Budgets
About
A budget is a plan for the distribution of resources. Budgets are documents where decision-makers display their values by allocating resources to services, policies or other initiatives.
Relationship to health and equity
How we design and enact budgets can impact health directly by funding health promotion and disease prevention. Budgets also impact health by distributing funds that shape community conditions. For example, education funding improves educational attainment, which in turn improves health. After the 1896 Supreme Court ruling on Plessy v. Ferguson constitutionally sanctioned segregation of schools by race, schools for Black children received substantially less funding than white schools during the early 20th century. Rural schools struggle with retaining teachers due to lower salaries than urban schools, high transportation costs and a large proportion of students living below the poverty level – all factors which impact educational outcomes and improve with funding.
Relationship to systems and structures
How we approach budgets support systems. Decision-makers direct local, state or federal funding to agencies and institutions that carry out programs put in place by laws and policies. Elected officials make decisions on federal budgets for programs like the Supplemental Nutrition Assistance Program (SNAP) and Section 8 that determine who in society is supported.
Worldviews, culture and norms significantly impact how we form and implement budgets. Stories about crime that depict people of color and immigrants as criminals have contributed to increased governmental spending on policing and practices that surveille, arrest, convict and imprison Black people, Native American and other people of color at disproportionate rates to whites.
Elected officials may pass laws and policies but not allocate any funding to implement them. Legislators who have passed laws may be lauded for reform, but agencies mandated to implement unfunded programs may have to cut back on other programs that may be just as worthy. Also, if the program is not implemented well due to a lack of funds, the public may conclude that the policy is not helpful.
To decrease health inequity, we must target allocation of resources to repair the harms of those who have been most excluded.
Additional Reading
- Heller, J. C., Givens, M. L., Johnson, S. P., & Kindig, D. A. (2024). Keeping it political and powerful: Defining the structural determinants of health. Milbank Quarterly, 102(2), 351-366. https://doi.org/10.1111/1468-0009.12695
- Mays, G. P., & Smith, S. A. (2011). Evidence links increases in public health spending to declines in preventable deaths. Health Affairs, 30(8). https://doi.org/10.1377/hlthaff.2011.0196
- Baker, R. B. (2019). Finding the fat: The relative impact of budget fluctuations on African-American schools. Explorations in Economic History, 72, 93-113. https://doi.org/10.1016/j.eeh.2018.11.002
- Lavalley, M. (2018). Out of the Loop. Center for Public Education. https://files.eric.ed.gov/fulltext/ED608842.pdf
- Fassler, E. (2021, February 24). 10 largest US cities will spend more on police than public health this year. Truthout. https://truthout.org/articles/10-largest-us-cities-will-spend-more-on-police-than-public-health-this-year/