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Local Health Departments' Spending on the Foundational Capabilities

Singh, Simone R. PhD; Bekemeier, Betty PhD, MPH, FAAN; Leider, Jonathon P. PhD

Journal of Public Health Management and Practice: February 14, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000922
Research Brief Report: PDF Only

Improving our nation's public health system requires a detailed understanding of public health expenditures and related revenue sources, yet no comprehensive data source exists that contains such information for governmental health agencies at all levels. Using pilot study data of a standardized financial accounting framework for public health agencies—in the form of a uniform chart of accounts crosswalk—this article presents local health departments' (LHDs') expenditures on the foundational capabilities, that is, crosscutting skills and capacities needed to support all of an LHD's programs and activities. Among 16 sample LHDs from 4 states, per capita foundational capabilities spending ranged from $1.10 to $26.19, with a median of $7.67. Larger LHDs and LHDs with greater financial resources spent more per capita, as did accredited LHDs. Future work using data from a larger sample of LHDs is needed to examine agency and community-level characteristics associated with adequate funding for the foundational capabilities.

Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan (Dr Singh); Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, Washington (Dr Bekemeier); and Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota. (Dr Leider).

Correspondence: Simone R. Singh, PhD, Department of Health Management and Policy, University of Michigan School of Public Health, 1420 Washington Heights, M3533 SPH II, Ann Arbor, MI 48109 (

This study was supported by grant no. 73187 from the Robert Wood Johnson Foundation. The authors gratefully acknowledge the enthusiasm, wisdom, and practical expertise brought to this project by the leaders and staff of their study's 20 participating health departments.

The authors declare no conflicts of interest.

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