Local Legal Infrastructure and Its Association with Population Health

This study will investigate a fundamental question in public health law: Does the legal infrastructure of local public health affect population health outcomes? The hypothesis is that the legal infrastructure of local public health, as expressed in the exercise of local fiscal and legislative authority, affects local population health outcomes. This hypothesis will be tested by combining original legal research with findings from three prior RWJF funded projects that address the scope of local public health law, the types of local public health delivery systems, and local funding authority for public health. A regression model will be utilized that includes control variables to test the relationship between identified varieties oflocal public health legal infrastructure and population health status. Because states shape the legal infrastructure of local public health through power-sharing arrangements, associations with population health status may support recommendations for state legislation that positions local public health systems for optimal impact. Because this study will focus on longstanding statutory infrastructure rather than recently enacted ordinances or targeted regulatory initiatives, the findings should support recommendations for best practices addressing the broad legal foundations for public health improvement. The study team includes an incumbent state commissioner of public health, who will provide essential guidance on dissemination of findings both within the state and in national forums. Findings from this study will further understanding of the contribution of public health law to community health outcomes by identifYing the association between well-established legal structures and levels of population health. Oeliverables include: at least one paper; presentation of findings at two academic conferences; dissemination of research findings to state policymakers through collaboration with Council of State Governments (CSG); presentation of research findings at appropriate CSG conference venues; and development of a web-based online data set.