Local government expenditure centralization and spatial variation in working-age mortality

Research finds disparities in local government spending to be one driver of place-based variation in population health outcomes in the U.S. This study asks: net of the amount of local government spending, does the centralization of local government expenditures shape spatial variation in working age mortality? We find that in more centralized local fiscal structures, that is, where the county government performs relatively more of the total local government spending, there is less cross-census tract variation in midlife mortality. In doing so, we reveal how the structure of local government—inherited from history and largely outside the purview of politics and policy discussion—impacts place-based variation of population health outcomes.