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    • Our study focuses on urban

    2018-11-02

    Our study focuses on urban governance that involves policies of local governments and provision of public goods and services. In accordance with federal and state authorities, many local agencies are established primarily at the county level. The delegation of authority to local governments, especially in the absence of federal or state laws, may lead to great variation of the structure and function of local health agencies across the country (Carter & Slack, 2010). Some counties vary in the extent of their public expenditures (e.g., public schools), taxes and social and fiscal policies. This large variation may affect the structures of economic and social opportunities, as well as the level of generosity of safety net programs. Such county differences may plausibly affect health disparities differentially, even if adjacent counties fall under the same larger metropolitan area. The literature regarding political fragmentation examines whether fragmented governance enhances economic efficiency and contributes to economic growth. This hypothesis traces its origins to Tiebout\'s model and public choice theory. Tiebout (1956) argues that local governments provide public goods more efficiently in fragmented governance structures through the purchase DMOG for residents who “vote with their feet”. This argument coheres with public choice theory that stresses economic growth through the interjurisdictional competition in a decentralized organizational structure. Public choice theory implicitly criticizes a lack of competition in the consolidated government (Brennan & Buchanan, 1980; Brueckner, 2011; Kim & Jurey, 2013). Empirical studies assess the relation between fragmented governance and government expenditure, gross product growth, personal income growth, and employment growth. Findings, however, do not converge and remain controversial (Akai & Sakata, 2002; Eberts & Gronberg, 1988; Nelson & Foster, 1999; Raimondo, 1989; Schneider, 1986; Stansel, 2005). Several studies examine the association between fragmented governance and social equity. Research reports that fragmented settings adversely impact income inequality and racial segregation presumably via increased poverty concentration in core urban areas and incorporation of the affluent community in the suburban areas (Bischoff, 2008; Hill, 1974; Swanstrom, 2001; Weiher, 1991). By contrast, other empirical studies that examine a panel of developing and developed countries report a positive association between fiscal decentralization and infant health (Mills, Vaughan, Smith, & Tabibzadeh, 1990; Robalino, Picazo, & Voetberg, 2001). Our study allows us to capture the variation of local government structures and its impact on health disparities in mortality. We also seek to replicate Hutson and colleagues\' findings by utilizing data over four time periods spanning 15 years. We test the hypothesis that fragmented governance at the county level moves positively with widening health disparities in mortality between whites and African-Americans. Given the changes in the urban landscape in the 1970s and 1980s in the U.S., we focus our test on this time period.
    Methods
    Results The number of local governments increases over the 1970s and the 1980s. Each type of local government, except for school districts, shows an upward trend overall. Fig. 1 displays local government statistics over time for counties with a population size greater than or equal to 200,000. The total number of local governments in 1972 is 16,380 and increases to 19,401 in 1987 by 18.4%. The total population of these counties grows by 22.03% over this period (approximately from 111 million to 136 million). Special district governments show a remarkable increase by 36.5% over the 15 year period, whereas municipal governments show a milder increase by 13.5%. However, the rate of increase for school districts is relatively small, at 10.9%. From 1972 to 1987, the mean number of local governments per county is 71.35. Table 1 lists the government types for the 20 most populous countries. Cook County (IL), Harris County (TX), King County (WA) and Allegheny County (OR) have relatively more local government entities than other counties with similar population size. Their indicators of political fragmentation are larger than 0.1. For example, a 0.1 fragmentation score indicates that a county has 0.1 government per 1000 residents.