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These 5 budget initiatives seek to address the COVID-19 pandemic, improve racial health disparities for historically marginalized groups, and ensure all Granite Staters are healthy now and into the future.

1. Support Public Health Programs & Services

Existing health disparities have been exacerbated by the COVID-19 pandemic and have placed an outsized responsibility on the 13 Regional Public Health Networks to ensure community health and safety. To protect the well-being of New Hampshire for years to come, there is a critical need to support Public Health Networks and their efforts to overcome health inequities, barriers, and eliminate all preventable diseases.

What can be done:

  1. Preserve and increase funds for local and state public health services. Public health investments keep NH safe and strong with tobacco and other prevention programs, vaccinations, protection from disasters and disease outbreaks, screenings for newborns, cancer and HIV/AIDS, rural health services, promotion of healthy lifestyles to reduce chronic conditions, protection of air and water, job safety programs, and more.

  2. Support funding for a Community Health Worker position at each of the state’s 13 Public Health Networks. CHWs are frontline liaisons between health/social services and the community. As trusted members of their communities, CHWs improve access, quality and cultural competence of services.

Why this matters:

Protects health and safety from threats. Community health outcomes are influenced by many factors, including: the physical environment, economic and social factors, and the availability of and access to clinical care. Public Health and CHWs help improve community health at all levels.

Effective investment. Every $1 spent on prevention saves $5.60 in health spending. For each 10 percent increase in local public health spending: Infant deaths decrease 6.9%, cardiovascular deaths decrease 3.2%, diabetes deaths decrease 1.4%, and cancer deaths decrease 1.1%. When CHWs address the needs of Medicaid recipients, a return of $2.47 was realized for each dollar spent.

The dynamic model improves health and safety. Through the performance-based delivery system, the CDC's 10 Essential Public Health Services includes assessment and monitoring of population health status; investigation and diagnosis of health challenges; and creation and implementation of health policies and plans.

Eliminates health disparities. These investments will go far to meet the state’s goal of reducing or eliminating all preventable diseases and to overcome barriers that have historically led to poorer health outcomes and lower vaccinations rates among many communities of color.

2. Grow New Hampshire Health Care Workforce

The COVID-19 pandemic has exposed and exacerbated NH's ongoing healthcare workforce shortage. Hospital capacity has been stretched thin due in part to workforce shortages, and rising levels of stress and anxiety heavily impacted substance use and mental health treatment providers, as well. Rural areas of the state have been hit especially hard. Further investments are needed to reinforce rural care and to boost the workforce all across the state.

What can be done:

  1. Invest in student loan repayment for health care professionals working in underserved areas. These funds represent a critical investment helping to recruit and retain primary, behavioral and other care workers.

  2. Maintain and increase funding for medically underserved areas of the state. Supporting workforce needs in the state’s rural areas will help to ensure all Granite State residents have access to healthcare services.

  3. Support adequate Medicaid Reimbursement rates to expand access to quality, affordable care. Maintaining past rate increases, which have built upon some of the lowest rates in the country, is essential to supporting NH health care providers.

Why this matters to NH:

When Granite Staters do not get the health care they need, our state suffers. To build a health care workforce capable of ensuring a healthy and thriving Granite State, critical investments are necessary to help recruit and retain primary, behavioral, and other care workers. 

Current clinical vacancies include physicians, family practice, internal medicine, pediatricians, obstetricians, gynecologists, psychiatrists, nurse practitioners, psychiatric NPs, certified nurse midwives, and physician assistants. These clinicians provide critical integrated behavioral health, substance use disorder, and primary care. Maintaining these rate increases, which have built upon some of the lowest rates in the country, is essential to supporting our health care providers

Maintaining an annual rate increase is essential to supporting our health care providers and continuing to address the workforce shortages that are limiting access to care across the state, during and after the COVID-19 crisis. The lack of access to community-based care has a far-reaching impact on our health care system, including backup in local emergency rooms while individuals in mental health crises wait for hospital beds.

Investing in a strong health care workforce supports our health care providers and boosts access and quality of care across the state

3. Sustain and Grow Behavioral Health Services

New Hampshire has some of the highest rates of substance misuse among youth and young adults in the country. The COVID-19 pandemic has exacerbated emotional challenges stemming from interpersonal and environmental stressors and created a detrimental disruption in prevention, treatment, and recovery services on which Granite Staters rely. By the numbers:

  • 14% increase in alcohol consumption during the pandemic compared to 2019.
  • 62% of Americans feel more anxious compared to 2019.
  • 33.8% of NH HS students report they have used e-cigarettes in the 30 days prior to taking the 2019 Youth Behavioral Risk Survey.
  • Tobacco use kills more than1,900 Granite Staters every year.
  • Tobacco-related healthcare expenses cost the State $729 annually.1
  • 90% percent of current smokers begin when they are 18 or younger - tobacco use is a problem that starts young.
  • 60,000 Granite Staters access health insurance coverage through NH Medicaid Expansion.
  • 10,500 Granite Staters used Medicaid Expansion to access SUD treatment from 7/19-7/20.

