The problem: Currently there is no established method to rigorously collect and analyze the financial data of local public health agencies, and no routine national reporting on agency funding or financial performance. This means there is no clear method to determine the best way to fund public health services and activities—or to know if funds are being used efficiently. Without this data, public health officials cannot determine the relationship between funding and health outcomes in their communities. “Officials and other stakeholders at the community level do not have the data they need to make important management and operations decisions,” notes Peggy Honore, D.H.A., M.H.A., chief science officer at the Mississippi Department of Health and an associate professor at the University of Southern Mississippi.

The proposal: Funded with a $670,000, three-year RWJF grant, Honore intends to increase understanding of public health financing. Her plan? “To develop data sets on how public health is financed at the local level,” she says.

With more than 30 years of finance experience in academia, government and private business, Peggy Honore is a key figure in public health research. “She has been a pioneer in promoting public health systems and services research,” says Debra J. Pérez, Ph.D., M.P.A., M.A., RWJF senior program officer.

As part of the project, researchers will determine the extent to which property taxes are used to fund local public health services in the 240 counties and parishes of the eight Mississippi Delta Region states (Alabama, Arkansas, Louisiana, Mississippi, Missouri, Illinois, Kentucky and Tennessee). In addition to being geographically close to Honore and her research colleagues, these states experience high rates of poverty and chronic disease in comparison to the rest of the country. The demographic and health profile of these states makes it even more important to understand how to leverage available funding to improve people's health.

A comparison will be made using quantitative analysis of community health indicators for those counties/parishes that dedicate a portion of property taxes to public health services and those that do not. The tax data acquired through this research will be presented on a public health finance Web site for use by researchers, practitioners, academics, policy-makers and the public.

Researchers also will analyze public health funding in the state of Georgia. This effort takes advantage of a 2006 Georgia legislative committee's mandate to examine the state's formula for funding public health services. “We will be able to look at funding changes over the years and the impact that changing demographics in the state are having on funding and service provision,” says Honore.

Another component of the project is to conduct a national scan to identify formulas used by states and local jurisdictions to fund public health. This data also will be available on the public health finance Web site.

While the gathering of tax data, though laborious, is fairly straightforward, “it is very difficult to get community-level health data,” says Honore, “because local health agencies do not have systems in place to get health status data.”

Despite the difficulties, it is worth it to Honore to assemble the data. “There is a lag in financial theories and concepts being applied to public health, as they are in health care and education,” notes Honore. “Via this project, we hope to provide knowledge to bridge this gap.”

RWJF perspective: Peggy Honore “is a persuasive and talented researcher,” says Debra Perez. “She is among a group of respected leaders calling for better information on public health funding--and the research and policy communities have taken notice.

Honore's work “rallies the interest of folks not normally interested in public health systems and services, such as the NIH [National Institutes of Health],” notes Perez. “Today, we can't answer some of the most basic questions about the public health system,” but with Honore's research “we will have better evidence to make recommendations on what policy-makers and public health officials can do to improve the public health infrastructure.”