Editor’s note: This commentary is by Tom Pelham, formerly finance commissioner in the Dean administration, tax commissioner in the Douglas administration, a state representative elected as an independent and who served on the Appropriations Committee, and now a co-founder of Campaign for Vermont.
[O]ver at the Vermont Health Department, a relatively small corner of the state budget, a group of concerned and dedicated state employees are trying to make the best of a bad situation. As most Vermonters are now aware, the state budget is on unstable footing as threatening budget deficits year after year get plugged with higher taxes, one-time funds, and a heavy dose of wishful thinking. Our leaders like to grow the budget each year at around 5 percent even though Vermont’s economic growth plods along at 2 to 3 percent. The inevitable consequence is constant fiscal crisis.
The overall Health Department budget is $146.9 million, or just 2.6 percent of the state budget. Within this budget is the Department of Alcohol and Drug Abuse which distributes $43.9 million in community based grants, most of which go toward opiate addiction treatment, with only a minor portion (less than $2 million) for drug and alcohol prevention efforts. Another $2.5 million is budgeted in the public health section for tobacco prevention and counter marketing, and a plan, though no funding, for combating obesity is emerging. You can see the budgets for these grant programs here.
Bottom line, resources to support prevention in the areas of tobacco, drug and alcohol abuse, and obesity are a miniscule portion of the state budget and the Health Department budget. Though the time-tested saying “an ounce of prevention is worth a pound of cure” applies to this group of diseases, Vermont spends tens of millions on treatment and only a few million on prevention. Yet responsible studies show savings ratios of between 7 to 1 and 36 to 1 for each dollar invested in prevention programs. (http://www.samhsa.gov/sites/default/files/cost-benefits-prevention.pdf)
An acquaintance of mine, former Colchester legislator and registered nurse Kerry Kurt, operates Sentinel Farm, a beef cattle and equine operation in Starksboro. Unbound Grace, a nonprofit dedicated to helping area youth achieve intentional lifelong health and wellness, is layered into the day-to-day fabric of farm activities. Ms. Kurt’s commonsense approach, especially in a rural state, is that farms are rich in building nurturing and responsible relationships. Farms depend on the many daily and interdependent relationships among humans and farm animals. From growing animal feed to attending to shelter and health care needs, trusting relationships develop between animals and humans. Further, the human teamwork required for a farm’s success develops trusting, responsible and respectful relationships. Unbound Grace does not receive any public funds; yet most likely saves taxpayers’ money by steering youth toward healthy behaviors and away from unhealthy addictions.
Our leaders cannot dig or tax their way out of the current fiscal mess until government leaders turn inward to find savings in the current budget.
Ms. Kurt invited me to attend a session sponsored by the Vermont Health Department regarding “Community-Based Prevention Funding Process.” The agenda for the session was simple: “to solicit feedback on the best ways to distribute Vermont Department of Health’s Alcohol and Drug Abuse, Tobacco, and Physical Activity and Nutrition prevention funding in the future by exploring current and other creative ways to address the funding process, ways to distribute funds more efficiently and effectively, assessing the pros and cons of different funding models and learning from each other.”
I was glad to see this effort by the Health Department, led by staffers Sarah Wylie (community tobacco specialist), Suzanne Kelley (public health specialist), Patty Baroudi (ADAP) and Deputy Commissioners Barbara Cimaglio and Tracy Dolan. Inviting players from all segments of the addiction prevention community to spend a morning brainstorming and challenging the status quo was inspiring.
Ideas for breaking down program silos built around specific funding sources or specific addictions in order to allow greater flexibility and creativity to foster prevention were put on the table. Maybe small incentive grants to households more prone toward youth addictive behaviors that directly steer low income youth toward healthy pursuits that otherwise would be financially out of reach, such as music lessons, sports or drama camps, or programs such as Unbound Grace might engage a child’s attention in a powerful way. At this Health Department session, there were no sacred cows preventing the flow of new ideas.
From a fiscal perspective, it would be of great value if every agency and department across state government followed the introspective example of the Department of Alcohol and Drug Abuse. From 2010 to the current 2016 budget, the expenditure of state (non-federal) funds has grown by $599.1 million, from $1.759 billion to $2.358 billion, or a rate of just over 5 percent annually. It is certain that not every dollar of this growth is necessary or well spent. If for example, state dollar spending had grown at the still generous rate of 4.5 percent since 2010 rather than 5 percent, state dollar spending today would be $70.8 million lower. Such savings would negate the current estimated budget deficit for fiscal 2017 which continues to threaten the stability of Vermont’s state budget.
It is unfortunate that in the middle of the last recession when one-time federal stimulus funds of over $940 million flowed into Vermont, that our state leaders did not use these temporary funds to unleash the creativity, as the Department of Alcohol and Drug Abuse is now doing, to keep the state budget sustainable. In fact, the Legislature and governor abandoned such efforts in 2011 like Challenges for Change and Tiger Teams. While that’s all water over the dam, our leaders cannot dig or tax their way out of the current fiscal mess until government leaders turn inward to find savings in the current budget. A savings target of 3 percent in the face of spending growth totaling over 34 percent since 2010 is not an unreasonable target.
