Local Funding for Public Health a Key Variable of Equitable Access

Using data from NACCHO's 2008 National Profile of Local Health Departments (LHDs), this study assess the correlation between the level of public health services at local health departments and i) departments' reliance on local funding, ii) the local tax burden and iii) the number of local taxing authorities. This study builds on the existing literature of how certain LHDs rely more heavily on local funding (Meit et.al 2008), and proceeds to determine what factors further impact that reliance. The study uses the NACCHO data and builds a database on local level tax burdens (Tax Foundation), and a second database on local financing characteristics built from in-depth financial data from counties across ten states. Using the county-specific local financing data and NACCHO's data the study explores the relationship between service levels and local financing characteristics.

Initial results show that counties in which LHDs funding is reliant on local level financing (specifically through local level taxes) have fewer LHDs, provide fewer services per capita, are more susceptible to funding changes, and are impacted by changes that occur as a result of electoral events. Initial findings indicate that funding for local public health, as with many different social services, are determined less by the needs of the population and more by the socio-political characteristics of the local area.

There are few studies that look at this variation, and therefore it has not been a major focus of public health advocacy, this study will bring attention to the importance of local level policy-making and funding in eliminating disparities in public health access.