Geographic Variations in Public Health Spending

Correlates and Consequences

As state and local health departments continue to cope with budget cuts, job losses and the demands of preparing communities for both seasonal and H1N1 flu, it’s more important than ever to build the evidence for what works—and what is cost-effective—in public health. The field of Public Health Services and Systems Research (PHSSR) answers some of the most important and challenging questions about how public health can be structured, managed, staffed, funded and organized so it can improve the lives of the people it serves.

This month, the journal Health Services Research published an RWJF-funded issue devoted to the latest research in PHSSR featuring nine papers that cover a range of topics, from the implications of geographic variation in public health spending to recommendations about how best to implement quality improvement methods in public health departments. The journal issue was co-edited by F. Douglas Scutchfield, the Peter P. Bosomworth Professor of Health Services Research and Policy at the University of Kentucky College of Public Health and Nicole Lurie, assistant secretary for Preparedness and Response at the U.S. Department of Health and Human Services.

“The research in this special issue gets to the heart of the field of PHSSR, answering questions about how public health can best be funded and organized,” said RWJF Senior Program Officer Debra Perez, Ph.D., M.P.A., M.A., and co-author of a commentary in the issue. “Lessons learned from this research will ultimately identify strategies to keep people healthier and ensure that they receive critical public health services.”

Lessons learned from PHSSR research can often inform both public health practitioners and policymakers. An article by Glen P. Mays and Sharla A. Smith in the special PHSSR issue suggests that medical care spending to treat people may actually be at the expense of investing in public health programs meant to keep people from getting sick in the first place. Mays and Smith found that local public health agency spending varies widely across communities, suggesting that depending on where they live, people have greater or lesser access to public health services. Geographic variations in medical care spending have long been a source of discussion among policy-makers and medical professionals, and this study shows that these variations occur to an even greater degree when it comes to public health spending. Clearly, the nation’s medical care and “prevention delivery” systems are closely connected, underscoring the need for an overall health system that takes into account both treatment and prevention.