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Local Fiscal Allocation for Public Health Departments

      Introduction

      We examined the percentage of local government taxes (“fiscal allocation”) dedicated to local health departments on a national level, as well as correlates of local investment in public health.

      Methods

      Using the most recent data available—the 2008 National Association of City and County Health Officials Profile survey and the 2007 U.S. Census Bureau Census of Local Governments—generalized linear regression models examined associations between fiscal allocation and local health department setting, governance, finance, and service provision. Models were stratified by the extent of long-term debt for the jurisdiction. Analyses were performed in 2014.

      Results

      Average fiscal allocation for public health was 3.31% of total local taxes. In multivariate regressions, per capita expenditures, having a local board of health and public health service provision were associated with higher fiscal allocation. Stratified models showed that local board of health and local health department taxing authority were associated with fiscal allocation in low and high long-term debt areas, respectively.

      Conclusions

      The proportion of all local taxes allocated to local public health is related to local health department expenditures, service provision, and governance. These relationships depend upon the extent of long-term debt in the jurisdiction.
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      References

        • Riley W.J.
        • Gearin K.J.
        • Parrotta C.D.
        • Briggs J.
        • Elizabeth Gyllstrom M.
        Tax levy financing for local public health: fiscal allocation, effort, and capacity.
        Am J Prev Med. 2013; 45: 776-781https://doi.org/10.1016/j.amepre.2013.08.012
        • Wall S.
        Transformations in public health systems.
        Health Aff. 1998; 17: 64-80https://doi.org/10.1377/hlthaff.17.3.64
        • Bernet P.M.
        Local public health agency funding: money begets money.
        J Public Health Manag Pract. 2007; 13: 188-193https://doi.org/10.1097/00124784-200703000-00016
        • Honoré P.A.
        • Fos P.J.
        • Wang X.
        • Moonesinghe R.
        The effects on population health status of using dedicated property taxes to fund local public health agencies.
        BMC Public Health. 2011; 11: 471https://doi.org/10.1186/1471-2458-11-471
        • Brown T.T.
        How effective are public health departments at preventing mortality?.
        Econ Hum Biol. 2014; 13: 34-45https://doi.org/10.1016/j.ehb.2013.10.001
        • Plough A.
        Understanding the financing and functions of metropolitan health departments: a key to improved public health response.
        J Public Health Manag Pract. 2004; 10: 421-427https://doi.org/10.1097/00124784-200409000-00008
        • IOM
        For the Public’s Health: Investing in a Healthier Future.
        National Academies Press, Washington, DC2012
        • Baum N.M.
        • DesRoches C.
        • Campbell E.G.
        • Goold S.D.
        Resource allocation in public health practice: a national survey of local public health officials.
        J Public Health Manag Pract. 2011; 17: 265-274https://doi.org/10.1097/PHH.0b013e318207599c
        • Mays G.P.
        • Smith S.A.
        Geographic variation in public health spending: correlates and consequences.
        Health Serv Res. 2009; 44: 1796-1817https://doi.org/10.1111/j.1475-6773.2009.01014.x
        • Grembowski D.
        • Bekemeier B.
        • Conrad D.
        • Kreuter W.
        Are local health department expenditures related to racial disparities in mortality?.
        Soc Sci Med. 2010; 71: 2057-2065https://doi.org/10.1016/j.socscimed.2010.09.004
        • Dodson E.A.
        • Stamatakis K.A.
        • Chalifour S.
        • Haire-Joshu D.
        • McBride T.
        • Brownson R.C.
        State legislators’ work on public health-related issues: what influences priorities?.
        J Public Health Manag Pract. 2013; 19: 25-29https://doi.org/10.1097/PHH.0b013e318246475c
        • Leider J.P.
        • Resnick B.
        • Sellers K.
        • et al.
        Setting budgets and priorities at state health agencies.
        J Public Health Manag Pract. 2014 Aug 5.; ([Epub ahead of print])https://doi.org/10.1097/PHH.0b013e318297369d
        • Gamm L.
        • Hutchison L.
        Public health rural health priorities in America: where you stand depends on where you sit.
        J Rural Health. 2003; 19: 209-213https://doi.org/10.1111/j.1748-0361.2003.tb00563.x
      1. National Association of County and City Health Officials. 2008 National Profile of Local Health Departments. 2009; www.naccho.org/topics/infrastructure/profile/resources/2008report/upload/NACCHO_2008_ProfileReport_post-to-website-2.pdf.

