Publication Title: 
American Journal of Public Health
Publication Date: 
Monday, October 1, 2012

This study explored the association between the legal infrastructure of local public health, as expressed in the exercise of local fiscal and legislative authority, and local population health outcomes. The analyses suggested that public health legal infrastructure, particularly reformed county government, had a significant effect on population health status as a mediator of social determinants of health. Because states shape the legal infrastructure of local public health through power-sharing arrangements, the findings suggested recommendations for state legislation that positions local public health systems for optimal impact.


Costich JF, Patton DJ. Local Legal Infrastructure and Population Health. American Journal of Public Health. 2012; 102(10): 1936-1941.