Reconfiguring the organization and financing of public health systems in some communities-such as through consolidation and enhanced intergovernmental coordination-may hold promise for improving the performance of essential services.

The period from the 1980s to the present has witnessed a lively and unsettled debate concerning the legalization of marijuana, cocaine, heroin, and other illicit substances in the United States. Proponents of legalization argue that the demand for these harmful and potentially addictive substances is not responsive to price. Opponents argue that prices will fall tremendously in a regime characterized by legalization and that the option of legalization and taxation is not feasible. In this paper we summarize theoretical and empirical evidence suggesting that none of these propositions is correct.

Governmental spending in public health varies widely across communities, raising questions about how these differences may affect the availability of essential services and infrastructure. This study used data from local public health systems that participated in the National Public Health Performance Standards Program pilot tests between 1999 and 2001 to examine the association between public health spending and the performance of essential public health services. Results indicated that performance varies significantly with both local and federal spending levels, even after controlling for other system and community characteristics. Some public health services appear more sensitive to these expenditures than others, and all services appear more sensitive to local spending than to state or federal spending. These findings can assist public health decision makers in identifying public health financing priorities during periods of change in the resources available to support local public health infrastructure.