142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Local Health Department Environmental Health expenditures and their impact health: Findings from the Public Health Activities and Services Tracking (PHAST) Study

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 9:10 AM - 9:30 AM

Betty Bekemeier, RN, PhD, FAAN , School of Nursing, Department of Psychosocial & Community Health, University of Washington, Seattle, WA
Michelle Pui-Yan Yip, MN, MHA , Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA
Tao S. Kwan-Gett, MD, MPH , Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, WA
Matthew Dunbar, PhD , Center for Studies in Demography and Ecology, University of Washington, Seattle, WA
Greg Whitman , School of Nursing, University of Washington, Seattle, WA
David Grembowski, PhD, MA , Health Services, University of Washington School of Public Health, Seattle, WA

Public health practice-level decisions regarding the distribution of public health services and system investments have largely been based on “conventional wisdom or expert opinion.” The Institute of Medicine (IOM) attributes the failure to make informed decisions based on evidence, in part, to a lack of accessible data that measure the volume and reach of services provided by public health agencies. In connection with the Public Health Activities and Service Tracking (PHAST) Study, our research objective was to investigate relationships between local-level Food Safety and Sanitation expenditures and health outcomes.


Uniquely detailed, unpublished annual local-level Food Safety and Sanitation expenditure data were obtained from state health departments in Washington (WA) and New York (NY). Through engagement with practice partners across the states, data were matched across 93 LHDs and over 2000-2010. We used a multivariate panel time-series design to examine relationships between Food Safety and Sanitation expenditures and annual rates of the most common notifiable enteric diseases.


Higher LHD Food and Sanitation spending were found to be associated with a lower incidence of Salmonellosis in WA, a lower incidence of Cryptosporidiosis in NY, and a lower overall incidence of Hepatitis A.   


Beneficial relationships appear to exist between LHDs’ specific food and sanitation expenditures and certain related enteric disease outcomes. Detailed administrative data that represent changes and variation in service delivery can be used to examine important research questions for public health practice, when reviewed and examined in collaboration with practice partners.

Learning Areas:

Administration, management, leadership
Protection of the public in relation to communicable diseases including prevention or control
Public health administration or related administration
Public health or related public policy
Public health or related research

Learning Objectives:
Describe the relationship found between health outcomes and related environmental health administrative expenditures among local health department jurisdictions in Washington and New York. Describe the nature of the difference that exist between certain levels of expenditures administered by LHDs and their association with health outcomes.

Keyword(s): Public Health Administration, Funding/Financing

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have substantial experience in public health practice, public health practice-based research, and public health systems.
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.