Investing in preventative health care would pay huge dividends


If I had one wish for the future of health and health care, it would be a simple one. Lawmakers and agency policymakers would use evidence to develop public policy. Policy decisions and resource allocation would be driven by data and prioritized by long-term return on investment.

For one thing, that would lead to placing a higher priority on preventing, rather than treating illnesses.

Will Humble
Will Humble

Here are just a few examples of public health prevention investments that would pay dividends:

  • Teen births are a primary cause of inter-generational poverty and result in higher health care costs and increased reliance on public benefits. Simple interventions to reduce teen births have a dramatic effect on reducing these bad outcomes. Colorado has invested in a Long-acting Reversible Contraception initiative (LARC) that has greatly reduced teen pregnancy and abortion rates and has a 6:1 return on investment in health care costs. Their initiative will also pay additional long-term dividends with less lifetime reliance on public benefits like Medicaid and food stamps.
  • More than half of U.S. children experience adverse experiences like physical or sexual abuse, and more than 20 percent live in poverty, contributing to a range of expensive physical, mental and behavioral health issues. Supporting nurse-family home visits for high-risk families has a return on investment of 6:1 just in health care costs.
  • One in three children will develop type 2 diabetes in their lifetime. The data suggest that, if we spent $10 per person on evidence-based community prevention programs to increase physical activity, improve nutrition, and reduce tobacco use, we could save the country more than $16 billion annually in health care costs, a 6:1 return on investment.
  • Income is the number one determinant of overall health status and a significant driver of health care costs for chronic medical conditions and reliance on public benefits. A recent report from the Arizona Board of Regents found that persons with an undergraduate degree earn 82 percent more than those with a high-school diploma. Making college more affordable and increasing access to post-high school options is a great way to improve long-term health outcomes and reduce dependence on public benefits.

We spend a lot of time and money pulling people out at the bottom of the waterfall.  Let’s focus more on things we can do to scoop them out of the water at the top – or better yet, keep them out of dangerous water all together.

— Will Humble is the executive director for the Arizona Public Health Association and former director of the Arizona Department of Health Services. Connect with him at [email protected].


The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.

Results show why demand for charter schools remains strong


There is a reason charter schools continue to gain students in Arizona. Parents are demanding options. Indeed, the market has responded, offering parents a long list of ways to educate their children, all of them tuition free. Our lawmakers have wisely created an atmosphere in which quality charter schools can flourish.

Primavera has recently joined a long list of charter schools that have been targeted by The Arizona Republic as the paper seems intent on halting the growth of charter schools and limiting options for parents and students.

Donald Mitchell
Donald Mitchell

The Republic’s anti-charter agenda runs counter to what parents and students need and want.

Primavera is an online charter school, designated by the state as an “alternative school.” Nearly 80 percent of our students come to us missing critical skills, behind in school credits, or needing more support and flexibility than traditional schools are able to offer. Operating over some 20 years, we now educate upwards of 24,000 students per year.

Some of our students have been bullied at their previous school. Some are low income students working to support their families or teen moms needing a more flexible schedule. We have a large contingent of LGBTQ students who felt unwelcome in other educational settings.

More than 20 percent of our students are between the ages of 18 and 21, most of whom had previously dropped out of high school.  Primavera offers tuition free summer school to our students. This ensures that every student has access to the same educational options, regardless of their ability to pay.

Without Primavera, Arizona’s overall dropout rate would be higher. Primavera is the top choice for students who need to make up classes they’ve failed or missed. Without this option, they won’t stay on track to graduate. Yet The Republic took aim at Primavera’s dropout rate without context.  Students who successfully complete classes with us, leave our program and transfer those credits back to their home school are picked up in the drop-out statistic used by The Republic. These are not drop-outs at all, but students who came to our school and got what they needed.

Compared to our peers, we excel. In 2018, 13 percent of all alternative school students passed the AzMERIT test for English Language Arts (ELA) and 10 percent passed the math portion. But at Primavera, 36 percent of students passed the ELA portion and 23 percent passed math.

The Republic also takes Primavera to task for having significant cash reserves. This money has been accumulated over the past ten years in our nonprofit and can only be used for educational purposes. We have invested it to grow our resources, just as any responsible entity would.  Those reserves are now being used to develop brick-and-mortar charter schools and our nonprofit is currently developing more charter schools, beginning in the West Valley. Applications to build the new schools have been submitted to state education officials.

Our average teacher salary is $53,000 a year, considerably higher than the statewide average. In a state where teacher pay has lagged behind other school priorities, we are proud of our track record.

Our student-to-teacher ratio is actually 35-to-one, not the 215-to-one ratio cited by The Republic. The Republic simply added up the number of students we serve and divided that by the total number of teachers. As in any high school, one teacher may have 35 students per class but teaches five classes per day. Using the Republic’s math, that school would show a student-teacher ratio of 175-to-one.

