Impact of economic recession on local health departments' (LHDs) budget, workforce, and programs: Are we out of the woods yet?

Background: With anecdotal evidence of improvement in economic indicators, it is important to assess the situation of local health departments' (LHDs) budget. Objectives: The primary objective is to examine trends in LHDs' funding, workforce, and program cuts from 2008–2011 in the context of an economic recession. Methods: 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 LHDs. Results: The proportion of LHDs who reported reduced budgets in the current year as compared to the previous year rose continuously between 2008 and 2010. In January 2008, 27 percent reported a lower budget than in the prior year. This figure rose to 45 percent in August 2009 and to 56 percent in November 2010. One-time funding from the American Recovery and Reinvestment Act (ARRA) and/or H1N1 supplemental funding offset only some of these losses. By November 2010, half of all LHDs had received this type of assistance. When taken into account, the percentage of LHDs that experienced budget cuts during calendar year 2010 falls to 44 percent. These budget cuts have translated into significant staff and program reductions. Since 2008, 30,000 cumulative jobs have been lost, approximately 19 percent of the LHD workforce in the country. In calendar year 2010, an additional 18,000 LHD employees were affected by cuts in working hours or mandatory furloughs resulting from budget cuts. Conclusions/Discussion: 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. The study findings will improve our understanding about impact of recession on public health agencies' budgets, staff and programs.