Budget Cuts and Health Outcomes: Examining a Natural Experiment

Year: 2011
Funding: NNPHI PHS2 Award
Status: Completed

Back to Grantee Profiles                                                                                                           


Our study will use longitudinal local health department (LHD) expenditure data for categories of service expenditures (i.e. Maternal/Child Health, Environmental Health, Communicable Disease Control) in 305 LHDs from four states over six years (2005-2010). The current unfortunate economic crisis provides a unique “natural experiment” to examine relationships between changes in LHD expenditures for specific LHD services and changes in population health behaviors and proximal health outcomes on the county level. Unique and critical partnerships with Public Health Practice-based Research Networks (PBRNs) and the University of Washington’s Center for Studies in Demography and Ecology (CSDE) will underlie the promising and innovative geospatial and statistical approach we will use to examine a poorly understood area of Public Health Systems and Services Research (PHSSR). Understanding these relationships is vital to developing an evidence base for public health planning and decision-making.                                                                                   


  • Local health department environmental health expenditures and their impact on health: Findings from the Public Health Activities and Services Tracking (PHAST) Study (PHSSR Keeneland Conference, April 2014)
  • Targeted maternal/child health expenditures by local health departments can impact health outcomes (APHA Annual Meeting, November 2013)
  • Understanding local health department service philosophy: A latent class analysis of NACCHO profile data (APHA Annual Meeting, November 2013; PHSSR Keeneland Conference, April 2013)
  • Delivering data for decision-making in Washington: An academic/practice partnership examining state and local spending and services (APHA Annual Meeting, November 2013)
  • Delivering data for Decision-Making in Washington: A practice-based partnership to optimize data accessibility & utility (AcademyHealth PHSR IG, June 2013)
  • Targeting Resources: The Benefits of Targeted Local Health Department Expenditures on Health Outcomes for Women & Children (AcademyHealth Annual Research Meeting, June 2013)
  • Engaging public health practitioners in data analysis and interpretation: The PHAST experience, (PHSSR Keeneland Conference, April 2013)
  • Local health department expenditures on MCH impact health outcomes: Findings from PHAST for advancing policy (PHSSR Keeneland Conference, April 2013)




Betty Bekemeier
University of Washington

Research Areas