What can be done to strengthen NH:

  1. Continue to fully finance the Alcohol Fund and Medicaid Expansion to ensure critical substance use disorder services.

  2. Ensure sustainability and solvency for substance use treatment and recovery programs.

  3. Invest in evidence-informed tobacco prevention and cessation programs that are a proven method of preventing kids from starting to smoke and helping adult smokers quit. 

Why this matters:

Substance use disorder is a preventable and treatable condition. When appropriately resourced and fully implemented, evidence-informed strategies will help address emergent and acute mental and behavioral health needs, as well as to take preventative action to avert future suffering.

Behavioral health challenges are a major cost to the state economy. Substance misuse costs NH $2.36 billion a year in health and criminal justice costs, lost labor force participation, and lost worker productivity – a cost equal to $1,780 for every resident.

Prevention works and is effective. Reductions in youth rates of alcohol and drug dependency in recent years have corresponded with an increase in evidence-based prevention programs, showing that funding for prevention is helping New Hampshire kids.

With needed investments, NH will continue to overcome the addiction and mental health crises. The state has established a network of 17 recovery centers and has supported critical substance use prevention programs across the state. These efforts have contributed to a meaningful decline in the number of overdose deaths over the last three years.

4. Strengthen NH Families and Children

As a State, we are struggling with multiple crises impacting the health and wellness of our children; the COVID-19 pandemic, substance misuse, mental health, and child abuse and neglect. These situations, which cause toxic stress, can have long-term, negative consequences on the health and well-being of our children and families. Primary prevention services, such as the programs provided at Family Resource Centers, help to prevent and mitigate childhood trauma and stress. Through support and education, Family Resource Centers help strengthen families by promoting health, well-being and self-sufficiency and positive parenting.

  • 71% of NH Children have both parents in the workforce.
  • $12,192 Annual cost of childcare for one infant.
  • 10.2% Of the NH population reported 4-7 adverse childhood experiences (ACEs).
  • 12% of NH children ages 0-5 are living in concentrated poverty.

What can be done to strengthen NH families:

  1. Protect investments in NH's Childcare Scholarship Program to ensure access to quality childcare. This program is a critical support for low-income working families that enables parents to work and children to thrive in a learning environment.

  2. Support Family Resource Centers and Home Visiting programs to prevent and mitigate childhood trauma. These programs promote both the strengthening of families through formal and informal support and the restoration of a strong community.

Why this matters: 

Brains are built from the bottom up. Children who are given a strong foundation for their brain architecture during their first five years are proven to be more productive contributors to society.

Chronic negative experiences produce toxic stress in children, which can lead to lifelong problems in learning, behavior, and health.

Primary prevention programs that promote brain development and reduce toxic stress during children's early years are more effective and less costly than repairing issues later in life. For New Hampshire of these program shows a return of $4 to $6 for every dollar invested by reducing societal costs associated with poor health and academic child protection, K-12 special education, grade retention and criminal justice expenses.

Early childhood development programs provide essential support to children in their first five years, as well as whole families, which help create a healthier and more prosperous state overall.

5. Support Children's Behavioral Health Services

The COVID-19 pandemic continues to adversely impact the social and emotional health of NH youth and families. Exacerbating the existing behavioral health crisis in NH, many Granite State children now face heightened struggles related to the changes in their social lives and routines, the inability to access education and food, longer periods in unsafe living environments, among others. Investments supports that guard against these threats and bolster protective factors are needed to protect NH youth.

  • 1 in 5 of NH children reported mental health challenges prioir to the pandemic.
  • There has been a 20% increase in calls to NH state-wide crisis hoteline since 2019.

What can be done to support children's behavioral health: 

  1. Behavioral health supports in schools. Maintain funding for the Department of Education’s Office of Social and Emotional Wellness to provide technical assistance to schools as they implement the Multi -Tiered System of Supports (MTSSB).
  2. Secure support for children when and where they are needed. Ensure funding and implementation of statewide mobile crisis response, stabilization and other services and programs in compliance with RSA 135-F.
  3. Support for all levels of care. Secure needed funding to provide community-based services and alternatives to emergency room treatment for children with behavioral health needs.

Why this matters:

Crises can have long term negative effects on a child’s mental well-being. However, with a coordinated system of supports, hard times can build resilience in young people, giving them the ability to manage and rebound from stress.

Community-based interventions such as mobile crisis can help to keep children in their own communities and schools, as well as reduce long term costs such as emergency room treatment, police and court involvement and residential placement.

Cost savings from community-based services can be utilized in other systems such as the child protection and juvenile justice system and to divert youth entering the juvenile justice system.

Want to become a public health advocate?

  • Share your health and wellness interests with us here: https://new-futures.org/become-an-advocate. Let our team know what issues matter to you and we will help you use your voice effectively throughout the legislative session and beyond. Your voice matters and we want to help you use your voice effectively to make health and wellness improvements in the Granite State!