The Impact of Public Health Spending on California STD Rates



This study assesses the impact of county-level public health spending on rates of sexually transmitted disease (STD) in California. Across a variety of empirical specifications, increases in own-county public health spending reduce rates of gonorrhea and syphilis. Indeed, a $1 increase in per capita public health spending reduces the gonorrhea (syphilis) rate by approximately 0.30 (0.60) percent. Spillover effects are also associated with public health spending, as increases in border-county spending reduce STD rates. To varying degrees of significance, county STD rates are also sensitive to lagged STD rates, county racial composition, whether or not a public university is located within the county, and a yearly time trend.


County public health spending STD rates California 

JEL Classification

H75 I12 I18 


  1. Anand, S., & Bärnighausen, T. (2004). Human resources and health outcomes: cross-country econometric study. The Lancet, 364, 1603–1609.CrossRefGoogle Scholar
  2. Baicker, K. (2005). The spillover effects of state spending. Journal of Public Economics, 89, 529–544.CrossRefGoogle Scholar
  3. Bokhari, F., Gai, Y., & Gottret, P. (2007). Government health expenditures and health outcomes. Health Economics, 16, 257–273.CrossRefGoogle Scholar
  4. Brown, T. T. (2014). How effective are public health departments at preventing mortality? Economics and Human Biology, 13, 34–45.CrossRefGoogle Scholar
  5. Brown, T. T., Martinez-Gutierrez, M. S., & Navab, B. (2014). The impact of changes in county public health expenditures on general health in the population. Health Economics, Policy, and Law, 9, 251–269.CrossRefGoogle Scholar
  6. California Department of Public Health. (2015). Sexually transmitted diseases in California, 2013. Sacramento: California Department of Public Health.Google Scholar
  7. California Department of Social Services. (2002). The regions of California: recommended grouping of the counties for regional studies. Sacramento: California Department of Social Services.Google Scholar
  8. Chesson, H. W., Harrison, P., & Kassler, W. J. (2000). Sex under the influence: the effect of alcohol policy on sexually transmitted disease rates in the United States. Journal of Law and Economics, 43, 215–238.CrossRefGoogle Scholar
  9. Chesson, H. W., Harrison, P., & Stall, R. (2003). Changes in alcohol consumption and in sexually transmitted disease incidence rates in the United States: 1983-1998. Journal of Studies on Alcohol, 64, 623–630.CrossRefGoogle Scholar
  10. Chesson, H. W., Harrison, P., Scotton, C. R., & Varghese, B. (2005). Does funding for HIV and sexually transmitted disease prevention matter? Evidence from panel data. Evaluation Review, 29, 3–23.CrossRefGoogle Scholar
  11. Crémieux, P., Ouellette, P., & Pilon, C. (1999). Health care spending as determinants of health outcomes. Health Economics, 8, 627–639.CrossRefGoogle Scholar
  12. Ellen, J. M., Kohn, R. P., Bolan, G. A., Shiboski, S., & Krieger, N. (1995). Socioeconomic differences in sexually transmitted disease rates among black and white adolescents, San Francisco, 1990 to 1992. American Journal of Public Health, 85, 1546–1548.CrossRefGoogle Scholar
  13. Erwin, P. C., Greene, S. B., Mays, G. P., Ricketts, T. C., & Davis, M. V. (2011). The association of changes in local health department resources with changes in state-level health outcomes. American Journal of Public Health, 101, 609–615.CrossRefGoogle Scholar
  14. Ettner, S. L., Huang, D., Evans, E., Ash, D. R., Hardy, M., Jourabchi, M., & Hser, Y. (2006). Benefit-cost in the California treatment outcome project: does substance abuse treatment “pay for itself”? Health Services Research, 41, 192–213.CrossRefGoogle Scholar
  15. Gallet, C. A. (2002). A note on the determinants of sexually transmitted disease rates. The Social Science Journal, 39, 613–616.CrossRefGoogle Scholar
  16. Gallet, C. A. (2009). The determinants of AIDS mortality: evidence from a state-level panel. Atlantic Economic Journal, 37, 425–436.CrossRefGoogle Scholar
