Trends in Variation in Public Health Spending Across Programmatic Areas: Evidence from Washington and Florida

Examining the variation in investments in local public health services is an important first step in understanding existing disparities in population level health metrics. Previous research has documented the breadth of variation in total public health spending but due to limitations in data reporting there is little evidence regarding variation in expenditures by programmatic domain at the level of the local health department (LHD) across states. This study provides a longitudinal examination of change in expenditures across two states in four major areas of public health practice; maternal and child health (MCH), communicable disease control (INF), chronic disease programs (CHD), and environmental health (EH). Annual LHD financial data was collected as part of the Public Health Activities and Services Tracking (PHAST) study in collaboration with state-level Practice Based Research Networks (PBRN) in Florida (FL) and Washington State (WA) for the period from 2005 to 2010. Expenditures by programmatic area were examined both in combination and separately by state to evaluate trends. Community and organizational level control variables were included in modeling.Findings indicate that while overall expenditures for local public health in FL and WA may be increasing during the study period, that trend is not true for each of the primary programmatic domains of service. MCH and EH services have been targeted more in budget cuts among this study population. Since the expiration of the Federal preparedness grants spending on INF programs has decreased. These findings suggest that expenditures when considered at the programmatic area level are not uniformly rising and thus further research is indicated to examine the relationship of this variation to population health.