Mandated activities and limited decision-making authority among local public health officials

Local public health department leaders face difficult decisions regarding the allocation of increasingly scarce resources, yet existing evidence for public health decision making, while still limited, is underutilized by public health officials. Participants in this study described processes regarding resource allocation in response to local budget cuts as based largely on legally mandated activities and categorical funding and perceived these factors as limiting much of their agency-level decision making to a relatively small portion of flexible funding. In the limited areas in which they perceived themselves to have flexibility, they generally considered their agencies to have very little capacity for accessing or using data-driven processes in their decision making. Given the apparent large role that mandated practices and categorical funding parameters have as factors in local public health decision making, policy making and practice-based research is urgently needed to narrow the divide between what is known regarding the effectiveness of mandated and categorical public health practices and how local public health leaders feel they can approach local decision making.