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Objectives: The primary objective of this study is to examine trends in LHDs’ funding, workforce, and program cuts from 2008–2011 in the context of an economic recession.

Data: The study analyzes data from multiple waves of a survey, specially designed and conducted by the National Association of County and City Health Officials (NACCHO) to measure impact of recession on local public health agencies.

Findings: The proportion of LHDs that reported reduced budget in current year than previous year increased from 27 percent in December 2008 to 45 percent in July 2009. In January 2010, 38 percent (53 percent, if one-time funding is excluded) of LHDs reported cuts in their budget compared to the previous fiscal year. Preliminary results of the recent survey closing in November 2010 show that the proportion of LHDs with budget cuts has actually increased to 43 percent. Fifty-four percent of LHDs would have had lower budgets if they excluded one-time funding such as H1N1 and American Recovery and Reinvestment Act (ARRA). The final results of the study will also include data from the fifth wave of the survey, to be conducted in 2011, highlighting trends of jobs lost and programs/services reduced or eliminated by LHDs during the time period under study. The results will also highlight variation in these trends by size of the LHDs, their governance structure, geographic location, and other important infrastructural characteristics.

Conclusions: 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. There is no indication that impact of recession is subsiding.

Implications: The study findings will improve understanding of the practice community, researchers and the funding agencies about impact of recession on public health agencies’ budgets, staff and programs. Results will provide empirical evidence to policy makers and funding agencies in support of their decisions for resource allocation.


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.


2011 Keeneland Conference on Public Health Systems and Services Research