While COVID-19 has consumed much of Ocean County public health coordinator Dan Regenye’s time in the past two years, it is far from his only concern. There are increasing levels of addiction, domestic violence, mental illness and cancer, all exacerbated by the isolation and restrictions that came with the pandemic, and worsening chronic diseases like high blood pressure that may have gone unchecked for too long.

Addressing this wide range of issues takes resources, which can be hard to get, even for a sizeable department like the one Regenye oversees, which he said also enjoys strong support from county leaders. Additional funding is elusive and usually comes with “strings attached,” he said.

“It’s ‘We’ll give you the money, but you have to do this and only this,’” Regenye said. “Not everything is going to fit into the box prescribed for us at the federal or state level.”

Under COVID, long-standing problems ‘came home to roost.’

For years, public health leaders have warned about underinvestment in New Jersey’s system — a patchwork of local, county and state programs designed to keep residents safe and blunt the impact of disasters — and academics have documented these concerns. Many believe the COVID-19 pandemic, which exposed many of the system’s flaws, may now be a tool to drive change.

“These problems are longstanding, but under COVID they came home to roost,” said Joel Cantor, director of the Center for State Health Policy at Rutgers University, who has worked on these issues for years.

A robust public health system is particularly important now, as New Jersey faces rising rates of mental illness, overdoses and emerging cancer spikes in the wake of the pandemic. COVID-19 cases have fallen dramatically from their peak early this year, but the coronavirus continues to circulate — Gov. Phil Murphy tested positive last week — while pandemic infrastructure in the state is receding and the federal government is cutting back on funding and other resources.

The goal of a public health institute

For some, the solution is a public health institute, an independent, apolitical nonprofit organization that would work closely with government and other stakeholders to help New Jersey overcome some of these historic challenges while reducing racial inequities in health care and outcomes.

While the concept has come up before, supporters said this time is different: Pandemic urgency, broader support — the state Department of Health has been directly involved in the planning — and seed money from the Robert Wood Johnson Foundation (a supporter of NJ Spotlight News) give it a better chance for success. The foundation has committed $250,000 to help launch an incubator with up to $1 million available over two years to seed pilot programs that supporters hope will attract additional funding to create the institute itself.

“Given the COVID-19 pandemic, we seized this catalytic moment to bring these issues to light and comprehensively address them. We also brought together a diverse group of partners,” said RWJF program officer Sallie George, noting that in addition to public health professionals the effort included faith-based and social justice groups, community development advocates and others outside traditional public health.

‘In today’s world, we can’t afford to fight health threats with our hands tied.’

“Previously, efforts were primarily driven by the public health community, but we intentionally convened a broader group to ensure diverse perspectives informed our approach,” George said, calling the 10-month planning process “an unprecedented collaboration that benefited from additional perspectives.”

While public health institutes began to emerge in the late 1950s in New York City, and in Texas and California during the 1960s, the concept has gained momentum recently, advocates said. There are now 43 nonprofits in this model nationwide, in 33 states, including Ohio, Virginia and metropolitan Chicago, according to the foundation’s proposal, “Seizing the Moment,” released in February. George said New Jersey’s would be the first institute built from the ground up with equity central to its mission.

“Now there is proof of concept,” Cantor said, noting that the experience in other states can improve New Jersey’s chance of success with the project.

NJ’s public health workforce is limited

The foundation’s proposal draws on a December 2021 publication from Rutgers’ Edward J. Bloustein School of Planning and Public Policy that identified ways to enhance local public health capacity in New Jersey. The 185-page report found the state has among the smallest public health workforces per capita nationwide. New Jersey ranks 31st in the nation for the amount spent on each resident’s public health, the report said, and the state lacks access to unrestricted funding that can be critical in an emergency. Other studies point to a need for better technology and data collection around public health and greater integration with hospital systems and other medical providers.

“In today’s world, we can’t afford to fight health threats with our hands tied. For New Jersey to be a truly healthy and equitable state, we need the public health infrastructure to function at full strength for everyone’s wellbeing,” report lead author Jeanne Herb, a public and environmental health expert at the Bloustein school, wrote in an editorial for NJ Spotlight News in January.

New Jersey’s health department expects to receive more than $480 million from the federal government in the coming year to fund dozens of statewide programs to respond to COVID-19 and other infectious diseases, HIV/AIDS, maternal health challenges, the growing opioid crisis, obesity, heart disease and more, as well as to promote healthy foods, exercise and other wellness strategies that can reduce the impact of chronic disease. The state has received more than $6 billion in general pandemic aid that has helped fund the COVID-19 response and been used to benefit small businesses and offset property-tax impacts, among other things.

‘You can change a lot of rules, but you can’t do everything fast.’

DOH communications director Donna Leusner said the governor’s budget proposal for the coming fiscal year, which lawmakers must approve by July, includes $1.6 million for maternal and child health programs and $2.5 million for initiatives to help people with substance use disorders or HIV/AIDS. It also continues a $1.9 million appropriation initially added earlier in the pandemic for local public health, she said.

“This funding is specifically earmarked for Local Health Departments statewide and their efforts in bolstering preparedness for infectious diseases,” Leusner said. Since the start of the pandemic, she said the state has provided $90 million to counties, cities and local health offices to help with their COVID-19 response. The DOH also provided at least $84 million in grant funding, much of it from federal sources, for local government entities and community groups to strengthen their pandemic capacity, support vaccination programs and address inequities — since the virus had an outsize impact on communities of color in New Jersey and nationwide.

Even when funding is available, local public health offices are subject to the same spending controls other government agencies face, which make it harder to hire more staff or obtain new equipment in an emergency. This was a problem for many local health offices when COVID-19 first surged and they were charged, at first, with tracking down the source of each infection and warning those at risk. While this contact tracing has long been part of their portfolio, some jurisdictions struggled to find the staff needed to meet the growing workload.

“There is nothing that can’t be done in government. There’s a tremendous amount that is extraordinarily difficult to do in government,” Cantor said. Murphy issued emergency orders that extended the state’s powers and provided tremendous flexibility, but limitations remained, Cantor said. “You can change a lot of rules, but you can’t do everything fast,” he added.

A public health institute could help. When Fairfax County, Virginia, was overwhelmed by a need for contact tracers in spring 2020, officials there turned to the state’s Institute for Public Health Innovation for assistance, according to the foundation’s proposal. The nonprofit recruited, hired and trained 80 people within a month and has hired more than 640 people since to help with contact tracing, community outreach, case management and call center staffing, among other duties.

“From a public administration perspective (public health institutes) make a lot of sense. It allows for some surge capacity,” Cantor said, given the greater flexibility a nonprofit provides. “But it shouldn’t be seen as a way of circumventing the checks and balances of government.”

‘You need to build this into New Jersey government culture and administrative procedures so that it can work smoothly in a trusted way.’

To create the permanent institute, Cantor believes legislation will be needed, while George, with the foundation, said she isn’t sure. Both agree the incubator can proceed without help from the Legislature and that the process, and the entity, should remain outside of politics and not become an arm of any government agency.

“You need to build this into New Jersey government culture and administrative procedures so that it can work smoothly in a trusted way,” Cantor said, “and New Jersey state officials are responsive to state laws.”

Cantor, whose own organization benefits from state funding, said he did not worry that a new institute would overlap or eclipse the work of existing state agencies, nonprofit entities or advocacy organizations that address New Jersey’s public health. “My feeling is there is so much work to be done, if they do something I am doing I’ll do something else,” he said. “The needs are far deeper than the resources available. I don’t view competition among entities as a threat to anyone.”