  17. Gallet, C. A., & Doucouliagos, C. (2016). The impact of healthcare spending on health outcomes: a meta-regression analysis. Working paper.Google Scholar
  18. Grembowski, D., Bekemeier, B., Conrad, D., & Kreuter, W. (2010). Are local health department expenditures related to racial disparities in mortality? Social Science and Medicine, 71, 2057–2065.CrossRefGoogle Scholar
  19. Gupta, S., Verhoeven, M., & Tiongson, E. (2003). Public spending on health care and the poor. Health Economics, 12, 685–696.CrossRefGoogle Scholar
  20. Harling, G., Subramanian, S. V., Bärnighausen, T., & Kawachi, I. (2013). Socioeconomic disparities in sexually transmitted infections among young adults in the United States: Examining the interaction between income and race/ethnicity. Sexually Transmitted Diseases, 40, 575–581.CrossRefGoogle Scholar
  21. Johnson, H. (2010). Higher education in California: new goals for the master plan. San Francisco: Public Policy Institute of California.Google Scholar
  22. Marton, J., Sung, J., & Honore, P. (2015). Does more public health spending buy better health? Health Services Research and Managerial Epidemiology, 2, 1–9.CrossRefGoogle Scholar
  23. Mays, G. P., & Smith, S. A. (2011). Evidence links increases in public health spending to declines in preventable deaths. Health Affairs, 30, 1585–1593.CrossRefGoogle Scholar
  24. McCullough, J., & Leider, J. (2016). Government spending in health and nonhealth sectors associated with improvement in county health rankings. Health Affairs, 11, 2037–2043.CrossRefGoogle Scholar
  25. Moscone, F., & Tosetti, E. (2010). Health expenditure and income in the United States. Health Economics, 19, 1385–1403.CrossRefGoogle Scholar
  26. Nixon, J., & Ulmann, P. (2006). The relationship between health care expenditure and health outcomes: evidence and caveats for a causal link. The European Journal of Health Economics, 7, 7–18.CrossRefGoogle Scholar
  27. Owusu-Edusai, K., Chesson, H. W., Gift, T. L., Tao, G., Mahajan, R., Ocfemia, M. C., & Kent, C. K. (2013). The estimated direct medical costs of selected sexually transmitted infections in the United States, 2008. Sexually Transmitted Diseases, 40, 197–201.CrossRefGoogle Scholar
  28. Patrick, K., Covin, J. R., Fulop, M., Calfas, K., & Lovato, C. (1997). Health risk behaviors among California college students. Journal of American College Health, 45, 265–272.CrossRefGoogle Scholar
  29. Rodriguez, H. P., Chen, J., Owusu-Edusei, K., Suh, A., & Bekemeier, B. (2012). Local public health systems and the incidence of sexually transmitted diseases. American Journal of Public Health, 102, 1773–1781.CrossRefGoogle Scholar
  30. Scott-Sheldon, L. A. J., Carey, M. P., & Carey, K. B. (2010). Alcohol and risky sexual behavior among heavy drinking college students. AIDS and Behavior, 14, 845–853.CrossRefGoogle Scholar
  31. Smith, D. H., Malone, D. C., Lawson, K. A., Okamoto, L. J., Battista, C., & Saunders, W. B. (1997). A national estimate of the economic costs of asthma. American Journal of Respiratory and Critical Care Medicine, 156, 787–793.CrossRefGoogle Scholar
  32. Thomas, J. C., & Gaffield, M. E. (2003). Social structure, race, and gonorrhea rates in the Southeastern United States. Ethnicity and Disease, 13, 362–368.Google Scholar
  33. White, H. (1980). A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica, 48, 817–838.CrossRefGoogle Scholar
  34. Wong, J. B., McQuillan, G. M., McHutchison, J. G., & Poynard, T. (2000). Estimating future hepatitis C morbidity, mortality, and costs in the United States. American Journal of Public Health, 90, 1562–1569.CrossRefGoogle Scholar
  35. Youm, Y., & Laumann, E. O. (2002). Social network effects on the transmission of sexually transmitted diseases. Sexually Transmitted Diseases, 29, 689–697.CrossRefGoogle Scholar

Copyright information

© International Atlantic Economic Society 2017

Authors and Affiliations

  1. 1.California State University SacramentoSacramentoUSA

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