US local public health department spending between 2008 and 2016 did not increase for communities in need

Olivia Reszczynski,Kaitlyn Shultz,Nandita Mitra,Krisda H Chaiyachati,John Connolly,Sheila Kelly,Atheendar Venkataramani,Jeffrey Hom

doi:10.1186/s12913-022-07613-2

Abstract

BackgroundGreater US local public health department (LPHD) spending has been associated with decreases in population-wide mortality. We examined the association between changes in LPHD spending between 2008 and 2016 and county-level sociodemographic indicators of public health need.MethodsMultivariable linear regression was used to estimate the association between changes in county-level per-capita LPHD spending and 2008 sociodemographic indicators of interest: percent of population that was over 65 years old, Black, Hispanic, in poverty, unemployed, and uninsured. A second model assessed the relationship between changes in LPHD spending and sociodemographic shifts between 2008 and 2016.ResultsLPHD spending increases were associated with higher percentage points of 2008 adults over 65 years of age (+$0.53 per higher percentage point; 95% CI: +$0.01 to +$1.06) and unemployment (−$1.31; 95% CI: −$2.34 to −$0.27). Spending did not increase for communities with a higher proportion of people who identified as Black or Hispanic, or those with a greater proportion of people in poverty or uninsured, using either baseline or sociodemographic shifts between 2008 and 2016.ConclusionFuture LPHD funding decisions should consider increasing investments in counties serving disadvantaged communities to counteract the social, political, and structural barriers which have historically prevented these communities from achieving better health.

Highlights

Greater US local public health department (LPHD) spending has been associated with decreases in population-wide mortality
The evidence supporting the value of US local public health departments (LPHDs), who financially support infrastructure or programs designed to promote health and prevent disease and injury, has been consistently positive
27% of funding for LPHDs is supported by federal sources, with a greater proportion of funding derived from state tax revenues, local tax revenues, and grants [5]

Summary

Introduction

Reszczynski et al BMC Health Services Research (2022) 22:237 of HIV, and the COVID-19 pandemic [5,6,7,8] These crises have disproportionately affected older adults, racial and ethnic minorities, and the impoverished [9]. Given these dynamics, it is imperative to examine how public health investments in disadvantaged counties have changed over time. It is imperative to examine how public health investments in disadvantaged counties have changed over time Such knowledge will illuminate how federal, state, and local policymakers should consider plans for allocating or reallocating funds to LPHDs to localities that have experienced disproportionally worse health and public health crises, addressing ongoing public health crises in the near term, and preventing those that may arise in the future. The absolute quantity and proportion of non-federal dollars supporting LPHDs varies within and across states, and whether this variation reflects the variable needs of local communities is understudied

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