Dollars and disparities: A longitudinal study of the effects of title v investments on select maternal and child health outcomes

Proper financing of the public health system is integral to governmental public health's role in assuring that services delivery is available in every community. Maternal and Child Health investments, the Title V MCH Block Grants (Title V), vary widely across states and overtime. However, there is limited empirical evidence on the causes and consequences of these variations. The purpose of this study is to analyze the effects of Title V spending variations on select MCH outcomes (infant mortality, low birth weight, and teen birth rate) and health disparities. The effects of state fiscal capacity, fiscal effort, and fiscal generosity on Title V spending are measured as possible sources of variations. This ten-year quasi-experimental longitudinal study uses panel data constructed by linking data from: the Consolidated Federal Funds Report, Census of Governments, National Vital Statistics System – Birth Data, Title V Information System, Pregnancy Risk Assessment Monitoring System, Census Bureau's Population Estimates, and Medicaid eligibility for low-income children and pregnant women. Fixed-effect regression models are used to estimate the effects of Title V on each health outcome measures while controlling for socio-economic determinants of health. Measures of political economy influencing governmental decision-making are used as instrumental variables to control the effects of unmeasured heterogeneity in Title V spending that might distally influence health outcomes. This research is currently being conducted as the primary author's dissertation and will be completed by the 2013 APHA Annual Meeting. Findings will provide unbiased measures of the causes and consequences of Title V spending across states and over time, during a period with a national economic recession and new health care reform law (2000-2010). In addition, the findings will provide evidence to inform MCH policy and management of Title V spending to ensure target populations receive appropriate services and mitigate racial and ethnic health disparities.