What Arizona’s charter school revolution has taught us is that educational approaches can be as diverse as the ever-changing needs of Arizona’s students. And thanks to our governor and state Legislature, those diverse needs are being served. It would be a shame for parents and students if the charter school revolution came to an end because a handful of anti-charter advocates managed to convince an even smaller group of reporters that Arizona neither needs nor deserves choice in education. After all, if charter schools were not doing a good job overall, why are so many students flocking to them?

— Donald Mitchell is principal of Primavera Online High School.

Editor’s Note: A family member of Arizona Capitol Times Managing Editor Gary Grado works for Primavera.


The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.

Treasurer debate turns personal, testy

 From left are Democratic State Treasurer candidate Mark Manoil, debate moderator Ted Simons, and Republican candidate Kimberly Yee. Yee and Manoil met Oct. 9, 2018, in a debate held at the studios of KAET-TV in Phoenix. (Photo by Howard Fischer/Capitol Media Services)
From left are Democratic State Treasurer candidate Mark Manoil, debate moderator Ted Simons, and Republican candidate Kimberly Yee. Yee and Manoil met Oct. 9, 2018, in a debate held at the studios of KAET-TV in Phoenix. (Photo by Howard Fischer/Capitol Media Services)

Republican treasurer candidate Kimberly Yee labeled a plan by Democrat contender Mark Manoil to have the state help rural financial institutions do more lending as “socialized banking.”

During a televised debate Tuesday on KAET-TV, Yee also accused Manoil of helping to evict families from their homes and his own foreclosure and vehicle repossession proves that voters should not put him in charge of an office that manages nearly $15 billion in assets.

Manoil said Yee, who as a state legislator has supported multiple tax cuts for Arizona corporations, is someone who is only “trusted  by lobbyists.” Those tax cuts, he said, have made the state far too dependent on sales taxes which now fund more than 45 percent of the state budget, compared to just 2.4 percent from corporations.

“He doesn’t want voters to know what he does to earn a living,” Yee said. “He steals people’s property when they fall on hard times.”

“Of course not,” Manoil said.

“I enforce property taxes against people who don’t pay them,” he said. “It’s largely speculators or abandoned properties that are the subject of these things.”

Pushed by moderator Ted Simons on whether he has been involved in forcing families from their homes, Manoil said it has occurred perhaps two or three times in the 26 years he has been in the business.

Yee then pushed deeper into Manoil’s personal life, citing his loss of a home to foreclosure and repossession of a vehicle.

“So you can’t even manage your own personal finances yet you want to manage the $15 billion,”’ she said.

“At the time of the Great Recession I had a foreclosure and I bounced back from it, just like many Arizonans,” Manoil said.

“I came back stronger and I’m strong now,” he continued. “This is a silly attack, a personal attack that you’d expect from a career politician who kind of considers the advancement into this office the next step in her career that she’s entitled to.”

Yee insisted that bringing up Manoil’s financial history is not a “personal attack.”

“Voters need to know if you can’t manage your own personal finances,” she said. “Even back in the time when all of us were in that recession, some of us planned for it.”

Going directly to the role of the treasurer, Manoil said the office should be using at least some of those resources to directly help Arizonans.

What Manoil said he has in mind is having the state partner with banks and credit unions in small communities, something Yee said amounts to a state-run government banking system.

“This is socialized banking,” she said.

“It does not compete with them but rather enhances their credit-granting capabilities,” Manoil said. The result, Manoil said, is greater access to loans by individuals, entrepreneurs and even local governments seeking affordable loans for infrastructure projects.

“I’m actually talking about is banks in towns that have been abandoned by the banks,” he said.

Yee pursued the issue, saying that Manoil would use some of the dollars under the control of the treasurer for “social justice” programs, though she provided no specifics.

“Oh, you don’t think social justice is something we should be concerned about?” he said.

“Not in the treasurer’s office,” she said. “There’s no return on your investment for the taxpayer dollar.”

And Yee said if Manoil wants to help set policy he should instead be running for the Legislature.

“The treasurer’s office is not a policy-making office,” she said. “You manage the office for safe and prudent investments, not on these types of fluffy programs that feel good to people.”

Manoil said every elected leader, including the treasurer, has a duty to serve constituents. And he said the idea of partnership banking is “an explicit choice not to continue entrusting all of our state monies to Wall Street bankers who had a fabulous run with our monies.”

“They are not lending back into Arizona,” he said.

Yee defended lending her campaign $400,000, first to defeat Jo Ann Sabbagh in the GOP primary and now in her general election race.

“This job is a job I know well,” she said, having worked for Dean Martin when he was treasurer. “To manage nearly $15 billion in assets under management takes someone you can trust, someone who understands the office and will uphold the position with honesty and integrity.”

Manoil sniffed at that qualification.

“I don’t have the experience of being the public relations flak for the treasurer’s office,” he said. What experience she does have, Manoil said, is as majority leader in the Republican-controlled Senate, a Legislature “that has left most Arizonans behind.”

The winner of the election will replace Eileen Klein. She was appointed treasurer earlier this year after Jeff DeWit, who worked in 2016 on the national Trump campaign, quit to take a job as NASA’s chief financial officer.

Klein is not seeking to retain the post.