The original work on this project was done by Christian Avy, Rachel Crumpler, Dominick Ferrara and Jamie Krantz, students at the University of North Carolina at Chapel Hill Hussman School of Journalism and Media. It began as a class project during the Fall 2020 Advanced Data Reporting class taught by Associate Professor Ryan Thornburg.

In April 2021, it added data contributed by Moss Brennan of the Watauga Democrat, Ahmed Jallow of The Burlington Times-News, Rachel Keith of WHQR public radio in Wilmington and Ivey Schofield of The News-Reporter in Whiteville. This reporting effort was organized by the N.C. Local News Workshop at Elon University.

This project tracks expenditures for local health departments in North Carolina and discusses what they can tell us about each county's preparedness for COVID-19 and other epidemic or pandemic level threats. It was inspired by and uses data from "Under Funded and Under Threat," a collaboration between Kaiser Health News and The Associated Press.

Spending on public health at the state level from 2010 to 2018 dropped by more than 27% when adjusted for inflation and population increase. This spending decline is even steeper than the national slide of 16% across all states.

At the state level, North Carolina spent about $72 per person on public health in 2018, which is less than all but 13 other states. For every dollar spent per person on state-level public health nationally in 2010, North Carolina spent 90 cents. By 2018, North Carolina spent only 78 cents per dollar spent nationally.

Based on our analysis of 52 health departments in North Carolina that provided data for every year from 2010-2018, county-level spending on public health dropped 22% from 2010-2018 when adjusted for inflation, compounding the 27% spending drop at the state level over the same period. At least 46 health departments saw a decline in inflation-adjusted public health spending per person from 2010-2018.

Because the state does not keep individual health departments’ annual expenditures in one centralized location, the data in this story is the most current and complete picture about spending on local public health in the nation’s ninth most populated state.

Starting in September, UNC students requested annual expenditure data from 1999 to the present from all 85 local health departments in the state, which serve each of the state’s 100 counties, in an effort to understand local public health spending in North Carolina. They originally received data from 51 local health departments, and there was some variance in the years each health department was able to provide.

After the publication of the original story in The News & Observer in January 2021, reporters from around the state, organized by the N.C. Local News Workshop at Elon University, gathered additional data. The collection now includes at least three years from 58 local health departments representing 65 counties

Our analysis of local health department spending records represents over half of the total departments in the state. These health departments serve about 80% of North Carolina’s population.

Data on expenditures and employees was originally collected by Kaiser Health News and The Associated Press.

Population data was retrieved from the U.S. Census Bureau and the North Carolina Office of State Budget and Management.

To promote transparency, support an ongoing data-driven conversation about public health in the state and continue the collaboration among journalists seeking to provide local context for the communities they serve, we are publishing all of the data we collected.

health_department_combined_expenditures.csv Annual expenditures from each department. (Updated: April 14,2021)

https://raw.githubusercontent.com/khnews/2020-underfunded-under-threat-data/master/data/05-local-health-departments-detail.csv Data from the KHN story that inspired this project, including full-time employees.

Our data set does not include revenues for each local health department. This data can often be found in counties' annual audits, which can often be found on the counties' websites.

A limitation to the story is that unlike some other states, North Carolina does not track each county's expenditures in one central location. Instead, state agencies such as the Treasurer and Department of Health and Human Services only track spending on specific state-backed programs.

The state budget passed by the General Assembly includes a line item for how much total money is headed towards counties, but not divided by county.

During the four months we originally worked on collecting expenditure data from local health departments in North Carolina, 29 agencies did not reply to our request. However, we are continuing to collect and publish expenditure data.

If you are a public official or local news reporter who would like to contribute data, you may complete this form.

R code to replicate the data reporting and visualizations done for this story.

The following UNC-Chapel Hill students originally reported this project, analyzed the data, wrote the original story and created data visualizations:

• Rachel Crumpler: [email protected]
• Chrstian Avy: [email protected]
• Dominick Ferrara: [email protected]
• Jamie Krantz: [email protected]

This project is edited by Ryan Thornburg, Associate Professor at UNC Hussman School of Journalism and Media. He can be reached at [email protected] .