ground up,” England said.
While England was working for Maricopa County, he found that per-person federal funds were also not as high as the national average.
Specifically, England found that, in 2010, federal funding per person on public health in similar metro areas was around $21. In Maricopa County, it was just $7.
There is another factor that both Humble and England agree can cause issues with public health funding as well: politics.
‘A divided government’
Humble said change is unlikely to happen until a specific set of circumstances are met.
“I don’t see it happening until we have a divided government,” Humble said. As Humble sees it, having the executive and legislative branches of Arizona’s government under one-party rule has created an inability to battle over differing budget priorities such as healthcare.
Since 2009, the Republican party in Arizona has controlled the governor’s office and legislature.
Prior to 2009, budget talks between then Gov. Janet Napolitano, a Democrat, and the Republican-led legislature would often lead to deals that would become beneficial to public health funding.
“When you don’t have divided government and tensions between the branches, you have less leverage,” Humble said.
For England, it’s not about having a divided house, it’s about helping people understand the good public health can create.
For example, England recalled a conversation he had with an unnamed lawmaker.
He was discussing the benefits of herd immunity, the scientific principle that, when the majority of the population is vaccinated, the resistance to a contagion is higher.
The lawmaker understood how it worked, but stated that it was “a shame” as “no one should be able to reap the benefits of the actions of someone else.”
“It’s just a fundamentally different way of seeing the world,” England said, adding that finding ways to come together and address the different world views while discussing public health is key.
“It’s about all of us. We ought to be able to find ways to come together on this,” England said.