Association for Public Policy Analysis & Management

While federal and state policymaking tends to receive the bulk of public attention, most public health policy is planned and implemented at a local level by Local Health Departments (LHDs). LHDs play an important role in community level initiatives, data collection, as well as implementation of the higher-level policies.

In recent years, an increasing tension has emerged between local public health departments that try to use their public health powers to set local policies and state governments that want to try to limit the powers of local public health authorities through preemption or other means. For example, subsequent to Mayor Bloomberg’s attempt to limit the size of sugar-sweetened beverages to no more than 16 ounces using the authority of New York City Board of Health, Mississippi adopted an “anti-Bloomberg bill” that preempts state and local administrative agencies to set public health policies regarding the sales and marketing of food.

This study analyses the LHD’s decision-making process through the lense of the obesity policy to assess the extent of local policy activism among LHDs and to examine how different LHD characteristics are associated with the type of policies adopted (i.e., whether a nudge versus shove approach is adopted). One reason that obesity interventions tend to encounter criticism and political resistance is the fact that many obesity prevention policies are considered to be paternalistic. Thaler and Sustein (2008) argue that libertarian-paternalist “nudge” policies, which merely direct individual behavior in a certain direction rather than t limit individual options should be less contentious.

Using data from the 2013 and 2016 National Profile of Local Health Departments study, this study seeks to examine the factors influencing local public health departments’ adoption of obesity prevention strategies, including State and regional ideology and LHD’s institutional characteristics, including its budget, whether it is a local agency, state agency or local and state jointly, whether it has a board of health. The study hypothesizes that LHD’s degree of policy activism, and the extent to which they adopt more paternalistic policies will largely be a function of the broader political environment that they encounter (i.e., state and local ideology) and institutional characteristics (how much discretion they are granted versus control by state politics).The study also controls for path dependency (by adding a controlling variable of percentage of nudge policies adopted for tobacco and alcohol control) and policy diffusion (by adding spatial matrix).

Preliminary finding shows that ideology is not significantly correlated with number of policy approaches taken by the LHDs, but LHDs in liberal states are likely to have a lower percentage of nudge obesity policy, which can be explained by LHDs in the more conservative areas choosing to adopt nudge policies due to their libertarian-paternalism appeal.