The politics of public health at the state level



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This dissertation focuses on the impact of citizen ideology on the funding of public health services by state governments. It establishes that some state governments spend relatively more than other states on public health services. Then it seeks to discover what factors impact this relative discrepancy among the states in the funding of public health services. Why is it that some states are willing to spend more to protect the population within their borders than other states? Specifically, how does citizen ideology impact state spending on public health? Data from a 50 state survey of immunization program officials is used as a case study to describe how politics impacts public health funding. The primary research question is: To what extent does citizen ideology impact the funding of public health services at the state level?

The history and structure of public health in the United States is viewed, with special attention to the role of state governments in the provision of public health services. The public health/health care dichotomy and the discounting of public health services in the policy making process are discussed. Because there is significant variation between the states in their funding of immunization programs, these programs provide a focused study of how citizen ideology drives state spending for public health. The text also uses a single state, Texas, for a more in-depth look at the funding of immunization policy, and it considers specific issues of the politics of public health in Texas. Conclusions are drawn about how citizen ideology and other factors may impact public health spending in the states. Suggestions for further research in the politics of state spending are made, and in particular, for the continued examination of the spending of state dollars for public health services.