Online Program

Targeted maternal/child health expenditures by local health departments can impact health outcomes

Tuesday, November 5, 2013 : 8:50 a.m. - 9:10 a.m.

Betty Bekemeier, PhD, MPH, FAAN, Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA
Youngran Yang, PhD, MPH, RN, University of Washington School of Nursing, Seattle, WA
David Grembowski, PhD, Department of Health Services, University of Washington, Seattle, WA
Matthew Dunbar, PhD, Center for Studies in Demography and Ecology, University of Washington, Seattle, WA
Background: Major local health department (LHD) cuts, in relation to the economic crisis, have occurred in the area of maternal and child health (MCH). Little evidence exists, however, regarding the outcomes associated with these services and how changes in MCH investments impact health. In connection with the Public Health Activities and Service Tracking (PHAST) study and in collaboration with 2 Public Health Practice-Based Research Networks (PBRN), we examined relationships between MCH-related investments of LHDs and health outcomes for women and children.

Methods: We used a multivariate panel time series design to estimate ecologic associations between annual MCH expenditures and related county-level outcomes, while controlling for other factors—including the availability of those services via alternative providers. Our sample included 102 LHDs and covered 11 years (2000 to 2010). Health outcomes examined included rates of no/late prenatal care, teenage births, low birth weight, and infant mortality.

Results: LHD expenditures for MCH services appear to have beneficial relationships with related health outcomes. This relationship is strongest and most consistent for more targeted expenditure categories—with expenditures in each of three individual MCH service areas (WIC, Family Planning, and a composite of Maternal/Infant/Child/Adolescent) demonstrating the strongest relationships; followed by relationships observed with aggregated totals of MCH expenditures. Total LHD expenditures produced the weakest relationship to health outcomes.

Conclusions: Findings suggest that LHD budget cuts to MCH services could undermine positive relationships between MCH expenditures and health outcomes for women and children. Annual expenditure data compiled through PHAST provide the potential for timely additional practice-based research.

Learning Areas:

Administration, management, leadership
Public health or related public policy
Public health or related research

Learning Objectives:
Describe the relationship found between health outcomes and related MCH expenditures among local health department jurisdictions in Florida and Washington. Describe the nature of the difference that exist between certain levels of LHD expenditures and their association with health outcomes.

Keyword(s): Public Health Administration, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal author on the research to be presented and have substantial experience in public health systems research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.