Special districts established to control mosquitos in parts of Florida claim significantly more funding and expertise than county-run programs, according to a new analysis co-authored by a Cornell public health expert.

But because special districts serve geographically limited and typically wealthier areas, they may also contribute to inequities, especially amid declining state and federal funding for public health initiatives.

In Florida, accelerating development and tourism catalyzed the creation of special districts – the first in 1925 – that could levy taxes specifically for mosquito control, independent of other local public health services. As of 2023, special districts ran 18 of 66 state-approved mosquito control programs; counties ran the remainder, while a handful had no coverage.

“The choice to organize mosquito control policy in this way means that there’s a lot of inequity in service coverage across the state,” said Charley Willison, assistant professor in the Department of Public Ecosystem Health in the College of Veterinary Medicine, and a core faculty fellow in the Cornell Health Policy Center. “Local governments that don’t have their own mosquito control board have much lower capacity to provide mosquito control services compared to those that have special districts. And several places across the state have no designated local mosquito control services.”

“Draining the Swamp: The Local Governance of Mosquito Borne Diseases in Florida” published in a special issue of Urban Affairs Review, guest-edited by Willison. The special issue and a related podcast include scholars from across the country investigating the local politics of public health issues ranging from sanitation, racism and COVID-19 to mosquito-borne diseases. Willison and co-authors investigated whether special districts are better equipped to conduct the surveillance and abatement needed to control Florida’s more than 80 mosquito species, capable of spreading diseases including dengue, West Nile and Zika.

Their analysis found special districts were better financed, on average spending about 20% more annually from 2017-21. In addition, more than half (56%) of special districts’ core staff claimed specific expertise related to mosquito control, compared to 35% of county programs. Those staffs also were more likely to have related college degrees, or any college degree.

At the same time, special districts do not cover entire counties, managing designated areas ranging from 1,200 square miles to just one square mile. And they tend to serve communities with higher property values and lower social vulnerability scores. As a result, special districts’ more robust public health capacity in parts of Florida constitute a restricted “club good,” rather than a public good, raising equity questions, the researchers said.

The researchers recommend expanding some special district boundaries; partnerships between special districts and county governments; or increased funding to improve counties’ capacity, which would be unlikely if Congress enacts proposed severe cuts to federal public health spending.

Mosquito control – one of the nation’s oldest public health challenges, and one climate change is expected to bring to more of the country – highlights local politics’ pivotal and understudied role in public health, the focus of the special issue Willison edited.

“So much of what we think of as public health is carried out in these decisions that are happening at the local level,” said Willison, director of the Public Health Governance Lab. “The neighborhood that you live in, the education and income levels that you attain, have the greatest effect on your health outcomes across the life course, much more so than your ability to access health care.”

Public health scholars, Willison said, have established the primary importance of so-called social determinants of health, from one’s access to housing, clean water and green space to schools, sidewalks and grocery stores – all greatly influenced by local politics. Yet public health research often excludes upstream political factors shaping social determinants of health, while political scientists have rarely prioritized public health concerns.

“We need a more comprehensive picture of what’s going on, so we can propose more successful interventions,” Willison said. “If we don’t know the root causes of these health disparities – which relate to policy choices being made by local officials – we can’t achieve our public health goals.”

In addition to Willison, co-authors of the mosquito control research include, from Cornell, Iris Holmes ’10, postdoctoral fellow in the Department of Public and Ecosystem Health, and Naquia Unwala, research associate in the Public Health Governance Lab; from the University of Michigan, first author Holly Jarman, associate professor of health management and policy and global public health, and undergraduate research assistants Jessica Hsu and Chloe Harper; and from the University of Utah, Phillip Singer, associate professor of political science.