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. While health programs are specifically pulled out in this graph, each of these categories support social determinants of health.

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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.


Social determinants of health are the conditions in which an individual is born, lives, learns, plays, works and ages that ultimately impact overall health, functioning and quality-of-life outcomes. These conditions are shaped by key social factors such as economic stability, education, health and access to health care, neighborhood and built environment and social and community context.

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. We also make significant annual investments in other local systems that impact the social determinants of health:

  • Human Services: $62.8 billion in federal, state and local funds in human services
  • Public Amenities: $20 billion on public amenities, including libraries, parks and natural resources
  • Housing: Nearly $13 billion annually in housing and community development
  • Public Transportation: Over $23 billion on transit options for residents that allow people to go to work and access healthy foods, education and more
  • Education: $103 billion in education, which includes the construction and maintenance of public-school buildings and support of higher education institutions, such as community colleges

Investments in the social determinants of health can help build communities where everyone has equal opportunity to achieve their maximal level of health and well-being.


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 the social determinants of health including increasing access to employment, education, housing, health care and healthy food as well as improvements to health infrastructure through broadband.


Clark County is investing $83 million in Recovery Funds to support initiatives to increase access to public health, mental health and substance abuse services through the expansion of programs and the development of new programs. These efforts will emphasize community outreach to inform the delivery of services and the expansion of health care providers.


Collier County is addressing the social determinants of health for underserved residents by allocating $2.25 million to fund and host nutrition classes and demonstrations to improve overall health and quality of life. The county is also funding mental health services, food programs, eviction prevention, small business economic assistance, non-profit aid, education aid to high poverty districts and a library collection enhancement project.


Cumberland County is expanding mental health services, adding capacity for substance abuse services, partnering with workforce training providers, and providing stop gap funding for affordable housing projects. The county is conducting a feasibility study on the building and operation of an emergency shelter and/or transitional housing facility.


Dona Ana County is accelerating equitable recovery efforts by utilizing $32 million in federal relief funding to establish a direct medical relief fund for residents, invest in flood mitigation for lower-income communities, support county-wide broadband accessibility, address behavioral health disparities and support affordable housing development to meet the needs of the most vulnerable residents.


Fairfax County is supporting school and public health preparedness, non-congregate housing and behavioral health initiatives. The county is also investing $25 million in Recovery Funds for a PIVOT Business Recovery Grant Program for impacted small businesses and non-profit organizations, affordable housing projects, basic needs and food assistance and workforce development. The county is supporting its Active and Thriving Community Grants Program and launching a Basic Income Pilot Program.


Fort Bend County is investing in mental health initiatives focused on vulnerable populations, including a $5 million allocation for the We All Eat Program, which assists individuals experiencing food insecurity and provides free to-go meals from local restaurants. The county is also deploying night shift Crisis Intervention Team (CIT) personnel to directly respond to the increased number and types of mental health crisis calls that arise during these hours.


Marin County is allocating Recovery Funds to support specific racial equity initiatives such as creating a more diverse workforce, fund projects that address climate change, expand permanent supportive housing, create partnerships to address homelessness and implement emergency preparedness improvements.


Monterey County is supporting COVID-19 mitigation efforts by hiring 120 community health workers who provide essential COVID-19 response supportive services to the most disparately impacted communities. This $5 million allocation in Recovery Funds is also supplemented by $600,000 for alternate housing sites for those testing positive for COVID-19, serving an estimated 100 individuals per month.


Montgomery County is improving its African American Health Program by removing barriers in eligibility and building a Black physician network to improve access to services. This expanded program is made possible by a $1.7 million allocation in federal relief funding. The county is also funding community-based services that provide education, outreach, mental health and social service support and access to COVID-19 testing and vaccination for Asian American Pacific Islander and Latinx communities.


Multnomah County is leveraging its Recovery Funds to support public health emergency services; offer housing stability and eviction prevention; provide wraparound supports for youth and families; address community violence through prevention, intervention and healing; deepen safety net services; increase disease prevention, intervention and surveillance and build community connection, assets and resilience.


Nassau County is supporting small businesses and economic recovery through grant, loan and technical assistance programs through a combined $21.5 million allocation of Recovery Funds. Additionally, the county is allocating Recovery Funds for workforce development, behavioral health services, senior programs and youth services, a health and social services grant program, a household assistance program and assistance to school districts.


Prince George’s County is expanding behavioral health services for more than 400 residents and conducting eight 35-person trainings to address the grief and trauma experienced by residents due to COVID-19. Alongside this $11.5 million investment, the county is planning to utilize $3 million to purchase and distribute food to individuals and increase residents served by approximately 20 percent each year. The county is also using Recovery Funds to support a Rapid Re-Employment Grant initiative that will make grants to employers who re-hire county residents with the expectation of hiring 1,417 unemployed residents. It is also funding gun violence reduction programs to promote safer communities.


Skagit County is prioritizing the health and well-being of residents by allocating $2.6 million in Recovery Funds to various support services. The county is hiring a community health worker to provide outreach and education on behavioral health issues, providing mobile mental health services for people experiencing homelessness, embedding additional social workers and clinical services in schools, funding senior outreach services and establishing a COVID-19 family resource center to promote healthy childhood environments.


Suffolk County/City of Boston is dedicating $2.5 million for a community grant program to tackle the social determinants of health. The program supports sustainability of community-based organizations and family child care small businesses that provide resources to communities most impacted by systemic health and economic inequities that have been exacerbated by the pandemic. The county is also investing in substance use services; food assistance programs; rent, mortgage and utility aid; internet access programs; job training; small business assistance; tourism and travel aid and early learning education assistance.


Wake County is supporting broad economic recovery efforts through a $9 million investment in small business loans and tourism assistance. The county is also utilizing $1.1 million in Recovery Funds to enhance food security through contracts with partners to distribute food at hub sites, offer meal delivery to college students, coordinate with the school system to ensure children have access to meals outside of school and provide food services to diverse populations and people with special dietary needs.


Washington County is promoting healthy life outcomes for residents disproportionately impacted by the pandemic through an approximately $10 million investment of Recovery Funds. The funds will support culturally specific nutrition and information programs and provide wraparound services for migrants and seasonal farmworkers. The county is also funding enhanced child care support, implementing behavioral and family health initiatives, fostering small business recovery, expanding place-based broadband investments and advancing data equity.


York County is utilizing the influx of federal relief funding to provide expanded mental health and substance abuse services, support job training assistance and opportunities, enhance early learning and child care services and provide additional housing. These comprehensive investments aim to provide holistic solutions to local issues and bolster community resiliency.


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