What are the causes and consequences of changes in local public health agency spending? In particular, researchers addressed the following questions: 1) How have local health spending levels and funding sources changed over the past decade? 2) How have disparities in spending levels changed among communities defined by population size, rural/urban location, socioeconomic and racial/ethnic composition, and structural characteristics of the public health system; 3) To what extent have economic, demographic, and policy-related factors precipitated change in local public health spending levels and funding sources over this period; and 4) To what extent are changes in local public health spending associated with changes in local population health status and disease burden. The objective of this study was to assist policymakers at the federal, state, and local levels in crafting desirable strategies for funding local public health services and to provide insight into the effects of changes in spending on population health, correcting existing gaps and disparities in the allocation of resources.