Deliberations on Government Spending Priorities: Listen to the People

BACKGROUND: The COVID pandemic's impact on health and financial well-being disproportionately affected low-income communities. Government safety net programs aim to improve equality of opportunity and might reduce such disproportionate effects but face constraints of limited resources. OBJECTIVE: To identify the social spending priorities of low-income individuals through informed group deliberations using a structured budget tool. DESIGN: The CHoosing All Together (CHAT) exercise was used to engage low-income persons in informed deliberations to set priorities for social programs within a limited budget. PARTICIPANTS: Twenty-one English-speaking and five Spanish-speaking groups composed of low-income individuals. APPROACH: Participants first made individual spending choices, then deliberated as a group to jointly allocate resources, and finally repeated individual choices. Deliberations were audio recorded and analyzed to understand reasoning. KEY RESULTS: Before group deliberations, individuals allocated at least some resources for food (89%), internet access (82%), transportation (80%), post-high school education (74%), income supplements (69%), employment assistance (68%), PreK-HS education (67%), housing (66%), climate protection (65%), and legal assistance (42%). Only health insurance and neighborhood were chosen by most individuals at the highest available spending level. After group deliberations, PreK-HS education was also selected at the highest possible level by most individuals. A majority of groups prioritized health insurance, neighborhood, PreK-HS education, climate protection, and internet access at the highest level. Deliberations emphasized basic needs, like food and health insurance, concern for the future (education), and learning from disasters (internet and climate). CONCLUSIONS: The priorities and reason-giving of people most affected by government spending on social determinants of health provide valuable insights and justification for policy-makers.