Across the nation, counties invest $100 billion in community health and hospitals each year and protect public health through the operation of more than 1,900 local health departments.

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Counties invest heavily in local residents’ health and well-being, often serving as a safety net for low-income and indigent residents. County health departments protect our residents and communities by offering a wide range of services like administering flu shots, providing health information and preventing and responding to public health emergencies. We are supporting COVID-19 vaccinations and administration through county operated vaccine clinics. Counties also often have significant responsibilities for behavioral and mental health services and care.

The COVID-19 pandemic response has highlighted the importance of the need for strong local health departments.*

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How will counties invest the funds? NACo’s analysis of 200 county ARPA Recovery Fund plans reveals county-designed investments across key areas of need. These local priorities are found within county plans at the rate displayed in the chart, e.g., 79 percent of county plans include investments in health programs. The darker bars are the investment categories adjacent to public health that support the continuation and expansion of services in counties.

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Note: NACo analysis of 200 county Recovery Plan Performance Reports from counties with a population of 250,000 and above, as required by the U.S. Department of Treasury. Analysis is as of Nov. 19, 2021. While the bar chart sources Recovery Plans, the narrative examples in this report draw from a variety of resources including the Recovery Plans, press releases and other official documents.

A strong public health infrastructure provides communities with the capacity to prevent disease, promote health and prepare for and respond to both emergencies, such as COVID-19, and ongoing challenges to public health. It includes efforts such as investing in county health departments capabilities, bolstering the public health workforce, implementing and improving health information systems, building new health facilities and more. The examples in this report further illustrate the allocations to support public health infrastructure.


The Coronavirus State and Local Fiscal Recovery Fund (Recovery Fund), part of the American Rescue Plan Act (ARPA), which NACo helped to develop and strongly advocated to pass, allocates $65.1 billion to counties. These funds provide direct, flexible aid for every county, parish and borough in America. Counties are on the front lines in delivering this aid to residents and are a driving force connecting communities and strengthening the economy.

As directed by the ARPA and the U.S. Department of Treasury, counties can invest Recovery Funds into a broad range of programs, services and projects under four categories: public sector revenue; public health and economic response; premium pay for essential workers and water, sewer and broadband infrastructure.

Since the enactment of the ARPA, America’s counties are working hard to develop Recovery Fund implementation plans that will help spur an equitable economic recovery across the nation. As sound financial stewards, counties are investing these critical Recovery Funds to ensure the health and well-being of our nation’s residents and the economic vitality of our local communities. Many counties are in the preliminary stages of development and implementation of our Recovery Fund Plans. This report highlights county investments in public health infrastructure.


Camden County is assessing the fiscal resources needed by primary health care facilities by utilizing $1 million in Recovery Funds to expand the county’s electronic health record systems capabilities.


Delaware County is supporting the development of its new Delaware County Health Department with $4.8 million in federal relief funding. This department will connect residents with health care resources and public assistance programs to build healthier communities. The department will also be key to efforts addressing health disparities and the social determinants of health in low-income communities.


Fairfax County is proposing to increase 82 new positions to meet its goal of one public health nurse per school for the entire school system, as well as 16 new positions to advance public health preparedness and health department operations. In response to the COVID-19 pandemic, the county will set aside $20 million in Recovery Funds for these investments, as well as fund nine new positions at the Department of Neighborhood and Community Services in support of the Emergency Rental Assistance (ERA) program.


Fort Bend County is allocating approximately $3 million in Recovery Funds to purchase additional Emergency Medical Services vehicles and equipment as well as hire night shift Crisis Intervention Team personnel to directly respond to the increased number and types of mental health crisis calls that arise during these hours. The county is also sponsoring a youth employment program to introduce 250 youth to employment opportunities in government and help address work backlogs in county offices.


Genesee County is optimizing public health and technology infrastructure by allocating over $1 million to support additional staff, expand contact tracing and implement a new electronic health record system that will allow for more streamlined communication and minimize future heath care related costs.


Hamilton County is bolstering community health outreach efforts by utilizing $5 million to fund a mobile tech bus that will provide vaccines, medical screenings and access to assistance programs such as rent and utility relief. The county is also allocating $6 million in Recovery Funds to strengthen health care facilities’ ability to address pandemics, provide additional COVID-19 surveillance, make physical improvements to homeless or congregate care shelters and develop public health data systems.


Hidalgo County is improving access to primary care for residents through a $17 million investment to build, renovate and reconstruct County Health Clinics. The county is also utilizing federal relief funds to expand vaccination efforts, purchase and upgrade electronic medical record programs, communicate public health announcements and install additional facilities necessary to help address current and future pandemics.


Jackson County is expanding operations at the county health department by using $16.5 million in Recovery Funds to employ supplemental staff so that the county can continue daily testing, contact tracing and vaccination efforts. The county is also investing $12 million to equip and improve the health department with adequate offices, laboratories, and testing spaces to support the ongoing pandemic response.


Maricopa County is bolstering the public health workforce by investing in more than 200 new positions hired during the pandemic, including home caregivers, direct service workers and other staff members. This $2 million allocation is supplemented by an additional $10 million to enhance the pipeline of future public and behavioral health professionals from historically underrepresented communities. The county is also investing in a vaccine management system that will provide access to real-time information and improve data-driven strategies to help guide immunization and outreach activities.


Monterey County is supporting COVID-19 mitigation efforts such as hiring 120 community health workers who provide essential COVID-19 response supportive services to the most disparately impacted communities. This $5 million allocation of federal relief funding will help sustain current and future public health outreach campaigns.


Montgomery County is supporting eight health and human services hubs within churches and other non-profit organizations in areas of greatest need. With the hubs, area residents can access food assistance, obtain other household necessities and meet with case managers. This $3.6 million investment was made possible through the influx of federal relief dollars, and will expand the county’s capacity to serve at-risk populations.


Skagit County is enhancing local disaster resiliency by allocating Recovery Funds to launch the County Medical Reserve Corps to assist with ongoing vaccination efforts, purchase a van for additional mobile testing and support future communicable disease response needs. The county is also hiring a community health worker to provide outreach and education on behavioral health issues.


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