Shortchanged? An assessment of chronic disease programming in major US city health departments

Mari Georgeson, Lorna E. Thorpe, Mario Merlino, Thomas R. Frieden, Jonathan E. Fielding, John M. Auerbach, Peter Beilenson, Matthew Carroll, Mary Des Vignes-Kendrick, John F. Domzalski, Franklin Judson, Mitchell H. Katz, Alonzo Plough, Eleni Sfakianaki, Adewale Troutman, Jonathan B. Weisbuch, Judith West, John L. Wilhelm, Steve Wilson

Research output: Contribution to journalArticlepeer-review


A self-administered survey was distributed to members of The Big Cities Health Coalition, a group of Health Officers/Commissioners from 17 of the largest US metropolitan health departments. The survey asked participants about their chronic disease priorities, data sources, budgets, and funding sources as well as examples of successful chronic disease interventions. Members of the Coalition discussed the survey results in a scheduled conference call. Chronic diseases account for 70% of all deaths nationwide on average, yet the health departments surveyed allocated an average of 1.85% of their budgets to chronic disease. Average chronic disease spending per inhabitant was $2.33, with a median of $1.56. Among the group's top chronic disease priorities were asthma, diabetes, tobacco, cancer, and cardiovascular disease (CVD). Nearly half of the group's chronic disease spending was on tobacco. Chronic disease funding sources varied across localities, but direct federal funding was minimal. In 14 cities serving a combined 37 million people (13% of the US population), direct federal chronic disease funding totaled $8.7 million, an average of $0.24 per capita. The group described successful chronic disease interventions, particularly related to tobacco and asthma.

Original languageEnglish (US)
Pages (from-to)183-190
Number of pages8
JournalJournal of Urban Health
Issue number2
StatePublished - 2005


  • Chronic disease
  • Funding
  • Public health practice
  • Urban health

ASJC Scopus subject areas

  • Health(social science)
  • Urban Studies
  • Public Health, Environmental and Occupational Health


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