826: Rethink Public Health Funding With PHIG

JANSON SILVERS: 

This is the award-winning Public Health Review Morning Edition for Tuesday, January 21 2025. I'm Janson Silvers. Now, today's news from the Association of State and Territorial Health Officials.

Before we jump into today's top story, we wanted to take a moment to recognize the National Day of Racial Healing. ASTHO is spending today at a day-long workshop related to racial healing. We hope you're able to set aside some time as well.

Now, this week's PHIG Impact Report. Twice a month, this segment will report on successes from the Public Health Infrastructure Grant, otherwise known as PHIG, including how your colleagues across the nation are using it and how it's impacting the U.S. Public Health System. Melissa Magstadt is the secretary of health for the South Dakota Department of Health and an ASTHO member.

Secretary Magstat, thanks for joining us this morning. Jumping right in. I'd love to hear how South Dakota has used PHIG funding in general to bolster public health initiatives in the state.

MELISSA MAGSTADT: 

What I have appreciated about PHIG is that, you know, some of the grants that we get, we're appreciative of all of them, but they have like a bucket, right? There is a maternal health bucket, or it's in an infant [health] bucket, or there is an immunization bucket, but PHIG really looks at, 'How do we develop this entire infrastructure?' This undergirding of public health that is not just about maternal, is not just about infant, but it's about the entire public having that healthy undergirding of public health across the board. So, that's what I love about PHIG, just in general, and with that kind of general set of buckets, we were able to work with, we were able to look at, 'What does South Dakota need,' right? It's not, 'only focusing on maternal, because that's what the grant did.' No, South Dakota's needs were identified, and that's how we sort of work together. We developed what- our first-ever State Health Assessment. We have never unwrapped the challenges and struggles of what our data says, what the community tells us, what the healthcare systems, what the non-profits want us to know. We have never unwrapped that. And because of the PHIG we were able to put a State Health Assessment. Now, the people who came together and made the State Health Assessment was the State Health Improvement Coalition, that's what they end up getting named. And now, after the SHIC, the State Health Improvement Coalition, developed the SHA the State Health Assessment, which now it became the State Health Improvement Plan, the SHIP. So, the SHIC made the SHA that made the SHIP, and now we are functioning off the SHIP. You know, I'm always sort of fascinated that, you know, sometimes we have these set of initiatives that we're doing, but we really never thoughtfully plan them out with an assessment and analysis, and what are we going to do about this? So, that failing to plan is planning to fail, right? So, five years from now, we talk about the same things, because we really weren't purposeful in the things that we've done to impact those areas that we're trying to impact. And so I appreciate now that we have a State Health Assessment to work from, to have an improvement plan that we can all be on board with, whether you're in the behavioral health area, whether you're in the maternal health area, whether you're in non-profits, whether you're with our youth, that we're all singing from the same music sheet.

SILVERS: 

More specifically, what do those initiatives look like on the ground?

MAGSTADT: 

So, some of the things that we're- some major ones that we're doing right now, is an IT systems upgrade. We gather a lot of data. I will tell you that a year ago, we couldn't tell you who had the data, who owned the data, how we could leverage the data, and I will tell you that our divisions didn't know also what data was being gathered by other people in our same division as well. So, IT and data modernization has been a huge one for us, because data becomes to alignment, becomes to action. Well, we were gathering a lot of data, but we were not necessarily utilizing it in a way that created actionable direction for frontline programs. And so I think, to me, that's one of our biggest ones that we've done, but we've also done what I would say sometimes is the 'ignored division' of the health department; we gather a lot of information on vital records, but that system was so old and so antiquated that pulling information out of it was like pulling teeth, right? So, we invested in our new vital records system, because that data is so rich for every other department that it's not the 'forgotten division.' But yet, it was because there really is not much funding for vital records. There's funding for maternal-child, there's funding for, you know, suicide prevention, there's funding for those things. But vital records, as vital as it is, was kind of the ugly stepchild that's not going to be funded. So, we use some of it for those types of things. We used it in long-term care facility investigations.

SILVERS: 

And then you think for these PHIG dollars, but really all public health dollars, to be sustainable that we need to reframe our thoughts on health in general. Can you elaborate?

MAGSTADT: 

I think we do have to change our perspective that says there's a triangle, right, and everyone needs public health at the bottom, everyone needs healthy water, everyone needs access to healthy food, everyone needs an education that is good enough to provide for you and your family as you get- I mean, like all of those things. And then at the top there's the few people that need to have that very specialized types of care, right? They need that cardiac intervention. They need that rheumatological intervention, whatever it is, that's a small piece. And somehow, in the United States, we have flipped the triangle over where we spend all our dollars on the small piece and very few dollars on the piece that impacts everyone. And I'll tell you that if you have a healthy population, they don't need health care much. You have a healthy group of people, they need health care very minimally. If you have a health care population that is generally unhealthy, that is becoming more and more obese as the years go by, that are having less and less access to healthy nutrition, that is not full of things that most of us can't pronounce, we're going to continue to get these kind of outcomes and spend all our money on the top part of the triangle, rather than on the bottom, which says we create a healthy population who doesn't need to use healthcare much.

SILVERS: 

Secretary Magstadt, we appreciate you taking this time to speak with us and we hope 2025 treats you and South Dakota well.

For more information about the Public Health Infrastructure Grant and to learn more about the great work going on, visit the PHIG website. We have a link in the show notes.

That'll do it for today. We're back tomorrow morning with more ASTHO news and information. I'm Janson Silvers. You're listening to the award-winning Public Health Review Morning Edition. Have a great day.