With the support of the American Rescue Plan Act (ARPA), the governmental public health workforce is experiencing one of its most significant funding boosts in decades. In addition to financing rapid COVID-19 response functions, the federal pandemic relief package has enabled communities to make vital improvements to their public health infrastructure.
For Ingham County, Michigan, and the Ingham Health Department, we have been investing our ARPA funds into a new community health center, repairs to the local septic system, and reliable broadband Internet, among other needs. Stimulus aid has also been spread among our community partners who are mobilizing to address growing crises in violence and mental health.
Across the country, many health department and county leaders are facing the exciting but daunting task of allocating their ARPA funds within their communities. How should this money be used most effectively when the toll of the pandemic has been so widespread?
In our own decision making, equity has consistently been at the forefront. The Ingham County Health Department has long championed health equity and social justice, and this commitment has deepened in the wake of the Black Lives Matter movement. This ethos extends to how we approach the allocation of stimulus aid. We have been successful by employing an equity- and community-centered process that we hope our colleagues in county and health department leadership also will embrace.
Seeing the Bigger Picture
Everyone in our community has been affected by the pandemic, but understanding who has suffered disproportionate impacts was essential to the funding allocation process. An environmental scan of the hardships experienced by residents of Ingham County shed light on abrupt losses of jobs and incomes, children falling behind in school, shuttered businesses, and mental health crises exacerbated by loneliness and isolation. ARPA funding alone cannot solve these problems, but it can help alleviate suffering.
Our assessment highlighted not only the challenges our community endured but also the opportunities to build on successes. We considered what living, working, and learning in the era of COVID-19 taught us about the investments we should pursue. For example, the pandemic forced us to find new ways to stay connected, making accessible and reliable broadband Internet an emerging priority.
An environmental scan tells the story of a community to help local leadership chart a path forward. This assessment offers a broad view of fallout from the pandemic while also pointing to areas in which county and health department officials can make a meaningful difference.
Bringing Partners Into the Fold
Once we took stock of the disparities among Ingham County residents, we were able to identify our core partners in the funding allocation process. Working alongside a diverse range of community partners, we collected feedback to help us take steps toward restoration and building resilience.
We have had input from county leadership, including the county administrator’s office and commissioners, as well as traditional partners in areas such as housing and other safety net organizations. In addition, community partners at the grassroots level have been invaluable to making these decisions. Throughout the pandemic, we have been in regular contact with these groups to bolster their response efforts. Community-based partners involved in violence reduction and services for people struggling with addiction have given us insights into the issues that have fallen by the wayside.
By inviting a range of voices into funding conversations, we were able to tap into nascent community relationships, including the local business sector. In collaborating with the Ingham County Chamber of Commerce, for example, we developed a better understanding of the issues facing local businesses and were able to be more responsive to their needs.
Talking with community members about the struggles they have faced in the pandemic provides us not only the quantitative data for decision making but also the personal anecdotes to humanize these numbers. We cannot decide and dictate what members of our communities need; we must be continuously listening and learning so that we can make informed choices about where to direct federal funds.
Advancing Shared Goals With Subgrantees
We in governmental public health have until 2026 to spend ARPA stimulus aid. The next 4 years will be marked by ongoing threats to public health, and our time and attention will be spread thin as we take on these challenges. Counties and health departments will be dealing with a massive amount of money to allocate, track, and monitor in addition to ongoing pandemic response activities. This can be made simpler by relying on subgrantees.
The more that your agency can collaborate with subgrantees to get money out to community entities, the better off all parties will be. It is easier to get money to the people who need it with the help of subgrantees who can track how ARPA funds are distributed and report back to health department and county leadership. Although it is the responsibility of officials to ensure that subgrantees are held accountable to their commitments, giving up some of the control makes for a more streamlined process.
Besides being a more efficient way to manage stimulus funds, using subgrantees is a means of putting our values into practice. Promoting health equity requires that we be open to shifting and sharing power, and sharing some of our power with groups that we know can move the needle on community health is a win-win.
As we like to say, “If you’ve seen one health department, you’ve seen one health department”—that is, every public health agency is unique, and in the case of stimulus aid, the priorities for each agency will be different. But no matter how funding is distributed, the process of getting it into communities must be rooted in equity. As we spend down our stimulus aid over the next few years, we will be listening to and learning from our community partners at every stage to ensure we get it right.
This column first appeared in the September/October 2022 issue of the Journal of Public Health Management & Practice. See the final authenticated version.