Association of changes in local health department resources with changes in state-level health outcomes

The purpose of this study was to explore the association between changes in local health department (LHD) resources and changes in health outcomes at the state level. A retrospective cohort design was used. Data sets used included the National Association of County and City Health Officials (NACCHO) Profiles for 1996-97 and 2005, and the America's Health Rankings reports for 1998 and 2008. LHD data for expenditures, FTEs, jurisdictional population, and presence of a governing Board of Health (BOH) were aggregated to the state level, for both 1997 and 2005. Relative and absolute change between 1997 and 2005 were calculated for expenditures per capita, FTEs per capita, and the percent of the population covered by a LHD with a governing BOH. Relative and absolute changes in state-level health outcome data were determined for the 1998-2008 AHR report timeframe. The association between LHD inputs (aggregated to the state level) and health outcomes was assessed using three different methods, including a dichotomous categorization, pairwise correlation, and multivariate regression. Usable data were produced for 42 states. Significant associations were found between overall LHD inputs and changes in state health rankings. In particular, increases in LHD expenditures were significantly associated with decreases in infectious disease morbidity at the state level (p = 0.037), and increases in full-time equivalent staff per capita were significantly associated with decreases in cardiovascular disease mortality (p = 0.014), when controlling for other factors. These results add to the empirical evidence that local public health activity is associated with improved health outcomes. These findings can be used to advocate for LHD support and may have policy implications for developing evidence-based standards for a National Public Health Accreditation Program.