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Participatory Budgeting:
A Pillar for Public Health —Marin County's First Participatory Budgeting Process Advances Equity, Systems Change with HPI

Impact Story | January 25, 2024
‍Marin County, CA (Public Health Alliance of Southern California) -
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In Marin County, California, a transformative shift in public governance is taking shape with the launch of its first-ever participatory budgeting process. This initiative, deeply rooted in a commitment to health equity and racial justice, is supported by a $2.5 million investment from the American Rescue Plan Act funds. The County is empowering community members from neighborhoods that score under the 70th percentile on the California Healthy Places Index (HPI) – a tool developed by the Public Health Alliance of Southern California – or those facing disproportionate economic and racial health disparities. Through participatory budgeting, these communities have an opportunity to decide how funds will be utilized to improve their neighborhoods.

Originating from Porto Alegre, Brazil, in 1989, participatory budgeting has grown into a globally recognized method for improving public health outcomes.
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This approach empowers community members to be active participants in budgetary decisions, enhancing civic engagement and strengthening the democratic process.  With its roots as an anti-poverty measure in Brazil, where it reduced child mortality by nearly 20%, participatory budgeting has been implemented in over 7,000 cities worldwide. 

Jamillah Jordan, Marin County's Director of Equity, noted the first step of the journey was initiating deep engagement with community members to brainstorm project ideas,
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"The first question we asked is how would they use $2.5 million to advance racial equity in their community. We invited community members to reimagine their neighborhoods and to dream of solutions that were rooted in abundance, self-determination and community wisdom."

Marin’s participatory budgeting process in and of itself is positioned to improve community health. Involving under-resourced community members in decision-making boosts social cohesion, which is linked to better health outcomes.
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 The HPI plays a pivotal role here. It includes census response rates and voting indicators into its ”Social” Policy Action Area. These measures capture aspects of ‘social cohesion’, a recognized social determinant of health. This incorporation is not arbitrary; it's grounded in substantial research. Several studies, including in California, have established a clear link between social cohesion and health outcomes as it empowers community members to influence decisions affecting their health outcomes. Recognizing this, the HPI’s policy action guide  elevates participatory budgeting as a strategy to enhance life expectancy. 

Jordan highlighted civic activities, like participatory budgeting, counteract structural racism—a public health crisis characterized by policies and practices that perpetuate racial inequality. By honoring community wisdom, fostering a sense of belonging, and challenging systemic biases, participatory budgeting becomes a powerful tool in dismantling the isolating, adverse impacts of such injustices.

Denia Candela, Marin County's Equity Analyst, echoes Jordan's insights on participatory budgeting and its role in promoting equity: 
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“The very people living through these challenges every day are also the ones holding the keys to the solutions. It's no surprise, really. Those who experience these injustices firsthand have the answers to the systemic challenges we face as institutions. This understanding is central to our approach. We're integrating grassroots wisdom into how we operate. It's about really listening to and valuing the voices of our community and uplifting their decision-making voice throughout the PB process." 
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Embedding Equity in Participatory Budgeting Processes with HPI
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Jordan underscored the importance of integrating equity considerations into Marin County’s participatory budgeting processes, particularly in a community known for its relative affluence. She highlighted the need for a tool that serves as an equity metric to identify and characterize historically under-resourced neighborhoods and prioritize them in participatory budgeting project proposals, thereby maximizing the impact on health equity.
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"When we discovered the Healthy Places Index, it really clicked for us. It confirmed much of what we already knew about the assets and challenges of under-resourced communities in our area, but more importantly, it provided a data-driven foundation for us to direct our participatory budgeting funds to communities with the greatest needs," Jordan explained.

Notable priority areas include Marin City, the Canal neighborhood, and portions of West Marin and Novato.
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“The HPI really embodies our Participatory Budgeting values and helped us ensure equity throughout the process. It helped us navigate engaging with the community, helped frame project proposals, and supported the way in which design our voter engagement efforts. The HPI has really been a bridge that helps the combination of strategies that allows us to stay deeply connected to community needs and maintain our core values at every phase,” Candela added.  


