State and local governments make important decisions about how resources and services — including public health services — are provided to citizens. This study will examine how these decisions impact population health. 

Examples of these decisions include how much decision-making autonomy local governments are given by the state, or the powers of local boards of health to impose public health taxes, and whether the public health delivery system provides basic or comprehensive services to the community. Based on the findings, this study will make recommendations for state legislation that will position local public health systems for optimal impact on population health.