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Nerd alert: collecting and analyzing data for our investigation on public health has been a *journey*. Data on our public health system is pretty much the wild west; there’s basically no central data. Here’s how we did it… https://khn.org/news/us-public-health-system-underfunded-under-threat-faces-more-cuts-amid-covid-pandemic/">https://khn.org/news/us-p...
Experts all said the same thing: we pretty much have no idea what this country spends on public health. There’s federal state, local, funding that goes to state and local departments but there is no centralized data system tracking it all.
Every state has a public health agency. But under those, almost all have a system of local health departments. Half are completely decentralized, totally run locally. Many of those states don’t track the local spending at all.
We requested local health department spending and staffing from many states. FL has 30 years of data online in a nice dashboard. NC has tracked staffing since the 80s. CA, CO and many others don’t track it at all. 50 states, 50 ways of counting (or not).
Minnesota initially wanted us to sign a truly wild data use agreement, saying we would run plans and analysis by them, not share the data, not use it to identify specific departments. This is basic info on govt agencies! We got the data in the end.
Where we did get data back, of course it was all formatted differently. Some were spreadsheets. Many PDFs. Often the health department names were written differently from year to year. 
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Then there’s structure - some depts cover a county, some a city, some multiple counties, then the fun ones that cover a county minus a city that’s inside it. (Missouri cities cross county lines too!) All that has to be accounted for to calculate population for per capita figures.
Public health funding doesn’t only come from the specific agencies though. To account for that, we also used data from SHED, which *hand codes* line item state spending data from the Census to separate out public health. Most states spend less than $100 on public health.
Local govt data sent to Census doesn’t have as much detail, so we can’t use that for public health specifically. So we also looked at nonhospital health, which includes PH, so you can see how it compares to other spending. PH is only part of this blue bar.
Since we can& #39;t get comprehensive national local data on public health, we used more data from SHED to look at local spending on nonhospital health (includes PH) vs policing. Those dark red counties spend at least 3 times more on police.
You& #39;re probably wondering why California looks so blue compared to the rest. Much of that is the other stuff included in nonhospital health, like outpatient care at county-run health clinics. It& #39;s complicated but it& #39;s the best we& #39;ve got.
Working on this series has been a dream. This was a team effort—besides a dream team of reporters I got to work with two (2!!) incredible data editors, @MeghanHoyer and @eklucas. And here’s the full methodology. We’re just getting started. https://khn.org/news/how-we-reported-underfunded-and-under-threat/">https://khn.org/news/how-...
Addendum: It didn& #39;t use to be this bad. The federal government used to track local health department spending and staffing. Decades ago.
