The Role of the Local Political Economy in the Opioid Settlement

Although local governments are responsible for delivering and financing many public health services, the existing public health literature has largely overlooked how the local political economy, or how political and economic structures interact to distribute resources across and within local governments, shapes health disparities. Since local governments will control over half of opioid settlement funds, variables related to the local political economy will be crucial for understanding variation in how local governments spend these funds and their effects. This commentary pursues 3 objectives. First, we highlight 3 critical aspects of the local political economy: local government fragmentation, the privatization of public health services, and local government fiscal stability. Second, we illustrate their significance to the opioid crisis and settlement spending. Finally, we discuss the implications of these variables for both research and practice. For researchers, we offer operationalizations, and for practitioners, we propose strategies for considering fragmentation, privatization, and fiscal stability when allocating settlement funds. We aim to convince researchers to integrate these variables into future studies and empower practitioners to design more effective interventions to address the opioid crisis.