title: Building the evidence for decision-making: the relationship between local public health capacity and community mortality.
abstract: OBJECTIVE
  We examined associations between local health department (LHD) spending, staffing, and services and community health outcomes in North Carolina.
  
  
  METHODS
  We analyzed LHD investments and community mortality in North Carolina from 2005 through 2010. We obtained LHD spending, staffing, and services data from the National Association of City and County Health Officials 2005 and 2008 profile surveys. Five mortality rates were constructed using Centers for Disease Control and Prevention mortality files, North Carolina vital statistics data, and census data for LHD service jurisdictions: heart disease, cancer, diabetes, pneumonia and influenza, and infant mortality.
  
  
  RESULTS
  Spending, staffing, and services varied widely by location and over time in the 85 North Carolina LHDs. A 1% increase in full-time-equivalent staffing (per 1000 population) was associated with decrease of 0.01 infant deaths per 1000 live births (P < .05). Provision of women and children's services was associated with a reduction of 1 to 2 infant deaths per 1000 live births (P < .05).
  
  
  CONCLUSIONS
  Our findings, in the context of other studies, provide support for investment in local public health services to improve community health.
authors.affiliation: Anna P. Schenck is with the North Carolina Institute for Public Health and the Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Anne Marie Meyer is with the Epidemiology Department, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Tzy-Mey Kuo is with the Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill. Dorothy Cilenti is with the Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina.
authors.forename: Anna P
authors.initials: AP
authors.lastname: Schenck
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Meyer
authors.forename: Tzy-Mey
authors.initials: TM
authors.lastname: Kuo
authors.forename: Dorothy
authors.initials: D
authors.lastname: Cilenti
mesh_terms: D003657:Decision Making; D006801:Humans; D009111:Local Government; D009026:Mortality; D009657:North Carolina; D010561:Personnel Staffing and Scheduling; D011635:Public Health Administration / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D015980:Public Health Practice / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies