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The Office of Public Health Practice & Training

Setting Budgets & Priorities Project

The Office of Public Health Practice & Training is currently involved in the Protecting Public Health in Times of Austerity: Measuring Impacts and Setting Priorities project. 

Study findings will help inform policymakers, advocates and the public on the need for critical federal public health funds.


Specific Aims

This mixed-methods project has three primary aims:

  1. Characterize the budget and priority-setting processes within state health departments and across specific divisions (Preparedness, Environmental Health Sciences, and Maternal/Child Health) using secondary data analysis.
  2. Model several federal financial reduction scenarios and consequent public health impacts, using ASTHO 2010 Profile and federal public health funding data.
  3. Integrate findings from aims 1 and 2 to identify likely decision-making factors, criteria, pressures, and opportunities practitioners will face under federal austerity measures, with a focus on public health practice and policy implications.


The proposed project is critical to public health practice and policy as federal public health funding cuts are currently debated. From a practice perspective, it is imperative that public health agencies, particularly at the state level, serving as intermediaries between the federal and local levels, gain a better understanding of budget and priority-setting decision-making within the macro and micro perspective in terms of both the process and public health impact. Knowledge of how other states are cutting and coping will, hopefully, enhance capacity to absorb funding cuts, as well as proactively prepare for impending cuts with a focus on maintaining adequate public health protections.

Additionally, with regards to the public health practice landscape, in fall 2011 the Public Health Accreditation Board (PHAB) is launching a nationally voluntary accreditation program for state and local public health departments to advance public health department quality and performance. In preparation for accreditation many health departments are initiating performance management and quality improvement (QI) processes. These processes facilitate continuous and ongoing efforts to achieve measurable improvements in efficiency, effectiveness, and performance with the ultimate aim of improved community health outcomes. Further understanding of and data regarding funding decisions, processes, and impacts will enhance capacity to assess public health performance and accountability. Additionally, this knowledge and information will add to the evidence base to allow for the linking of public health structure, performance, and finance to health outcomes.

From a policy point of view, study findings will fill a critical need to inform policy makers, advocates, and the public not only of the necessity for federal public health funds, but quantify implications of funding reductions. Additionally, the current debate has focused primarily on health care service delivery, and has lacked a much needed understanding of the need for and value of public health services, as well as the distinction between health care and public health protections.

Contact the Office of Public Health Practice & Training for more information.