Equity in the allocation of core public health services in Ohio

Research has found racial and ethnic minorities have worse health than whites and often receive lower standards of healthcare.  Disabilities and lower levels of education and income are also associated with worse healthcare. This study extends this line of research, assessing whether those inequities extend to the allocation of public health core services.

Focusing on nuisance abatement and maternal and child health, this study starts with administrative data from all 135 Ohio local health districts.  This information includes spending, staffing and service counts.  This data is linked to demographics, community health status indicators, and NACCHO profile data.

We analyze the association between resource allocation and measures of equity.  The first group of equity comparisons focuses on population characteristics, such as race, income, education level, and proportion rural.  The second set looks at equity measures focused on estimated need, such as birth outcomes or number of required inspections.  The models are constructed using a GINI style measure that quantifies the variance of actual resource allocations from theoretical equity ideals.

Study findings will identify patterns and determinants of resource allocation equity.  Factors such as overall spending on all programs, population levels and administrative structure are incorporated into the analysis as controls.  Most MCH resource allocation is done via a formula, so findings from Ohio shed light on the equity of that federal program.  Nuisance abatement, on the other hand, is funded primarily from local sources, so measures of equity will reflect individual health district spending priorities.

This project is the start of a new line of research assessing the equity of public health resource allocations.  Equity research can help administrators and policy makers alter resource allocations to those areas that will benefit most.