Intelligent design in public health fund allocation

This study searches for evidence that public health spending changes are related to factors associated with public health need or outcomes. During the natural experiment initiated by the recession that began in 2007, almost every state experienced reduced revenues and had to look for ways to cut spending. This study starts with a measure of change in local health department budgets and expenditures between 2008 and 2010. These figures are retrieved from the national profile compiled by the National Association of County and City Health Officials, and includes all health departments in all states. This information is linked to US Census socioeconomic and demographic variables, such as poverty, race and education. Key measures of public health outcomes and need from Community Health Status Indicators are also linked. Multivariate regression is used to estimate the influence of demographics, health status, outcomes and departmental characteristics on spending changes. The goal is to detect a rationale behind fund allocations. Were spending cuts uniformly applied, with all public health districts loosing the same amount? Or did areas with lower need get disproportionately larger cuts? At the national level, there is no evidence of consistent decision rules regarding public health spending changes. Although the study finds a number of factors influence changes in public health spending, the strength and direction of those influences often varies from state to state. At the overall national level, for example, neither population size nor a rural setting impacted spending. But for both factors, some states saw large significant increases while others experience significant decreases. This study furthers understanding of public health funding decisions. Although funding formulas, history and politics can constrain the ability of decision makers to make optimal funding decisions, this study helps identify known influences.