Public health finance is defined as a "field of study that examines the acquisition, utilization, and management of resources for the delivery of public health functions and the impact of these resources on population health and the public health system."1^(p89) Fundamentally, it lies within the domains of economics and other areas such as public health services and systems research (PHSSR).1 This special finance issue of the Journal of Public Health Management and Practice (JPHMP) marks a significant milestone in measuring progress in this area. Consistent with the definition of public health finance, the publication includes pioneering research on financing and allocation methodologies, policy, and economic impacts.

The guest editor, as well as the JPHMP, are recognized for this accomplishment. This issue represents the third JPHMP publication dedicated to public health finance over eight years. Previous issues were published in 2004 and 2007. There are no other journals with entire issues dedicated to finance, a topic so vital to the sustainability of the public health system. Leadership by the guest editor in developing this issue demonstrates the progress made to attract new scholars to the field and, at the same time, signifies the relevance of new scholars to building capacity and interest to study financing of the system.

The Robert Wood Johnson Foundation (RWJF) is a significant contributor to this progress. Since 2005, funding to advance research and other activities on finance has come primarily from RWJF. That same year, the First Annual Public Health Finance Roundtable (Roundtable) was held in Philadelphia as an ad hoc meeting of the American Public Health Association Annual Meeting. Events such as the Roundtable provide a venue for structured dialogue on public health finance issues. The 2007 JPHMP finance issue noted the lack of such venues as a significant barrier to advancing the field.2 Through continued RWJF financial support, the eighth Roundtable is scheduled for October 2012.

Measuring Progress

The 2007 publication provided additional recommendations to stimulate progress in public health finance.2 Suggestions called for:

* uniform revenue and expenditure classifications;

* nationwide electronic reporting;

* adoption of standardized analytical practices;

* creation of a public health chart of accounts;

* professional association;

* research; and

* guiding coalition.

In summary, the recommendations urged for the application of best practices to improve transparency and financial analysis along with the establishment of structures for workforce professional development. Progress in these areas is examined later.

Uniform financial data collection, analysis, and reporting

Achieving transparency by strengthening methods and capacity for routine financial analysis and reporting was a central theme in many of the recommendations. Significant barriers to analysis and research were data limitations and specifically the lack of standardized data collection and reporting methods.

Advancing forward five years, major progress in data collection, analysis, and reporting is on the horizon with the introduction of the Public Health Uniform Data Systems (PHUDS). PHUDS is a Web-based financial data collection and analysis portal hosted and maintained by the National Association of County and City Health Officials (NACCHO). Funded with support from the Robert Wood Johnson Foundation (RWJF), PHUDS was developed as a joint effort between NACCHO and the University of Southern Mississippi. Other academic institutions involved in the design of PHUDS include the University of North Carolina-Chapel Hill Gillings School of Global Public Health and Louisiana State University Health Sciences Center School of Public Health.

PHUDS is designed to collect local public health agency financial data and generate immediate feedback through the creation of dashboards, benchmarking, ratio and trend analysis, and analysis of program financial performance. A NACCHO national advisory committee provided direction on the development of PHUDS by reaching consensus on analytical functions, data elements, and standardized account definitions to ensure uniformity. The account definitions and criteria serve as a foundation for the development of a national uniform public health chart of accounts as recommended in the Institute of Medicine report For the Public's Health: Investing in a Healthier Future.3

Many of the advisory committee members were introduced to the ratio and trend analysis concepts included in PHUDS during a series of demonstration workshops conducted between 2007 and 2011. States and organizations participating in workshops led by faculty at the University of Southern Mississippi and the University of North Carolina-Chapel Hill include Florida, Ohio, Kansas, Kentucky, West Virginia, NACCHO, National Association of Local Boards of Health, and the American Public Health Association. During this period, Florida successfully conducted financial analysis on all sixty-seven local health departments in the state and Mahoning Health District in Ohio used the concepts to turnaround from a deficit to a surplus financial position.4 These activities created a guiding coalition of engaged stakeholders who embrace greater transparency and stewardship as a means to improving performance in the system.

A companion web site, dedicated to finance and management topics, is scheduled for wide public release in July 2012. The principal emphasis of the Public Health Finance & Management (PHF&M) web site is to provide knowledge to improve and sustain the public health system.

Primary features of the PHF&M Web site include access to:

* training and educational materials including those applicable for building coursework;

* national, state, and local public health financial, economic, and other relevant data;

* a comprehensive database of literature on public health financing topics; and

* a Discussion Board to seek or share information.

The PHF&M Web site, available at http://www.publichealthfinance.org, could eventually function as the structure for a public health finance professional association, given the focus on training, disseminating information, and connecting the public health financial management workforce and other stakeholders across the country.

Research

Progress with additional funding for PHSSR and examinations of public health financing issues has accelerated since the 2007 recommendations. RWJF continues to be a leader with developing the field and funding for PHSSR. Additionally, work by the Mississippi Department of Health with the U.S. Senate Subcommittee on Bioterrorism and Public Health Preparedness5 resulted in the infusion of at least $40 million for PHSSR to the Preparedness and Emergency Response Research Centers under the Office of Public Health Preparedness and Response at the Centers for Disease Control and Prevention.6 The RWJF sponsored Public Health Practice-Based Research Networks (PBRN)7 across the country provides opportunities for practitioners and academics to partner on examining practice relevant topics. Many of these topics focus on finance-related issues. As an example, Mays and Smith found links in local public health agency spending and reductions in preventable deaths.8 A recommendation to conduct property tax research was specifically mentioned in the 2007 finance issue.2 Research findings published in 2011 documented that levying a dedicated property tax for public health purposes is associated with improved health outcomes in counties with per capita incomes above $28 000,9 a level below the national average rate of roughly $39 000. The research also noted that the use of the property tax system is not a universally utilized financing source for public health, a strategy that is very inconsistent with financing of other public services.9 Research opportunities are expected to increase with the availability of data through PHUDS. PHUDS is designed to increase access to valid, reliable, and uniform finance data, which many identified over the years as a barrier to conducting analysis and research.2,10

Moving Forward

Included in the 2007 issue of JPHMP was an observation that a missing element to achieving transparency and greater accountability in public health was a guiding coalition of interested stakeholders to stimulate progress.2 Observations in this commentary provide evidence that a guiding coalition has in fact evolved. The guest editor and authors in this issue, Roundtable participants, PBRNs, PHUDS advisory committee, and workshop attendees all provided the momentum for greater emphasis on finance. Special acknowledgement is also given to Marie M. Fallon, former Executive Director of the National Association of Local Boards of Health, for contributing greatly to this momentum by inviting the training team to conduct the financial analysis workshops at numerous events over the past five years. This momentum is expected to accelerate exponentially with the implementation of PHUDS and the PHF&M web site. And as federal, state, and local resources continue to slide, greater attention to financing issues is certain to rise.

REFERENCES