A finely tuned analysis of state and local health spending indicates that the structure of state public health departments has minimal impact on spending patterns.

Estimates of public health spending often “double-count” money spent by state and local health departments (LHDs). State agencies sometimes report having used funds that only “passed through” their coffers on the way to LHDs. Public health leaders have demanded more precise accounting of state and local finances.

“Data harmonization” is the practice of standardizing and coordinating investigations of a particular issue. Until now, public health finance has lacked sufficient data harmonization. The authors of this report have harmonized data from two organizations: The Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO).

The analysis used several variables to counteract the double-counting problem. The authors described spending based on seven categories for the population size of each jurisdiction.

Key Findings:

• Expenditures by freestanding versus umbrella state health organizations were $104 and $110, respectively, per person.
• States that represented the middle 50 percent of spending levels, spent between $90 and $125 per person.

The Robert Wood Johnson Foundation is one of several organizations promoting data harmonization efforts. This article describes state and LHD spending in 2008, accounting for “pass-through” funds that often distort statistical analyses of public health spending.