The Tacoma-Pierce County, Washington, Health Department is always looking for ways to improve public health outcomes. To find what works best, the department tried something that may sound obvious but isn't always done. That means asking the public for their opinion on what matters most.
Benji Bittle, director of the Center for Public Health, a partnership between health officials and the city of Spokane, said health officials are too often prescriptive, stepping into communities they know little about. They say they apply standard interventions that may not suit local needs. Community Health District. “We may have subject matter expertise, but many traditional community engagement practices do not give due recognition to their lived experiences,” she told the journal Public Health. says Bittle, who has written about participatory budgeting.
Although participatory budgeting, the idea of citizens directly participating in decisions about how government funds are spent, is not new, there is growing interest in its use in public health. It not only informs decision-making on specific issues, but also fosters better relationships between health departments and the people they serve.
A new report from the university on the well-being of counties across the country finds that life expectancy is three years lower in areas with barriers to participation in civic life, such as access to libraries and broadband internet, policy deliberation, and voting. It is said to become. from the Wisconsin Population Health Institute. Sheri Johnson, the report's lead researcher, said participatory budgeting stands out among strategies to increase engagement.
One of the Tacoma-Pierce County Health Department's early exercise sites for participatory budgeting was an East Tacoma high school that serves students at risk of being pushed into the “school-to-prison” pipeline. Male students of color said the lack of mirrors in bathrooms “makes you feel like you're already in prison because you can't see.”
More than 1,000 students voted on seven projects drawn from hundreds of ideas submitted by their colleagues on how to spend $60,000 to improve school health. The voting was hosted by the Pierce County Elections Department and included printed ballots of the type used in county elections.
Along the way, students learned about the election administration process and conducted their own vote tabulations using county equipment. They decided to make improvements to the bathroom. Participating in public health decisions taught us lessons about democracy and voting as tools for bringing about change.
Students at Lincoln High School in East Tacoma, Wash., had the opportunity to vote on how to spend $60,000 on campus health improvements. (Pierce County Television)
(CHR&R)
information desert
Participation in civic activities is driven by information. A new report from the Wisconsin Institute shows the relationship between health and the county's “information environment,” including local news outlets and libraries. Overall, people living in the West and Northeast have better access to information and a longer life expectancy than those living in the South.
The report points to “digital redlining” by broadband providers that excludes low-income areas. Michael Stephenson, a policy analyst at the institute, said that in places where the information environment is less robust, there tend to be structural barriers to citizen participation, such as barriers to voting and other forms of discrimination.
This is one reason why participatory budgeting is so promising. This empowers historically marginalized groups of people, gives them the opportunity to make decisions that affect their lives, and helps build relationships between them and government.
The Tacoma-Pierce County Health Department has been running participatory budget meetings since 2017, most recently involving multi-million dollar projects in each of Tacoma's five city council districts. To ensure wider participation, the materials were translated into nine languages other than English. Voter turnout was higher than in the county's general election, with thousands of Vietnamese residents voting for the first time.
Bittle would like to see participatory budgeting used in public health on the national stage. While he's excited about the possibilities, he also acknowledges some drawbacks. Such efforts can move slowly, at the “speed of trust,” in Bittle's words. It also costs time and staff.
Elected officials tend to provide bipartisan support for placing public funding decisions in the hands of community members, but administrators are less enthusiastic about departing from traditional practices. There is a possibility that there is no. “Creating a critical path involves a lot of removing obstacles and talking with people,” he says Bittle. “All that work requires a lot of nuance.”
