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To assess the state of the public health system in the United States, KHN, also known as Kaiser Health News, and The Associated Press analyzed data on government spending and staffing at national, state and local levels.

What reporters found was a mix of survey and budget data, each measuring a slightly different concept of “public health.

Some datasets track only state public health systems, not agencies that operate at a county, city or regional level. Other data, including some from the U.S. Census Bureau, covers spending on all nonhospital health care. Public health efforts are mixed in with the costs of providing local medical transportation, running community clinics, and offering mental health services.

The lack of comprehensive data specifically about public health makes assessing community programs, agencies and staffing levels difficult, experts say. Public health information is scattered and can’t be easily compared, unlike data about hospitals and medical treatment, according to Betty Bekemeier, a public health systems researcher and professor at the University of Washington. She is seeking to fix this as the leader of a multistate effort to standardize local health department spending data.

“We will not be able to improve our systems if we don’t have a better idea of how it works,” she said.

KHN and AP calculated 2016-18 average annual state spending directly on public health initiatives using the State Health Expenditure Dataset. To create the dataset, a team of researchers encoded data from the Census Bureau’s “ Annual Survey of State Government Finances,” isolating public health costs to get the clearest sense of what governments spend only on public health efforts.

The data includes spending by all state agencies and their transfers to local governments. To account for inflation for this and all spending data, KHN and the AP adjusted to 2019 dollars using a price deflator from the Bureau of Economic Analysis targeted toward government expenses.

A decade of data on state public health agencies’ expenditures and full-time equivalent staffing came from the Association of State and Territorial Health Officials. The data was reported directly by the state public health agencies through a national survey.

When creating national percentage change estimates, reporters excluded a handful of states missing comparable spending or staffing data.

The analysis included census finance data from state and local governments to compare spending on nonhospital health with other priorities such as policing and highway construction and maintenance.

At the local level, the National Association of County and City Health Officials’ “ National Profile Study ” surveys local health departments every three years and weights answers to account for nonresponse.

Beyond that, some states collect local health department spending and staffing data. Reporters used detailed data on local health departments in Florida, Minnesota, Missouri, North Carolina, Ohio and Washington — along with census population estimates — to examine per capita trends over time.

Finally, AP statehouse reporters posed an identical set of questions to states to get a sense of recent and upcoming budget and staffing changes to state public health departments. The AP gathered responses from 43 states.


Contact AP’s global investigative team at


This story is a collaboration between The Associated Press and KHN (Kaiser Health News), which is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.

Copyright © 2020 The Associated Press. All rights reserved. This material may not be published, broadcast, written or redistributed.

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F1: Red Bull loses technical appeal against Mercedes

Red Bull lost an appeal against the dual driving assistance system (DAS) launched by rival Mercedes during Formula One winter testing in February.

DAS helps Mercedes cars around corners and reduces tire wear. Video from the tests in Spain shows world champion Lewis Hamilton repeatedly pulling the wheel on the straights, apparently changing the angle of the front tires.

Other teams were caught off guard by the innovation and Red Bull said in its protest that the DAS is a suspension and aerodynamic device. But the judges said it is only part of the driving system and exonerated Mercedes on Friday night after a hearing.

“DAS is part of the driving system, even if it is not conventional,” the FIA ​​said in a statement. “The biggest questioning of the legality of the DAS was based on not being part of the driving system. If that were the case, then it would have been a violation of the rules. ”

The system will be banned beginning in the 2021 season, but it can be used by Mercedes and other teams this season.

FIA President Jean Todt hailed Red Bull’s decision to question Mercedes, saying it was good for the competition.

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