      2. U.S. Census Bureau. 2007 Census of Governments: federal, state, & local governments. 2009. www.census.gov/govs/.

        • Willard R.
        • Shah G.H.
        • Leep C.
        • Ku L.
        Impact of the 2008–2010 economic recession on local health departments.
        J Public Health Manag Pract. 2012; 18: 106-114https://doi.org/10.1097/PHH.0b013e3182461cf2
        • Honoré P.A.
        Measuring progress in public health finance.
        J Public Health Manag Pract. 2012; 18: 306-308https://doi.org/10.1097/PHH.0b013e31824eb896
        • Bekemeier B.
        • Pantazis A.
        • Dunbar M.D.
        • Herting J.R.
        Classifying local health departments on the basis of the constellation of services they provide.
        Am J Public Health. 2014; 104: e77-e82https://doi.org/10.2105/AJPH.2014.302281
        • Mays G.P.
        • Smith S.A.
        Evidence links increases in public health spending to declines in preventable deaths.
        Health Aff. 2011; 30: 1585-1593https://doi.org/10.1377/hlthaff.2011.0196
        • Erwin P.C.
        • Shah G.H.
        • Mays G.P.
        Local health departments and the 2008 recession: characteristics of resiliency.
        Am J Prev Med. 2014; 46: 559-568https://doi.org/10.1016/j.amepre.2014.01.025
        • Bates L.J.
        • Santerre R.E.
        Does regionalization of local public health services influence public spending levels and allocative efficiency?.
        Reg Sci Urban Econ. 2013; 43: 209-219https://doi.org/10.1016/j.regsciurbeco.2012.07.001
        • Erwin P.C.
        • Greene S.B.
        • Mays G.P.
        • Ricketts T.C.
        • Davis M.V.
        The association of changes in local health department resources with changes in state-level health outcomes.
        Am J Public Health. 2011; 101: 609-615https://doi.org/10.2105/AJPH.2009.177451
        • Hsuan C.
        • Rodriguez H.P.
        The adoption and discontinuation of clinical services by local health departments.
        Am J Public Health. 2014; 104: 124-133https://doi.org/10.2105/AJPH.2013.301426
        • Winship C.
        • Radbill L.
        Sampling weights and regression analysis.
        Sociol Methods Res. 1994; 23: 230-257https://doi.org/10.1177/0049124194023002004
        • Manning W.G.
        • Mullahy J.
        Estimating log models: to transform or not to transform?.
        J Health Econ. 2001; 20: 461-494https://doi.org/10.1016/S0167-6296(01)00086-8
        • Efron B.
        • Tibshirani R.
        Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy.
        Stat Sci. 1986; 1: 54-75https://doi.org/10.1214/ss/1177013815
        • Mays G.P.
        • McHugh M.C.
        • Shim K.
        • et al.
        Getting what you pay for: public health spending and the performance of essential public health services.
        J Public Health Manag Pract. 2004; 10: 435-443https://doi.org/10.1097/00124784-200409000-00011
        • Eilbert K.
        • Barry M.
        • Bialek R.
        • Garufi M.
        Measuring Expenditures for Essential Public Health Services.
        Diane Publishing Company, Washington, DC1996
        • Gerzoff R.B.
        • Gordon R.L.
        • Richards T.B.
        Recent changes in local health department spending.
        J Public Health Policy. 1996; 17: 170-180https://doi.org/10.2307/3342696
        • Jordan M.M.
        Punctuations and agendas: a new look at local government budget expenditures.
        J Policy Anal Manage. 2003; 22: 345-360https://doi.org/10.1002/pam.10136
        • Jacoby W.G.
        • Schneider S.K.
        A new measure of policy spending priorities in the American states.
        Polit Anal. 2009; 17: 1-24https://doi.org/10.1093/pan/mpn009
        • Scutchfield F.D.
        • Knight E.A.
        • Kelly A.V.
        • Bhandari M.W.
        • Vasilescu I.P.
        Local public health agency capacity and its relationship to public health system performance.
        J Public Health Manag Pract. 2004; 10: 204-215https://doi.org/10.1097/00124784-200405000-00004
        • Leider J.P.
        The problem with estimating public health spending.
        J Public Health Manag Pract. 2013 Apr 26; ([Epub ahead of print])https://doi.org/10.1097/PHH.0b013e3182941a7b
        • Honoré P.A.
        • Clarke R.L.
        • Mead D.M.
        • Menditto S.M.
        Creating financial transparency in public health: examining best practices of system partners.
        J Public Health Manag Pract. 2007; 13: 121-129https://doi.org/10.1097/00124784-200703000-00007