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Rural Public Health Financing: Implications for Community Health Promotion Initiatives

Meit, Michael MA, MPH; Ettaro, Lorraine PhD, MPH; Hamlin, Benjamin N. MPH; Piya, Bhumika BA

Journal of Public Health Management and Practice: May-June 2009 - Volume 15 - Issue 3 - p 210–215
doi: 10.1097/01.PHH.0000349738.73619.f5
Article

Background Public health in rural areas has distinctive features, often shaped by state-level infrastructure and organization and financing of public health activities. Variation in the way funds are distributed can influence the ability of local health departments and nongovernmental organizations serving rural communities to conduct public health functions.

Purpose The purpose of this article was to describe how federal funds for selected chronic disease prevention and health promotion activities are distributed through states to the local level and identify infrastructure-related barriers that local health departments and nongovernmental organizations may face in securing these funds.

Methods Thirty semistructured interviews were conducted with individuals at the state and local levels responsible for managing funds and implementing initiatives in selected disease areas across six states, using a standardized protocol through which select funds were followed from the state to the local level.

Results Respondents report that states do not get sufficient Centers for Disease Control and Prevention funding for diabetes, cancer, and injury prevention to distribute effectively to the local level. Local funding, when provided, tends to be allocated through competitive mini-grant processes that are often difficult for rural communities to access because of infrastructural challenges. Mini-grant amounts are often too limited to build local program capacities and often awarded to communities with existing capacities.

This study describes how federal funds for selected chronic disease prevention and health promotion activities are distributed through states to the local level to identify infrastructure-related barriers that local health departments and nongovernmental organizations serving rural communities may face in securing and using funds for such purposes.

Michael Meit, MA, MPH, is Deputy Director, Walsh Center for Rural Health Analysis, NORC at the University of Chicago, Bethesda, Maryland.

Lorraine Ettaro, PhD, MPH, is Interim Director and Visiting Assistant Professor of Public Health, University of Pittsburgh Center for Rural Health Practice, Bradford, Pennsylvania.

Benjamin N. Hamlin, MPH is Senior Research Analyst, Walsh Center for Rural Health Analysis, NORC at the University of Chicago, Bethesda, Maryland.

Bhumika Piya, BA, is Research Analyst, Walsh Center for Rural Health Analysis, NORC at the University of Chicago, Bethesda, Maryland.

Corresponding Author: Michael Meit, MA, MPH, Walsh Center for Rural Health Analysis, NORC at the University of Chicago, Bethesda, MD 20814 (meit-michael@norc.org).

This research was funded by the Federal Office of Rural Health Policy, Grant 1U1CRH03715.

© 2009 Lippincott Williams & Wilkins, Inc.