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Local government expenditure centralization and spatial variation in working-age mortality
Rourke O'Brien1, Manuel Schechtl2, Robert Manduca3
1Yale University, United States.
SSM - Population Health
|April 16, 2025
Summary
Local government spending structures influence U.S. population health. More centralized county spending reduces midlife mortality variation across neighborhoods, highlighting government structure
Area of Science:
- Public Health
- Health Economics
- Political Science
Background:
- Disparities in local government spending are linked to variations in population health outcomes across U.S. locations.
- The structure of local government finance, beyond spending levels, may also influence health inequities.
Purpose of the Study:
- To investigate whether the centralization of local government expenditures affects spatial variation in working-age mortality, independent of total spending amounts.
- To explore the impact of historical and political factors on local government structures and their subsequent effect on population health.
Main Methods:
- Analysis of local government fiscal data and mortality statistics across U.S. census tracts.
- Statistical modeling to assess the relationship between fiscal centralization and mortality variation, controlling for total spending.
Main Results:
- Higher centralization of local government spending, with county governments performing a larger share, is associated with reduced variation in midlife mortality across census tracts.
- This finding holds true even after accounting for the total amount of local government spending.
Conclusions:
- The structure of local government fiscal systems, specifically the degree of centralization, plays a significant role in shaping place-based disparities in population health.
- Understanding these governmental structures is crucial for addressing health inequities, even when these structures are not primary subjects of political debate.
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