Does More Public Health Spending Buy Better Health?

Abstract

Background:In this article, we attempt to address a persistent question in the health policy literature: Does more public health spending buy better health? This is a difficult question to answer due to unobserved differences in public health across regions as well as the potential for an endogenous relationship between public health spending and public health outcomes.Methods:We take advantage of the unique way in which public health is funded in Georgia to avoid this endogeneity problem, using a twelve year panel dataset of Georgia county public health expenditures and outcomes in order to address the “unobservables” problem.Results:We find that increases in public health spending lead to increases in mortality by several different causes, including early deaths and heart disease deaths. We also find that increases in such spending leads to increases in morbidity from heart disease.Conclusions:Our results suggest that more public health funding may not always lead to improvements in health outcomes at the county level.

Government Spending In Health And Nonhealth Sectors Associated With Improvement In County Health Rankings

“…26 For example, in some states where funding for public health is determined formulaically, areas with low health status receive proportionately more funding than other areas. Thus, public health spending and health outcomes may be endogenous, 27 and the relationships observed between the two should be viewed as associative instead of causal.…”

The differential effects of rural health care access on race-specific mortality

“…We know that there are geographic variations in public health spending ( Mays & Smith, 2009 ), but that they exist has not yet been linked to health-related disparities nationwide. Recent studies examined how changes in public health expenditures affected health outcomes, but only in California ( Brown, Martinez-Gutierrez, & Navab, 2014 ) and Georgia ( Marton, Sung, & Honore, 2015 ).…”

Public Health and Corporate Avoidance of U.S. Federal Income Tax

“…Some public health programs are funded by state governments (sometimes passing through federal funds) and thus, there is a need for research about the relationship between corporate avoidance of state income taxes (Gardner, Davis, McIntyre, & Phillips, ) and state and local public health services, and whether the additional funding would improve health (Marton et al, ). The relationship between federal and state tax codes complicates such analyses (Clausing, ).…”

“…Although public health researchers have identified the influence of many corporate products and practices on public health (Kenworthy, MacKenzie, & Lee, ), there are few empirical studies about taxation and health outcomes (Kim, ; McCoy, Chigudu, & Tillmann, ; Reeves et al, ), and none about the effects of corporate income tax avoidance on public health (Wiist, ). There is a body of political science research about corporate taxation and political influence (Donohoe, McGill, & Outslay, ; Hanlon & Heitzman, ; Stratman, ) that public health could build on, and public health economists, political epidemiologists, and health policy analysts have compatible research agendas, surveillance, and other methodologies for conducting such research (Beckfield & Krieger, ; Bernet, ; Carande‐Kulis, Getzen, & Thacker, ; Erwin, ; Marton, Sung, & Honore, ). The unfamiliarity of many public health professionals with the terminology, analytic methods, and data sources of tax economics, accounting, and the commonly used business data sources, support the recommendation of Stuckler, Reeves, Karanikolos, and McKee () for conducting economic research across disciplinary “silos.”…”