1. Disparities in Public Health Resources in the Delta
Implications for Regionalization
Glen P. Mays, PhD, MPH Department of Health Policy & Management UAMS College of Public Health

2. Background: Local Public Health Resources and Performance
Wide variation in services performed by local public health systems
Wide variation in funding sources and levels for local public health services
Pressure for improving the effectiveness and efficiency of public health delivery

3. Variation in Local Public Health Spending
Median
20%
15%
10% 5% 0%
Percent
100
200
300
NACCHO, 1997
Expenditures per capita,

4. Local Public Health Funding Sources
NACCHO, 1997

5. Variation in Local Public Health System Performance
Performance of Local Public Health Systems, 1998
Mays et al. AJPH 2004

6. Performance Varies with Size of Public Health Jurisdiction
Spline Regression Estimates After Controlling for other Variables in the Model
Investigate
Inform
Monitor
Policy/plan
Partnerships
Mays et al. AJPH 2006

7. Performance Varies with Local Per Capita Spending
Percentage point 
Mays et al. JPHMP 2004

8. Rationale for Studying Public Health Resources in the Delta
Residents of the rural Lower Mississippi Delta experience disproportionately poor health and economic outcomes
Long history of failed interventions
Effective interventions require adequate public health infrastructure
Maintaining adequate infrastructure is difficult in small and rural communities

9. The Delta Region
Counties included in the 8 Lower Mississippi Delta states AR MO IL KY TN MS AL LA

10. The Delta Region Population Characteristics of the Delta RegionUS
Number of counties
240
3110
Population size (millions)
9.4
281.4
Per capita personal income ($)
22,718
29,469
Female life expectancy
77.2
79.7
Male life expectancy
69.9
74.3
Infant mortality rate
9.6
6.9
All-cause mortality rate
1047
869
Cancer mortality rate
232
200
Heart disease mortality rate
352
258

11. Study Objectives
Assess the extent and nature of disparities in public health resources in the Delta
Simulate the impact of regionalizing public health service delivery by pooling resources across small neighboring communities

12. Methods
Data from a national survey of local public health officials conducted in 1998 (N=497, response rate 78%)
public health activities performed within the community
local public health agency expenditures
local public health agency staffing levels
Use regression models to compare spending and staffing levels between Delta and Non-Delta communities while controlling for differences in economic, health, and social characteristics
Simulate the effects of regionalization using regression estimates of how local spending and staffing levels affect the performance of public health activities in the community

13. Regional Disparities in Public Health Spending in the Delta
Unadjusted Estimates of Local Public Health Spending per Capita

14. Regional Disparities in Public Health Spending in the Delta
Estimates of Local Public Health Spending per Capita Adjusted for Community Characteristics Affecting Need

15. Regional Disparities in Public Health Staffing in the Delta
Unadjusted Estimates of Local Public Health Staffing Ratios

16. Regional Disparities in Public Health Staffing in the Delta
Estimates of Local Public Health Staffing Ratios Adjusted for Community Characteristics Affecting Need

17. Simulated Effects of Consolidation
Predicted Change in Public Health Performance Scores Due to Consolidation of Jurisdictions with <25,000 Residents

18. Conclusions and Implications
Significant disparities in resources exist in the Delta region, but they are confounded by differences in community need
Inadequate public health resources may complicate efforts to develop sustainable interventions
Regionalized public health service delivery arrangements that allow agencies to pool their resources may help to address constraints

19. Conclusions and Implications
A variety of organizational arrangements may prove helpful
Shared services
Mutual aid agreements
Joint ventures/alliances
Formal consolidation/mergers