When New Jersey officials finalized their latest annual public spending plan in June, they agreed to add more than $600 million in additional funding at a later date for a range of programs, including money for community colleges, soup kitchens and baseball stadiums.
But despite long-standing calls for increased investment in public health, as repeated in the state's own COVID-19 post-mortem report, the $56.6 billion budget for the fiscal year that began in July included no additional funding for the state's 104 local public health offices. Moreover, federal emergency funding provided during the pandemic has nearly dried up.
“It's really disappointing that public health hasn't emerged as a budget priority,” said Sen. Vin Gopal (D-Monmouth), who is leading a push to provide an additional $10 million annually for these programs. “It's a pittance. It should be a lot more than $10 million, frankly.”
Gopal told New Jersey Spotlight News last week that he would continue to lobby for passage of his bipartisan bill (S-2010) that would restore the Public Health Priorities Fund, which was eliminated under former Republican Gov. Chris Christie, and provide $10 million per year. Gopal said he and other lawmakers have spoken with State Health Commissioner Dr. Kaitlan Baston and other state officials about the possibility of including more funding for public health in the health department's annual budget.
“We're going to be pushing the bill this session, but with a dual purpose, we're going to be lobbying to get it into the (Department of Health) budget,” Gopal said. “They obviously have a lot of priorities, but I expect to apply full pressure.”
Funding Options
Governor Baston has also been committed to identifying more sustainable funding options for local public health, and earlier this year asked staff to explore new options. A representative from the Health Department said public health infrastructure is a focus of the state's Pandemic and Emergency Preparedness Task Force, which was formed to implement the recommendations of the state's COVID-19 Post-Action Report and is co-chaired by Governor Baston.
“The COVID-19 pandemic has demonstrated the value of a strong network of state, county and local health departments in identifying, addressing and responding to emerging public health concerns and advancing health equity,” said Health Department Secretary Nancy Carney.
In New Jersey, public health responsibilities fall to county, city and regional agencies funded by local taxes and state and federal grants. This includes a two-year budget of $19 million in response to COVID-19 to help build local infrastructure and prepare for future pandemics, Carney said. These local agencies are responsible for inspecting commercial kitchens to prevent foodborne illnesses, helping prevent lead poisoning in homes, tracking communicable diseases and organizing vaccination clinics.
Public health officials acknowledge that the intangible nature of their work — if they're successful, people don't get sick — can make it hard to tell what's missing.
The annual report from nonprofit watchdog group Trust for America's Health, released earlier this month, highlighted that underinvestment in the nation's public health system is limiting its ability to improve maternal mortality, life expectancy and other health outcomes. Despite some progress in data collection and short-term workforce expansion during the COVID-19 pandemic, the 2024 report calls on federal and state governments to do more to sustain and build on these improvements.
While the Trust report didn't rank states' public health investments, other studies have shown New Jersey near the bottom, Gopal said, and this underinvestment particularly hurts people of color, many of whom already have poorer clinical outcomes than white people, he said.
“The burden of chronic disease is not equally distributed, disproportionately impacting historically marginalized and underresourced communities,” the Trust for America's Health report states. Public health agencies play a critical role in eliminating these disparities, the report adds, and “additional resources are needed to continue advancing health equity.”
Hard to quantify
Public health officials acknowledge that the intangible nature of their work (hopefully people don't get sick) makes it hard to tell what's missing. But while money exists to fund specific programs to reduce smoking and diabetes, for example, and short-term infrastructure grants are sometimes available after related disasters, local public health officials in New Jersey say they have long struggled to hire and retain staff and have limited funding for essential tools like computers, vehicles and office space.
“The most important thing that comes from unrestricted funding is the flexibility to meet the specific needs of a community,” said Linda Brown, executive director of the New Jersey Association of County and City Health Officials, which represents local health agencies. While public health trends may look similar across the state or even outside of it, there are differences from place to place, she said.
Attorney Paul Zubek, in a report released in March on New Jersey's response to the COVID-19 pandemic, said Trenton officials need to step up communication with community groups and local public health agencies in preparation for future emergencies.
For example, opioid addiction deaths are a widespread problem, but addiction affects different people in different communities, Brown said. Flexibility would allow public health agencies to target specific needs, such as hiring addiction specialists trained to work with seniors or teens or people who speak certain languages, Brown said. “We're a small state, but we have so many local variations,” Brown said.
Gopal agreed that it's not always easy for lawmakers to understand the role that local public health systems play. He acknowledged that it wasn't as clear three or four years ago. He continues to encourage public health officials to reach out to lawmakers and showcase their programs and work. Rank-and-file lawmakers also need to communicate the importance of public health work to congressional leaders, Gopal said, so public health funding can be made a bigger priority.
COVID-19 Response
In a 900-page report on New Jersey's response to the COVID-19 pandemic released in March, attorney Paul Zubeck said Trenton officials need to step up communication with community groups and local public health agencies to prepare for future emergencies. Zubeck stressed the need to bolster the local public health infrastructure, which has shouldered much of the COVID-19 testing, contact tracing and vaccination efforts during the outbreak.
“The overarching theme that emerged across different settings is that public health systems require sustained investment; they cannot be neglected or underfunded for years and then expected to be equipped to deal with a major global crisis,” Zoubek wrote.
The state agreed to pay $9 million for the report, which Zubeck, a partner at the Cherry Hill law firm Montgomery McCracken Walker & Rose, prepared with the help of the Boston Consulting Group.
