Fiscal Allocation for Public Health: Findings from New Census Data

Research Objective: Local sources of funding are a critical source of revenue for local health departments (LHDs). However, the relationship between LHD local revenues and local taxes is unknown, as are correlates of variation in LHD local revenue funding. The purpose of our study was to develop a national measure of the proportion of local tax revenues allocated to LHDs, identify associations between LHD local funding and public health service provision, and track changes in these measures before versus after the Great Recession.

Study Design: Data on LHD characteristics, including local sources of revenue, were obtained from the 2008 National Association of County and City Health Officials Profile survey. We matched this with 2007 local tax data from U.S. Census Bureau. Our outcome of interest is “fiscal allocation for local public health”, calculated as local revenues reported by LHDs divided by total local governmental tax revenue. Multivariable models were estimating using generalized linear models and robust standard errors clustered at the state level. Sample included data on 1,526 LHDs.

Principal Findings: LHD fiscal allocation varies substantially within and between states. Higher baseline fiscal allocation was associated with a greater number of services provided to the community, controlling for LHD setting, governance, total spending, services via other sources, and state-level clustering.

Conclusions: While local sources of revenue are important parts of the LHD budget, it generally constitutes only a small proportion of overall local governmental tax revenue. LHDs with broad service portfolios can make evidence-based calls for local funding commensurate with their work in the community, especially relative to peer departments within and across states. Current work will inform analysis of soon-to-be-released U.S. Census Bureau data from 2012 that will enable analysis of changes in fiscal allocation for public health before and after the Great Recession.