Abstract
Objectives Public health and social services spending have been shown to improve health outcomes at the county level, although there are significant state and regional variations in such spending. Texas offers an important opportunity for examining nuances in the patterns of association between local government health and social services spending and population health outcomes. The primary objectives of this study were to describe local investments in education, health, and social services at the county-area level for all of Texas from 2002 through 2012 and to examine how changes in local investment over time were associated with changes in health outcomes. Methods We used two large secondary data sources for this study. First, US Census Bureau data were used to measure annual spending by all local governments on public hospitals, community health care and public health, and >1 dozen social services. Second, County Health Rankings & Roadmaps data measured county health outcomes. We performed regression models to examine the association between increases in local government spending and a county's health outcomes ranking 4 years later. Multilevel mixed-effects linear regression models accounted for mean spending in each category, county health factors ranking, and county and state random effects. Results Local governments in Texas spent an average of $4717 per capita across all health and social services. Although spending was relatively consistent across 2002-2012, there was notable variation in spending across counties and services. Regression models found that changes in four spending categories were associated with significant improvements in health outcomes: fire and ambulance, community health care and public health, housing and community development, and libraries. For each, an additional one-time investment of $15 per capita was associated with a 1-spot improvement in statewide county health rankings within 4 years. Conclusions Existing evidence regarding the association between social services spending and health outcomes may not yield sufficiently granular data for policy makers within a single state. Investments in certain social services in Texas were associated with improvements in health outcomes, as measured by improvements in the County Health Rankings, in the years subsequent to spending increases. Similar analyses in other states and regions may yield actionable avenues for policy makers to improve population health.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 91-97 |
| Number of pages | 7 |
| Journal | Southern Medical Journal |
| Volume | 112 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2019 |
| Externally published | Yes |
Bibliographical note
Funding Information:From the Arizona State University School for the Science of Health Care Deliv-ery, Phoenix, and the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. Correspondence to Dr J. Mac McCullough, Arizona State University, 550 N 3rd St, Phoenix, AZ 85004. E-mail: mccullough@asu.edu. To purchase a single copy of this article, visit sma.org/smj-home. To purchase larger reprint quantities, please contact Reprintsolutions@wolterskluwer.com. This work was funded in part by a grant from the Episcopal Health Foundation, Houston, TX. The authors did not report any financial relationships or conflicts of interest. Accepted August 13, 2018. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (http://sma.org/smj-home). Copyright © 2019 by The Southern Medical Association 0038-4348/0–2000/112-91 DOI: 10.14423/SMJ.0000000000000935
Publisher Copyright:
© 2019 by The Southern Medical Association.
Keywords
- county health rankings
- local government
- population health
- public health
- social services