Building Sustainable Financing Structures for Population Health Insights from Non-Health Sectors: Proceedings of a Workshop (2018) / Chapter Skim
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2 Sustainable Financing Structures for Population Health: Historical Patterns and Insights for the Future
2 Sustainable Financing Structures for Population Health: Historical Patterns and Insights for the Future
Pages 7-18
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From page 7... ...
Session moderator Debbie Chang, the senior vice president of policy and prevention at Nemours Children's Health System, said that these are examples of existing structures that have the potential to be effective for population health and that new financing structures are not necessarily the solution. (Highlights are presented in Box 2-1.)
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From page 8... ...
• ealth is often a side benefit of policy programs in other sectors. Partnering H with others who are interested in solving non-health problems offers a better chance of getting funding requests approved by Congress, city councils, etc.
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From page 9... ...
Orlando highlighted two key events, one at the state level and one at the federal level, that catalyzed the change. At the state level, thenGovernor Ronald Reagan created the California Air Resources Board (CARB)
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From page 10... ...
Participating residents were assigned by lottery to one of three groups: a group that received housing choice vouchers and were required to use them to move to a low-poverty neighborhood; a group that received housing choice vouchers to use wherever they chose, with no restrictions; and a control group that stayed in public housing and did not receive any vouchers. Orlando noted that a complex issue in the context of housing choice vouchers is that people often choose to stay in the same highpoverty neighborhoods.
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From page 11... ...
One of the more successful housing interventions was the Healthy Homes Initiative, launched in 1999 by HUD. The initiative awarded federal grants to state and local governments to create their own programs to reduce household hazards -- in particular, to reduce children's exposure to lead in homes.
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From page 12... ...
From a financing perspective, Harlem Children's Zone is a typical charter school in the sense that it has city funding. It is also a public– private partnership, and like many high-achieving charter schools, it receives significant funds from private foundations, including the Gates Foundation and other education reformers.
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From page 13... ...
Orlando also noted the need to define the set of secondbest solutions and not just the ideological "big idea." Politics is a matter of compromise, and securing the political will requires people who are willing to compromise and work toward achievable solutions. Applying an Equity Lens Chang pointed out that the roundtable applies an equity lens to all of the population health topics it considers, and she asked what the examples suggest is needed to adequately address equity issues.
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From page 14... ...
For example, in addressing the air quality conditions in the immediate Los Angeles area, the trucking industry and industrialization moved further up toward the mountains, and now places in the Inland Empire Riverside– San Bernardino area have tremendous air pollution issues. With regard to people's ability to move to opportunities or change communities to improve themselves, there have also been considerable challenges related to gentrification and neighborhood change.
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From page 15... ...
Orlando agreed and said that, for example, charter schools are often very controversial in these neighborhoods, in part because residents feel that outside foundations are coming in and telling them how to run their schools and not asking for the input of the local communities. He stressed that it is important to take into account what people's actual desires are in the affected communities.
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From page 16... ...
Bostic briefly described how housing vouchers work, including the percentage of a recipient's salary to be contributed to housing cost and the government portion that is added, up to a calculated fair market rent. He added that there is a proposal out for comment to change how the fair market rent is calculated (based on smaller zip code areas, rather than an entire metropolitan area)
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From page 17... ...
Orlando did caution that the spending cited by Kottke mostly captures health expenditures that are not social determinants (i.e., elements of the medical system)
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From page 18... ...
One of the biggest challenges, particularly in addressing the social determinants of health, Bostic said, is a lack of binding long-term enforcement mechanisms. In some cases, for example, individuals at the city and the county level might have an agreement that the one who reaps the savings will transfer some money back to the one who spent.
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