DPH 840 Module 5 Public Budgets and Population Health Example

Following the Money: A County Health Department Budget and What It Means for Population Health

Student Name

Doctor of Public Health Program, Aspen University

DPH 840: Strategic Planning and Financial Management in Public Health

Instructor Name

Month Day, Year

Following the Money: A County Health Department Budget and What It Means for Population Health

A budget reveals an organization's real priorities more clearly than its mission statement. For a public health agency, the budget also shapes population health, because it determines which services exist, where and for whom. This paper analyzes the budget of a public health agency in a composite county of 420,000, examines the evidence linking public spending to health outcomes and proposes changes to align the budget with the department's strategic plan.

How Public Budgets Are Made

Public budgets are political documents. The department prepares a request each spring based on county guidance, commissioners hold hearings in the summer and adopt the budget before the fiscal year begins in July. State and federal grants follow their own calendars and rules. Unlike a private organization, the department cannot simply raise prices to cover costs; its revenue depends on elected officials and external funders.

Revenue Sources

The table summarizes the department's $41 million budget by source. Federal funds arrive through the state, which adds its own conditions and reporting.

Categorical and Flexible Funds

About two-thirds of revenue is restricted to specific programs or diseases. Categorical funding ensures attention to national priorities but limits the department's ability to respond to local needs such as heat or housing. Only the county general fund and a small part of state funding can be moved freely. This structure explains why the strategic plan emphasizes increasing flexible funds.

Spending by Program Area

Spending follows funding. Communicable disease and immunization account for 26% of spending, environmental health 18%, maternal and child health including nutrition programs 24%, chronic disease prevention 7%, behavioral health and overdose prevention 6%, emergency preparedness 8% and administration and data 11%. Chronic disease, the largest cause of death in the county, receives the smallest share.

Public Health Spending and Outcomes

Evidence suggests that how much communities spend on public health matters. Communities whose local public health spending rose saw significant drops in deaths from infant mortality, cardiovascular disease, diabetes and cancer, according to a national longitudinal study (Mays & Smith, 2011).

Social Spending and Health

Health depends on more than health care. Across high-income countries, a higher ratio of social service spending to health care spending was associated with better outcomes such as longer life expectancy and lower infant mortality (Bradley et al., 2011). Among US states, those with higher ratios of social and public health spending to health care spending had better outcomes on several measures, including adult obesity and mortality from heart attack (Bradley et al., 2016).

What the Evidence Means Locally

For the county, the evidence argues for protecting public health funding and for partnering with housing, transportation and social service agencies whose budgets affect health. It also supports shifting some spending toward prevention of chronic disease, where the department's investment is smallest relative to burden.

Budget Politics

A new commission majority favors lower taxes, and public health competes with law enforcement, roads and parks. Budget requests succeed when they link spending to outcomes commissioners care about, such as fewer emergency calls, lower jail health costs or healthier workers, and when they show results from past investments. Showing commissioners concrete results from the previous year's investments has proved more persuasive than national statistics.

A Proposal to Realign

The department will propose three changes: redirect $600,000 of general fund from lower-priority administrative functions to chronic disease prevention in east-side neighborhoods; negotiate with the state for more flexibility in per capita funds; and seek $1.5 million a year in hospital community benefit and overdose settlement funds for shared priorities. Together these would raise flexible funds from 34% toward the plan's 45% target.

Presenting the Request

The request to commissioners will open with the east-side life expectancy gap, show how current spending misaligns with the causes of death, cite evidence that public health spending reduces preventable deaths and propose specific, measurable investments. It will include a one-page summary and invite commissioners to visit programs on the east side.

Risks

Risks include federal cuts to categorical grants, pressure to reduce the general fund and delays in settlement funds. The department will maintain a reserve equal to one month of operating costs, track grant renewals and prepare scenarios for a 10% reduction in each major source.

Transparency

Publishing the budget in plain language, with spending by priority and neighborhood, helps residents and partners understand trade-offs and hold the department accountable. The department will post an annual budget summary alongside its strategic plan progress report. A public dashboard will show spending alongside results for each priority.

Hidden Costs of Categorical Funding

Categorical grants carry administrative costs that rarely appear in budgets: separate reporting systems, time-tracking rules and staff who cannot be moved between programs. The finance office estimates that grant administration consumes about 6% of staff time. Consolidated or more flexible funding would free that time for services.

Budgeting for Equity

An equity lens asks who benefits from each dollar. The department will map spending by neighborhood where possible and compare it with need. Early analysis suggests that spending per resident on the east side is below the county average despite far greater burden, a gap the realignment proposal begins to close.

Multiyear Thinking

Annual budgets encourage short-term thinking, but prevention pays off over years. The department will present a three-year budget outlook alongside its annual request, showing how investments in chronic disease prevention are expected to reduce costs and improve outcomes over time.

Grant Strategy

The department will review every grant against the strategic plan before applying, declining small grants that add reporting burden without advancing priorities. It will also seek grants that allow indirect cost recovery at realistic rates, so that administrative costs do not drain the general fund.

Budget Monitoring

Monthly budget reports will compare spending with plan and flag variances early. Quarterly reviews will link budget and program performance, so that underspending in one area can be redirected before year-end rather than returned to funders.

Conclusion

The department's budget is dominated by restricted funds that leave chronic disease, the leading cause of death, underfunded. Evidence links public health and social spending to better outcomes, supporting efforts to protect funding, increase flexibility and realign resources toward prevention. A clear, outcome-focused request gives commissioners reasons to invest in closing the east-side gap.

References

Bradley, E. H., Canavan, M., Rogan, E., Talbert-Slagle, K., Ndumele, C., Taylor, L., & Curry, L. A. (2016). Variation in health outcomes: The role of spending on social services, public health, and health care, 2000-09. Health Affairs, 35(5), 760-768. https://doi.org/10.1377/hlthaff.2015.0814

Bradley, E. H., Elkins, B. R., Herrin, J., & Elbel, B. (2011). Health and social services expenditures: Associations with health outcomes. BMJ Quality & Safety, 20(10), 826-831. https://doi.org/10.1136/bmjqs.2010.048363

Mays, G. P., & Smith, S. A. (2011). Evidence links increases in public health spending to declines in preventable deaths. Health Affairs, 30(8), 1585-1593. https://doi.org/10.1377/hlthaff.2011.0196