Time is now to invest in public health infrastructure

We have all been hit hard by this pandemic, some of us especially so: health workers who are putting their lives on the line despite a lack of masks, gowns, and other personal protective equipment; low-income, immigrant, and communities of color who don’t have adequate health care or paid sick days, and who are working essential jobs; and youth who can’t access critical necessities like food and health care at their schools.

As a state, we are fighting this pandemic with a hand and a foot tied behind our backs. Decades of disinvestment in public health infrastructure has weakened our public health system, making this crisis even worse.

According to Governing magazine, over the past two decades, corporations have doubled their profits but contributed increasingly less to state revenues.

According to reports from Trust for America’s Health, between 2008 and 2017, the budgets of local health departments have shrunk by as much as 24%, the CDC’s budget remained flat, and local health departments nationally have eliminated more than 50,000 jobs.

In California, spending on our state public health department has plateaued since the Great recession. Local health department officials across the state reported to the LA Times that widespread budget cuts meant fewer trained staff to track cases and work in labs. Indeed, 11 local public health laboratories have closed, in part due to budget cuts, over the past 15 years.

Meanwhile, according to Governing magazine, over the past two decades, corporations have doubled their profits but contributed increasingly less to state revenues. The Trump Administration’s 2018 tax overhaul gave more than $1.3 trillion in cuts to corporations, whose tax rate dropped from 35% to 21%. In contrast, everyday wages (accounting for inflation) have not experienced any trickle down effect — purchasing power is the same as 40 years ago and the vast majority of wage gains have mostly flowed to the highest-paid corporate executives.

This shift in investment has left many of us more vulnerable to this pandemic. Los Angeles County’s available data shows that 14% of those who have died from COVID-19 are Black while they only represent 9% of the County’s population. To be clear: this is not any individual’s fault. Our long history of structural racism and disinvestment has led to Black people, and other communities of color, being less likely to have healthcare access, disproportionately represented in jobs with fewer benefits and higher risks of exposure, and more likely to have pre-existing medical conditions that stem from inequities in wealth, housing, and education.

The social and economic conditions on which this novel coronavirus lands aren’t new themselves — they have been entrenched in our lives for decades. And, in this moment of crisis, our systems are unable to scale up to respond effectively and people are left far more vulnerable to the virus and its aftereffects.

Improvements in health require significant investment in the social, economic, and environmental conditions that keep us healthy. The Schools & Communities First initiative, which would invest $12 billion dollars per year in our critical local services and schools, is an opportunity we have in California to do this.

Schools & Communities First is a November voter initiative that j   just submitted a record 1.7million signatures of support to qualify for the ballot and would invest in things we all value: healthy families, safe neighborhoods, and good schools.

For example, based on a 2018 analysis by our organization, if the initiative passed, Los Angeles County could build affordable housing for at least 44,000 people, cover the costs of 48,000 people to receive healthcare at community clinics, and connect 1,750 people with mental health or substance abuse support. As the county faces a looming budget crisis, the initiative means more support for our public health workers, teachers, and all those other heroes on the front lines — and every county in the state would benefit.

We simply can’t afford corporate tax loopholes at the expense of these investments in our health and well-being. Public health claims just 3 cents of every health dollar spent in the country. Meanwhile, corporations in California are using a property tax loophole to avoid paying their fair share and resources are being drained from community health clinics, emergency responders, and schools.

Now more than ever, we need to reclaim these resources, and provide the support that our local officials and communities need. Let’s come together in this most turbulent time to invest in Schools & Communities First — in the infrastructure we’ve sorely lacked for the past 40 years to achieve healthy, thriving communities.
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Editor’s Note: Lili Farhang is co-director of Human Impact Partners, a national public health research and advocacy non-profit based in Oakland.