Understanding the Healthy Places Index (HPI)
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"What made HPI stand out was its comprehensive approach. It didn't just examine one aspect of community well-being, such as health or education, but it considered a whole range of factors. This holistic view was exactly what we needed. And, the support we received from the HPI team was very beneficial. They were ready to help us deepen our understanding of how to apply the tool effectively. That made a huge difference in our decision to go with HPI," Jordan said.

So, what is the HPI? It’s a peer-reviewed and published tool that measures the impact of community conditions on population health and provides recommendations for policy action, all using a positive, asset-based frame. Combining 23 measures of community conditions that drive health – including employment, income, educational attainment, and safe and affordable housing – the HPI ranks California neighborhoods using a single HPI score. 
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Higher HPI scores correlate with healthier community conditions and longer average life expectancy.
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Place-based factors measured by HPI are important drivers of health. But they aren’t the only ones. The experience of race in the United States influences health outcomes, too. We believe that both race and place must be understood to implement lasting systems change. That’s why the HPI also displays race and ethnicity data alongside the HPI scores, demonstrating a commitment to illustrating how community conditions intersect with these factors without oversimplifying complex relationships into a single score.

“Improving the basic foundation as it pertains to the social determinants of health is crucial for a successful, healthy life - unfortunately, communities of color experience disproportionate, negative imbalances in resource distribution, systems of care, and ultimately health outcomes. The Healthy Places Index allows us to highlight the inequities that systemic racism creates in terms of someone’s ability to live a healthy and thriving life,” Candela added.
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‍Community at the Core - How Marin's Participatory Budgeting Advances Health and Well-Being
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 From palpable excitement and anticipation to a poignant acknowledgment of long-standing unmet needs, the initiative struck a chord with community members. Reflecting on the response, Jordan remarked,
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“Many people were appreciative of the County inviting their ideas and providing real financial resources to bring those ideas to life. They were also inspired by the County sharing decision-making power and transforming power structures to center the needs and perspectives of community members at the margins of our system."
The community's active engagement is evident in the generation of 250 project ideas, garnering nearly 3,000 virtual “likes” and culminating in 104 formally submitted grant proposals. These proposals represent a blend of visionary, long-term initiatives aimed at systemic changes. Proposals encompass youth mentorship programs, climate resilience and preparedness initiatives, ancestral healing for women, and cultural arts projects, among others.

Out of these proposals, 24 projects have been selected for inclusion in the participatory budgeting Community Ballot. This voting process, running from October 26th to December 29th, 2023, is notably inclusive. It welcomes participation from anyone over 14 who lives, works, owns a business, or attends school in Marin County, regardless of immigration status or traditional voting eligibility.

Candela explained that while the inaugural participatory budgeting process represents a small fraction of the county budget, it serves as a foundational step towards cultivating healthier, more prosperous communities.

Jordan said it's already sparking dialogue across various departments, laying the groundwork for a future where participatory methods become standard in county budget processes.  Marin County departments like Parks and Recreation and the Community Development Agency are also considering using HPI to guide the distribution of their own American Rescue Plan Act funds.

Jordan explained participatory budgeting is inspiring the question,
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"How can we use this process to think through our County Budget and to engage community members in deciding how to allocate our General Fund resources in a participatory way?"


Best Practices for Successful Participatory Budgeting Implementation
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  Drawing from Marin County’s experience, the following are key strategies for agencies embarking on a participatory budgeting process:
“The process matters, but so does the impact of the final projects. Ultimately, we’re asking ourselves and our project partners, “How well did we do? How much did we so? And are people of color in Marin better off as a result?” Jordan said.
 
Interested in learning more about harnessing HPI for participatory budgeting? Reach out to Helen Dowling, MPH,  Director of Data Initiatives at the Public Health Alliance. Email: hdowling@phi.org