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Can Voter-Approved Tax Levies Provide Fiscal Advantages and Stability for Local Public Health Agencies?

Schmalzried, Hans D. PhD, MSEPH; Fallon, L. Fleming Jr MD, DrPH

Journal of Public Health Management and Practice: May/June 2013 - Volume 19 - Issue 3 - p E14–E19
doi: 10.1097/PHH.0b013e31825b8a13
Original Articles

Context: Major funding cuts have occurred throughout the United States public health system during the past several years. Funding for local public health agency (LPHA) services and programs is obtained through a patchwork of sources that vary both within and among states. Even though local city and county sources provide a significant proportion of funding for LPHAs, information available in the literature about these revenues is sparse and is not clearly described.

Objective: This study focused on a single specific revenue stream included in the local sources (local city and county) category: funds voted on directly by the public. The primary purpose of this study was to examine whether this type of funding source provided fiscal advantages for LPHAs. Specifically, we wanted to see how sensitive levy votes were to changing general economic conditions.

Methods: A questionnaire to collect LPHA levy data was developed, approved, and mailed to county boards of elections in Ohio (n = 88). Elections officials were asked to provide voting results for all LPHA levy ballot attempts since 1994 regardless of outcome.

Results: In the study period (1994 through 2011), 250 LPHA property tax levies were placed on election ballots in Ohio. LPHAs were successful in 155 (62.0%) and unsuccessful in 95 (38.0%) attempts. Over the 18-year period, the most noteworthy outcome was a 94.6% pass rate for renewal levies.

Conclusion: Our study demonstrated that voter-approved tax levies provide some fiscal advantages for LPHAs: higher per capita revenues than those who have to rely on other sources of income and predictable revenue streams. This translates into more funds being available for public health programs and services. Property tax levies allow citizens to make direct investments in their local health departments.

This study examines whether funds voted on directly by the public provided fiscal advantages for local public health agencies (LPHAs) and demonstrates that voter-approved tax levies provide some fiscal advantages for LPHAs.

Department of Public and Allied Health, Bowling Green State University, Bowling Green, Ohio.

Correspondence: Hans D. Schmalzried, PhD, MSEPH, Department of Public and Allied Health, Bowling Green State University, 231 Health Center, Bowling Green, OH 43403 (

The authors thank Andrew Mariani, MPH, and Stephen Thomas, MPH, for their contributions to this study.

The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.