Targeted health department expenditures benefit birth outcomes at the county level.
BACKGROUND
Public health leaders lack evidence for making decisions about the optimal allocation of resources across local health department (LHD) services, even as limited funding has forced cuts to public health services while local needs grow. A lack of data has also limited examination of the outcomes of targeted LHD investments in specific service areas.


OBJECTIVE
This study used unique, detailed LHD expenditure data gathered from state health departments to examine the influence of maternal and child health (MCH) service investments by LHDs on health outcomes.


METHODS
A multivariate panel time-series design was used in 2013 to estimate ecologic relationships between 2000-2010 LHD expenditures on MCH and county-level rates of low birth weight and infant mortality. The unit of analysis was 102 LHD jurisdictions in Washington and Florida.


RESULTS
Results indicate that LHD expenditures on MCH services have a beneficial relationship with county-level low birth weight rates, particularly in counties with high concentrations of poverty. This relationship is stronger for more targeted expenditure categories, with expenditures in each of the three specific examined MCH service areas demonstrating the strongest effects.


CONCLUSIONS
Findings indicate that specific LHD investments in MCH have an important effect on related health outcomes for populations in poverty and likely help reduce the costly burden of poor birth outcomes for families and communities. These findings underscore the importance of monitoring the impact of these evolving investments and ensuring that targeted, beneficial investments are not lost but expanded upon across care delivery systems.
School of Nursing, Psychosocial & Community Health, University of Washington, Seattle, Washington. Electronic address: bettybek@uw.edu.
Betty
B
Bekemeier
School of Nursing, Psychosocial & Community Health, University of Washington, Seattle, Washington; Chonbuk National University College of Nursing, Jeonju, South Korea.
Youngran
Y
Yang
Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington.
Matthew D
MD
Dunbar
Department of Sociology, University of Washington, Seattle, Washington.
Athena
A
Pantazis
School of Public Health Department of Health Services, University of Washington, Seattle, Washington.
David E
DE
Grembowski
D003695:Delivery of Health Care / Q000191:economics; D005431:Florida; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D009111:Local Government; D008430:Maternal-Child Health Centers / Q000191:economics*; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011203:Poverty; D011634:Public Health / Q000191:economics*; D040841:Resource Allocation / Q000191:economics; D014861:Washington