The role of cities and public health expenditures in the COVID-19 era

Local health departments are generally involved in assessing community health status and demands, improving access and delivery of health care, surveillance and control of contagious diseases, maintenance of public hygiene, and providing health information. Although most local health departments function at the county level, municipal governments in the 25 largest cities serve more than 42 percent of the national population (Census, 2021). The objective of this chapter is twofold. The first goal is to provide a general explanation of the roles of city governments and their health departments in promoting public health by looking at their public health spending. The second goal of this chapter is to describe how two large metropolitan cities, New York and San Francisco, responded to COVID-19 between 2020 and 2021. This chapter also includes a discussion about how the recent pandemic might have affected intergovernmental dynamics between municipal governments and other, higher-level governments.