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This study sought to quantify the impact of the economic recession on the budgets, workforce, and programs of Local Health Departments (LHDs) across the United States. The National Association of County and City Health Officials (NACCHO) conducted two on-line surveys in 2008–2009; the first conducted in December of 2008 using census design, and the second in August 2009 using a nationally representative stratified sample of 990 LHDs. Trends found in the first two surveys will be compared with a third survey to be conducted in January 2010. Findings of the first two surveys demonstrate that across the country, LHDs experienced substantial reduction in budgets, employees, and public health activities and services. In 2009, 45 percent of LHDs reported cuts in their budget compared to the previous fiscal year; this is up from 27 percent in 2008. Job losses increased; in calendar year 2008 an estimated 7,000 LHD jobs were lost, while 8,000 staff positions were lost over six months in the first half of 2009 (January 1–June 30). In addition to staff lost through layoffs, an additional 12,000 LHD employees were subjected to reduced hours or mandatory furloughs in January–June 2009. From July 2008–June 2009, 55 percent of LHDs made cuts to important public health programs. As of July 2009, only 14 percent of LHDs had received funding from the American Reinvestment and Recovery Act. The findings from this study show that LHDs are severely strained by increasing budget and workforce cuts, to the point that they are being forced to eliminate or reduce vital programs that protect the public’s health. These pressures come even as LHDs are being called upon to take the lead in local H1N1 vaccination campaigns and as the demand for many different services has increased due to adverse 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.


2010 Keeneland Conference on Public Health Systems and Services Research