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The purpose of this research is to explore the attributes of local health departments (LHDs) which have survived the recent economic crises without loss of staff. A retrospective cohort study is being conducted, using the 2005 and 2010 Profile of Local Health Departments datasets from the National Association of County and City Health Officials. LHDs which responded to both surveys and which provided data on full-time equivalents (FTEs) and expenditures are included for analysis. LHDs are categorized as resilient or non-resilient based on whether the LHD gained or did not lose FTEs between 2005 and 2010 (“resilient LHD”) vs. those LHDs which experienced a loss of FTEs (“non-resilient LHD”).

Resilient vs. non-resilient LHDs are compared across a range of LHD characteristics, including jurisdictional population size, expenditures, tenure of the LHD director, and presence of a governing Board of Health. Resilient LHDs (n=625) experienced an increase in the median number of FTEs from 15.8 in 2005 to 20 in 2010, while non-resilient LHDs (n=589) experienced a decline from a median of 33 to 25 FTEs. Expenditures per capita for resilient LHDs increased from a median of $35.29 to a median of $44.16, while expenditures per capita for non-resilient LHDs rose only slightly from $40.60 to $41.52.Compared to non-resilient LHDs, resilient LHDs tended to have somewhat smaller jurisdictional populations (median of 35,825 vs. median of 48,896 (z=4.374, p=0.000)) and to have a governing Board of Health in 2005 (chi-square 8.52, p=0.004) and in 2010 (chi-square=6.29, p=0.012).

There were no differences in the tenure of the LHD director comparing resilient vs. non-resilient LHDs. Investigators will be conducting additional analyses, specifically exploring the differences in LHD context (local unemployment rate, poverty rate, population density, etc), sources of revenues, and array of LHD services and activities. A second set of comparisons will be made between LHDs in the lowest and the highest quintiles of percent change in FTEs between 2005 and 2010. The goal of these analyses will be to identify potential modifiable factors that may protect LHDs from subsequent negative economic conditions.


Reproduced with permission of the National Coordinating Center for PHSSR and the Robert Wood Johnson Foundation, Princeton, N.J. Presentation obtained from the Keeneland Conference site.


2012 Keeneland Conference on Public Health Systems and Services Research