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Research Objective: The general objective of this study is to examine the manner in which current economic downturn facing the country has impacted the budgets of local health departments (LHDs) around the country, and to identify factors instrumental in predicting the vulnerability of a LHD to experiencing budget cuts. Specific research objectives include: 1. To determine the proportion of LHDs that have had their budgets reduced compared to previous fiscal year; 2. To examine the extent to which LHD budgets have decreased over the past year; 3. To identify organizational characteristics that are associated with vulnerability to budget cut; and 4. To examine factors associated with level of reduction or increase in the LHD budgets.

Study Design: This study involves analysis of linked data from two recent cross-sectional national surveys of LHDs conducted by NACCHO in late 2008 – the National Survey of LHD Budget Changes; and the 2008 National Profile of LHDs. Potential explanatory variables for the multivariate models include population size and degree of urbanization of jurisdiction, type of governance, funding mix (sources of LHD revenue), per capita LHD expenditures, type of services provided, and characteristics of the LHD’s top executive. We will use logistic regression to model the dichotomous variable representing whether or not LHD experienced a budget cut, as well as polytomous variable representing the extent of budget cut.

Population Studied: The target population for the study is all local health departments in the country, defined as “an administrative or service unit of local or state government concerned with health, and carrying some responsibility for the health of a jurisdiction, smaller than the state.” The Profile survey was a complete census of all LHDs (2795 at the time of the survey), whereas the Budget-Cut Survey used predominantly census approach with exception of five states, where sampling was performed for only those groups of LHDs, for which the same contact person was listed for the entire group, and not separately for each LHD in the group.

Principal Findings: Our preliminary analysis shows that 27% of LHDs experienced a decrease in budget in the current year compared with the prior year and this percentage shows considerable variation across states and categories of jurisdiction population. We expect to find a significant impact of several organizational characteristics on vulnerability for budget cuts.

Conclusion: The proportion of LHDs experiencing budget reductions, and the level of reductions are substantial enough that it should draw attention of all stakeholders to the factors associated with vulnerability of LHDs, to be identified by our multivariate analyses.

Implications For Policy, Delivery Or Practice: The findings of this study are very timely, given the current economic crisis. Identifying characteristics of local health departments that make them particularly vulnerable to budget cuts during an economic downturn will provide insights to leaders at all levels of the public health system. Local health department leaders and local government officials will be able to gauge the expected relative impact to their agency in a general economic downturn and consider whether changes to their structure, funding, or service mix might result in more stable funding levels in the future. A better understanding of the types of local health departments most severely impacted by an economic downturn may allow state and federal public health leaders to make better decisions about resource allocation, particularly at times when budgets are declining.

Funding Source(s): CDC, Robert Wood Johnson Foundation

Theme: Public Health


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


2009 Academy Health PHSR Interest Group Meeting