The Resilient Local Health Department: Surviving the 2008 Economic Crisis

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Frontiers in Public Health Services and Systems Research






The purpose of this study was to identify potential modifiable factors that can protect local health departments (LHDs) from job losses and budget cuts during periods of economic stress. This was a retrospective cohort study based on the 2005 and 2010 surveys of LHDs conducted by the National Association of County and City Health Officials. The outcome of interest – resiliency of the LHD – represented financial resiliency for maintaining budgets during the 2008 recession, and was based on the ratio of observed-to-predicted expenditures per capita for 2010. LHDs which successfully weathered the economic recession of 2008 represented smaller populations and were better resourced in 2005, were less likely to have had a board of health with the authority to hire/fire, and were less likely to be dependent on local resources compared to LHDs which experienced significant losses in funding by 2010. These results varied by size of the jurisdictional population.