Association for Public Policy Analysis & Management

BACKGROUND. The Public Health Emergency Preparedness (PHEP) cooperative agreement allocates federal resources to state and local jurisdictions to enhance public health preparedness capabilities. The Centers for Disease Control and Prevention allocates the awards using population-based formulas as a proxy for need; more highly populated states and jurisdictions receive higher awards. Since 2002, $11 billion have been allocated under the cooperative agreement, although total allocations have declined annually. In New York State (NYS), the Department of Health allocates its grant to counties using solely a population-based allocation formula that awards all counties at least a base award and a plus based on population size. Although population-based formulas are commonly used for federal and state grant allocations, they do not consider other population and institutional characteristics that may reflect variations in need across grantees. We develop a novel metric of need and assess how its use would alter PHEP grant allocations to NYS counties.

METHODS. We built a community resilience index for 57 NYS counties by adapting published community and disaster resilience indicators and using data from 12 publicly available sources. We excluded New York City because it is a different federal grant reporting jurisdiction. The index is comprised of 5 components: social, economic, institutional, infrastructure resilience and community capital. We generated 8 hypothetical allocation formulas using different combinations of population metrics, population size and population density, and components of the community resilience index. We compared how the amount allocated to each county differed when we compared the hypothetical allocations to the 2013-2014 fiscal year awards.

RESULTS. Under the PHEP base award, NYS allocated $6.27 million to counties, with a median allocation of $78,038 (interquartile range (IQR): $61,831), ranging from $50,825 to $556,789. When we simulated allocations using the alternative formulas, we found variations in the amounts that would have been awarded to counties, with the largest changes among counties with smaller population size. Under allocation strategies using the community resilience index as a measure of need, 75% of all counties had lower awards, with a median reduction of -47.9% (IQR: 112.4%). In allocation formulas that emphasized different components of the community resilience index, approximately 60% of counties experienced lower awards, with an average reduction of approximately 6%. In the formula based on population components only, approximately 15% of all counties faced reductions in the awards with some extreme outliers experiencing reductions of 100% (median: 39.5%, IQR: 34.4%). Which counties received the greater allocations remained the same; more highly populated counties still received the greater amounts under alternative allocation scenarios.

 CONCLUSIONS. Population-based formulas with funding floors are commonly used to allocate funding, assuming that population size is a proxy for need or risk. However, this strategy does not consider variations in population characteristics or program objectives. Our results show that combining population metrics with a measure of need related to the grant objectives could alter how funds are allocated across NYS. Our study is an example of how publicly available data can aid decision making by providing new strategies to prioritize allocations.