Why do cities innovate in public health? Implications of scale and structure.

Author:Diller, Paul A.
Position:III. Incomplete, But Partially Helpful, Explanations for Local Innovation through Conclusion, with footnotes, p. 1254-1291

    A number of scholars have theorized that cities are uniquely capable of providing a more responsive and representative form of government, which could theoretically lead to more stringent public health regulation than found at higher levels of government. In addition to the Tiebout-ian narrative, discussed above, a separate strain of thought stresses the "communitarian" advantages of local government. Unlike Tiebout and public choice, communitarianism is decidedly noneconomic in its approach. Instead of assuming rational, self-interested actors in public and private spheres, communitarianism draws on civic republican theory to posit that local democracy is peculiarly capable of transforming both the individuals who participate in it and what local government does. In other words, communitarians argue that public choice is less descriptively accurate at the local level than at higher levels of government. Communitarians theorize that the smaller scale of local government can smooth some of the coarser elements of national and state politics that thrive on public choice dynamics, like the naked pursuit of self-interest (by individuals and groups), the negative campaign attacks, and partisan warfare. (203) Indeed, public health advocates, in particular, have invoked communitarian themes in explaining why cities may be better venues for regulatory policy innovation. (204)

    Reconciling the vast differences between communitarianism and public choice theory is beyond the scope of this Article. This Section wrestles only with those strands of communitarian theory that might help explain local public health innovation in public choice terms. To begin with, the Section focuses on that part of communitarianism that stresses the effect of local participation on government outputs or policies (the "utilitarian" strand of communitarianism, (205) as opposed to the "dignitary" strand of communitarianism, which emphasizes the participation's transformative effect on citizens. (206) Unless the dignitary benefits of communitarianism cycle back into the governmental process and affect local outputs, they are irrelevant to this Article's objective of assessing why different levels of government produce different policies.

    1. Utilitarian Communitarianism: Its Limits and Insights

      Communitarians argue that local government is more democratically responsive, in large part due to its smaller scale. (207) This smaller scale enables participants in local government to engage in more deliberative democracy that promotes the "public good" rather than mere interest-group politics. (208) As an explanation for local public health innovation, the utilitarian communitarian account proceeds from a premise that is difficult to defend. Many communitarians assume that citizens should and will care more about local than higher levels of government because of its closeness to them. (209) As measured by voting rates, however, (210) citizens care least about local government, and care much more about national government, the level from which, per communitarian theory, they should feel most removed. (211) David Schleicher's explanation for this relative disinterest is the lack of true ideological competition in local elections, and his proposed solutions might boost voter interest in local government. (212) Nonetheless, in smaller cities and those cities with more evenly split party registration among voters--where one might expect more ideological competition--turnout in local elections still lags behind state and national elections. (213)

      Even if one is skeptical of communitarianism's premises and its foundational claims of civic republicanism, the smaller scale of local government may nonetheless impact the public choice narrative. In particular, the lower constituents-to-official ratio and the physical proximity of government decisionmakers to their constituents may lower the costs of both campaigning and lobbying, key tools by which interest groups pursue their goals. The synergy between these factors may help explain why proponents of public health regulation have comparatively more influence at the local level than at the state and federal levels.

      Although it varies widely among major cities, the constituents-to-official ratio is generally lower at the local level than at the federal and state levels. (214) The ratios vary from 50,000 to 250,000 per councilor at the city level, (215) whereas for federal senators, the ratio reaches into the multimillions for large states (e.g., two senators for California's thirty-eight million people), while dipping to 300,000 or so in the least populous states. (216) The average city ratio is also lower than the average for the federal House of Representatives, which is 710,000 residents per member. (217) The degree to which local constituents-to-official ratios depart from their state counterparts fluctuates widely. Among state lower houses, only California has a ratio much higher than that of large city councils: more than 400,000 constituents per representative. (218) All other states' ratios are lower than 220,000. (219) Among state upper houses (usually "senates"), there are at least ten with ratios upwards of 200,000, including California with over 930,000; Texas with 811,000; Florida with 470,000; and Ohio with 349,000. (220) As compared to at least some large states' senates, therefore, populous cities offer a lower constituents-to-official ratio. As the following table shows, the comparison within states like New York and California makes this disparity more striking.

      Insofar as fewer constituents results in fewer inquiries and contacts, and assuming that legislators at all levels of government have an equal amount of time, fewer constituents allow a local legislator to devote more attention to the concerns of a particular constituent. Of course, accounting for staff greatly complicates this inquiry. If legislators at higher levels of government have more, and abler, staff members than those at local levels, and assuming the staff members serve as perfect agents of the legislator, the effect of the constituents-to-official ratio in this regard could be neutralized. To the extent that staffs are not perfect agents and that actual face-to-face time with legislators matters, the lower constituents-to-official ratio is more important. Moreover, the lower constituents-to-official ratio, in addition to greater geographical proximity, makes it more likely that legislators will have informal interactions with constituents, which might make their legislation more responsive to a broader base of constituents. To be sure, the mix of at-large and district representatives, which varies among cities, may affect the degree to which councilors interact with their constituents and the costs of campaigning. Presumably, races for at-large city council seats cost more than those for district seats. (222) I do not focus on these differences here but I recognize that they may affect local political dynamics.

      Unfortunately, good comparative data regarding the costs of campaigning and lobbying at the local level are hard to find. (223) Even though local campaigns are sometimes more expensive on a per-vote basis than elections for higher-level offices, (224) the absolute costs of local campaigns appear to be lower than those at higher levels of government. City council races are substantially cheaper than those for Congress (225) and appear to be cheaper--at least usually--than those for state legislature. (226) Hence, it takes decidedly less money for candidates to reach the electability threshold at the local level as compared to the federal level, and usually considerably less money than at the state level. Lower constituents-to-official ratios likely explain these lower costs in part, as lower ratios make lower-cost methods of campaigning (i.e., knocking on doors rather than television ads) more effective. (227) The perceived lower stakes of local elections may also play a role in keeping costs lower. Finally, local campaign finance regulations, like caps on donations and public financing, may play a role in reducing the costs of local campaigns. (228) Excluding the handful of public financing schemes, however, the relevant caps for campaign contributions to local candidates will usually be the same as the caps for contributions to state candidates.

      Of course, a lower financial electability threshold need not militate against well-funded interest groups. If there are no or weak limits on campaign contributions, as is the case in a number of big cities, (229) candidate can more easily get to the electability threshold with a handful of donations from interest groups like Big Tobacco and the Food Industry at the local level than she can at a higher level with a higher electability threshold. Moreover, limits on independent expenditures by third parties and "issue advertisements" are generally weak. (230) On the other hand, the option of amassing many smaller contributions is more viable at the local level; at a higher level of government, it may be more difficult for candidates to run credible campaigns without attracting contributions from at least some well-funded donor groups. (231) Further, in the handful of big cities with public financing, small-donor participation is magnified. (232) Thus, there is usually a more plausible path to electability for a candidate with less campaign cash at the local level than at higher levels of

      government. (233) Assuming that campaign contributions affect politicians' stances, (234) this dynamic may reduce the relative influence of some well-funded interest groups at the local level, thereby enabling public health organizations to achieve comparatively greater influence.

      It bears noting that the constituents-to-official ratio for mayors is also relevant due to the role of the mayor in the local...

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