Background: Public health in rural areas has distinctive features, often shaped by state-level infrastructure and organization and financing of public health activities. Variation in the way funds are distributed can influence the ability of local health departments and nongovernmental organizations serving rural communities to conduct public health functions.
Purpose: The purpose of this article was to describe how federal funds for selected chronic disease prevention and health promotion activities are distributed through states to the local level and identify infrastructure-related barriers that local health departments and nongovernmental organizations may face in securing these funds.
Methods: Thirty semistructured interviews were conducted with individuals at the state and local levels responsible for managing funds and implementing initiatives in selected disease areas across six states, using a standardized protocol through which select funds were followed from the state to the local level.
Results: Respondents report that states do not get sufficient Centers for Disease Control and Prevention funding for diabetes, cancer, and injury prevention to distribute effectively to the local level. Local funding, when provided, tends to be allocated through competitive mini-grant processes that are often difficult for rural communities to access because of infrastructural challenges. Mini-grant amounts are often too limited to build local program capacities and often awarded to communities with existing capacities.