Associations between local government expenditures and low birth weight incidence: Evidence from national birth records

Abstract

Local governments play an integral role in providing public services to their residents, yet the population health benefits are frequently overlooked, especially when services are outside the traditional health domain. With data from the U.S. Census of Governments and national birth records (spanning from 1992 to 2014), we examined whether local government expenditures on parks and recreation services (PRS) and housing and community development (HCD) predicted county low birth weight outcomes (population incidence and black-white disparities). Hypotheses were tested using bias-corrected county-by-period fixed effects models in a sample of 956 U.S. counties with a total of 3619 observations (observations were defined as three-year pooled estimates), representing 24 million births. Adjusting for prior county low birth weight incidence, levels of total operational, health, and hospital expenditures, and time-varying county sociodemographics, an increase in per capita county PRS expenditures of $50 was associated with 1.25 fewer low birth weight cases per 1000. Change in county HCD expenditures was not associated with low birth weight incidence, and, contrary to hypotheses, neither expenditure type was linked to county black-white disparities. Further examination of the benefits to birth outcomes from increasing parks and recreation services is warranted.

Does a Rising Median Income Lift All Birth Weights? County Median Income Changes and Low Birth Weight Rates Among Births to Black and White Mothers

“…41 Moreover, county governments have increased their role as service providers in recent decades, are involved in administration of income transfer programs (e.g., Temporary Assistance for Needy Families), and play a large role in economic development. 71,72 Methodological advantages include stability in borders and the extensive data available for counties, which make this project feasible.…”

“…Socioeconomic characteristics of residents within counties are homogeneous relative to larger commuting zones or states, and the smaller space of counties relative to states provided a better representation of the resources residents could access and conditions to which they may have been exposed 41 . Moreover, county governments have increased their role as service providers in recent decades, are involved in administration of income transfer programs (e.g., Temporary Assistance for Needy Families), and play a large role in economic development 71,72 . Methodological advantages include stability in borders and the extensive data available for counties, which make this project feasible.…”

The Timing of Managerial Responses to Fiscal Stress

“…Nonmetropolitan counties and older suburbs exhibit higher local effort, while outlying suburban areas have lower effort. Curtis et al (2019) show how housing and community development and parks and recreation expenditures decrease county low birth weight incidences. They show that the effects of these improvements in maternal health, in preconception and prenatal periods, are through enhanced physical activity and social interaction mechanisms.…”

Expanding the Curriculum in a School of Public Health

“…In all of these cases, diverse experts with training in, for lack of a better term, "leisure" disciplines (including parks, recreation, hospitality, tourism, and events) worked closely with public health researchers and practitioners in a way that models the mindset and skillset needed by the future public health workforce. Indeed, there are many more opportunities for experts in hospitality management (6)(7)(8) and parks and recreation (9)(10)(11)(12) to enhance the work of public health. However, public health students have traditionally not been exposed to the theories, practices, nor methods of these disciplines.…”