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Deliberations on Government Spending Priorities: Listen to the People.
Susan Dorr Goold1, Zachary Rowe2, Lydia Perry3,4
1University of Michigan, Ann Arbor, MI, 48109, USA. sgoold@umich.edu.
Journal of General Internal Medicine
|April 14, 2026
Summary
Low-income individuals prioritized basic needs like food and health insurance, alongside future-oriented education and climate protection, in budget deliberations. Their insights inform social spending for greater equity.
Area of Science:
- Public Health
- Health Economics
- Social Policy
Background:
- COVID-19 disproportionately impacted low-income communities' health and finances.
- Government safety nets aim to reduce inequality but face resource limitations.
Purpose of the Study:
- To determine social spending priorities of low-income individuals.
- Utilized informed group deliberations and a structured budget tool.
Main Methods:
- Employed the CHoosing All Together (CHAT) exercise.
- Engaged 26 groups of low-income individuals (English and Spanish-speaking).
- Participants made individual choices, deliberated in groups, and repeated individual choices; deliberations were recorded and analyzed.
Main Results:
- Initial individual priorities included food, internet, transportation, and education.
- Post-deliberation, PreK-12 education was prioritized at the highest level by most.
- Group consensus prioritized health insurance, neighborhood, PreK-12 education, climate protection, and internet access.
Conclusions:
- Participant priorities highlight the importance of basic needs, future planning, and disaster preparedness.
- Insights from affected populations offer valuable justification for policymakers regarding social determinants of health spending.
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